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Question:

Assalamualaikum wrm. wbt.

Can Tuan Mufti give your opinion regarding the Islamic ruling of undergoing placenta injections from human or sheep placenta for cosmetic treatment? Thank you.

 

Answer:

Waalaikumussalam wrm. wbt.

Alhamdulillah, praise and thanks to Allah for the many countless blessings He has blessed us all with. Blessings and salutations to the prophet Muhammad PBUH, his family, companions and all those that follow his teachings to the day of judgement.

Definition of Placenta

4th Edition of Kamus Dewan defines placenta as a temporary organ that joins the mother and fetus, transferring oxygen and nutrients from the mother to the fetus and permitting the release of carbon dioxide and waste products from the fetus. It is also known as an afterbirth.

In the world of science today, the placenta is studied and characterized as an organ that joins the expecting host organism and its fetus. The placenta is a temporary organ that is vital in pregnancy of humans and most mammals. The human placenta is the attachment of fetus in the trophoblast stage through the cytotrophoblast section on the endometrium layer of the uterine wall of its mother. The growth of trophoblast on the uterine wall forms an exchange medium for blood cells between the fetus and its mother. This includes the exchange of small protein molecules such as amino acids, glucose, mineral salts, and other important gases such as oxygen and carbon dioxide. These exchanges happen through the placenta via the umbilical cord of the fetus that transports the multifunctional stem cells. It is also through the umbilical cord that waste products are transported to the mother before being excreted out from the body.

Other than providing nutrients to the fetus, the placenta also acts as a hormone secretor. This is important for the healthy growth of the fetus especially after the endocrine function by the ovaries of the mother have stopped due to the closure of the corpus luteum during the eighth week of pregnancy.

Placenta products and their usage

Are there medical benefits of placenta products? The medical benefits of placenta products are still under discussion and research by medical experts. This is due to the fact that there are different parts of the placenta that are being used, for example, the placenta as a whole, estrogen and progesterone hormone, amniotic fluid and stem cell (main cell) that are extracted from the placenta, just to name a few. We state a few literature reviews in placenta usage in the health or medical field as follows:

To date, there are barely any scientific findings supporting the claim that the nutrients in placenta have health benefits. This is due to the difficulty of identifying the active biological material that could give a positive effect to certain health issues or in fulfilling the golden standard of medical practises which is passing the random clinical trials. However, a few paperwork has been published related to the benefits of the placenta and its potential usage. Other than just a few types of research from Korea on the widely used placenta, the clinical trials on animals reported a positive effect on skin regeneration if used using a topical formulation which means direct application onto the skin. It is also found effective in handling menopausal symptoms and fatty liver inflammation. However, there are risks when using this product such as prion disease or virus infection, for example, hepatitis virus infection is always a risk and it is the responsibility of the manufacturers to ensure the safety of their products for consumers.

Placenta products are available in injections, tablets, drink solutions, dried food form or sometimes even in the form of frozen tissues of placenta. The source of the placenta can be from humans, sheep, or swine. Most placenta products are used in the third stage of medical treatment (with advice from an expert) or self-bought food supplement. The following are a few research papers on the usage of placenta’s extract for skin regeneration and wound healing, to increase general health, the treatment of liver inflammation and menopausal symptoms:

  • International Basic and Clinical Pharmacology, IJBCP in July 2017 reported that in terms of wound healing, placenta extract is comparable to products based from nanosilver (a common substance used in wound healing). The research found that in 21 days, the rate of decrease in wound size excised on rabbit species after placenta’s extract treatment is the same as nanosilver product’s treatment. Increase growth in collagen and regenerative tissues (granulation tissues) are comparable. [1]
  • In an earlier research publication on wound healing in July 2010, from the Annals of Plastic Surgery publication, the findings showed a significant increase in the rate of wound healing for mouse species that are injected with placenta’s extract compared to the mouse species that wasn’t injected. The researcher suggests a relationship between two growth factors, the transformation growth factor beta, TGF-beta and vascular endothelial growth factor, VEGF as the active biological substance that increases the rate of wound healing. [2]
  • International Dermatological Journal reported in November 2002 that placenta’s extract has mitogenic potential (cell growth enhancer) and melanogenic action (normal “blue” skin enhancer) and is effective in vitiligo skin condition treatment. This research on mouse species found that the resurgence of blue skin, followed by shiny black hair, at the regions of application of the extract demonstrated the reversal of the age-induced prolonged telogenic phase of hair growth to the anagenic phase after topical application of the extract. It is reported that at the extract-treated sites, the development of new melanogenic centres and hair follicles was observed. Two known melanocyte activity-modulating peptides, endothelin-1 (ET-1) and adrenocorticotropic hormone (ACTH), were determined as the two biologically active substance responsible for skin regeneration in the extract and the melanin cell’s growth changes depending on the concentration of the extract. Though this research proves the potential of vitiligo treatment using placenta’s extract, it still needs further tests and trials on humans. [3]
  • Another research published by PLOS ONE in June of 2014, found another biologically active compound that enhances skin health. Using swine’s placenta extract, researchers found a type of protein which is alpha feto-protein, AFP which causes oxidation. Other than enhancing the growth of keratin cells, AFB also lowers the rate of apoptosis which is cell death through the fragmentation of nuclear DNA. This biological compound, however, is sensitive to heat and needs its own carrier. At the end of this research paper, the researchers suggest the usage of placenta’s extract in skincare routine. [4]
  • In 2010, another research regarding contact hypersensitivity, CHS by researchers from Japan and America reported that placenta’s extract affects the process of inflammation due to immune response when dealing with an allergen. In this research, mouse species are used to receive placenta extract that is surgically implanted under the skin before being exposed to allergens. The research found that the group of mice that receive the implantation didn’t show any signs of hypersensitivity as compared to the group that didn’t receive the implantation. Helper white blood cell and inflammatory cell driver (cytokine) that causes inflammatory reaction is found to be decreased. Moreover, the paper also states that the extract may be able to change memory T cells in our body so that it will no longer react to an allergen like it used to. This paper concludes that placenta extract has the potential to heal and the ability to modify our immunity system against contact hypersensitivity even with prolonged exposure to an allergen. [5]

There are only a small number of researches run on humans as their test subjects. Four of the researches stated below was run in Korea and one in Japan. However, these research are not focused on beauty but on general health, the treatment of inflammation of fatty liver and treatment of menopausal symptoms.

  • The first research is published by Evidence-based Complementary and Alternative Medicine in July 2011 to study the effectiveness of placental extract on fatigue. The study was done on 294 participants where each participant experiences chronic fatigue syndrome and was given a placental extract solution to be taken orally once a day for four weeks. Over the course of the study, each participant is monitored and assessed in a few meetings using Checklist for Individual Strength, CIS. At the end of the research, it was recorded that the individuals that receive the placental extract show a decrease in their CIS score, which gives a positive implication towards fatigue. There’s a significant difference between the group that receive the extract and the group that receive a placebo. [6]
  • The second study was also run in Korea and was published by the same research body in February 2012. A number of 39 test subjects aged 65 and above were either given a total of 32ml placental extract in the course of eight weeks or a placebo injection. Using Korean Health Status for the Elderly KoHSME, it was found that the group that received the placental extract shows an increase in quality of life for physical function, sexual function, and perception as well as general well-being at the end of the study while the group that received the placebo didn’t show any improvement. Depression score and the frequency of pain score also decreases for the group that received placental extract. [7]
  • The third research is published by Biological and Pharmaceutical Bulletin in 2014 to study the effectiveness and safety of placental extract usage for fatty liver inflammation patients, alcoholic and non-alcoholic steatohepatitis. The amount of alanine transaminase, ALT an enzyme that reflects the severity of fatty liver inflammation is monitored for eight weeks for a number of 154 patients. A group of the patients were given placental extract through injections five times a week while another group received conventional treatment, they were given liver extract mixed with flavin adenine di-nucleotide compound. There was no serious negative response from the patients throughout the study and the effectiveness of the placental extract is comparable to the conventional method of treatment referring to the significant decrease of the enzyme ALT. At the end of the research, it is concluded that placental extract treatment is comparable to liver extract treatment for fatty liver inflammation, alcoholic and non-alcoholic steatohepatitis. [8]
  • To study the effects of placental extract treatment on the menopausal syndrome, a group of researchers from Korea has published their findings in the Journal of The North American Menopause Society in March 2008. In this research, the group of women that were given placental injections was found to experience a significant decrease in their menopausal symptoms and their level of estradiol hormone which is a type of estrogen increases compared to the group that received placebo. [9] In a similar study by a group of Japanese researchers in the year 2017 and was published by Upub Climacteric, they found that the group of women that received placental extract from swine which was taken orally experienced a decrease in their menopausal symptoms though there is no increase in their estradiol-2 hormone and follicle-stimulating hormone, FSH. [10]

Looking from another angle, a report issued by Control for Disease Center, CDC on 30th June 2017 recorded a case of a new-born infant contracting Group B Strep infection, Guillain-Barré syndrome, GBS. The infection happened five days after birth and was suspected contracted from the mother’s vaginal infection. However, the results from culture tests and sensitivity vaginal swap were negative and later they found out that the mother took placenta pills that contain the GBS bacteria. [11]

Products based from placenta are usually found in extract form rather than their original tissue form. However, the usage of placental tissues is usually used for medical purposes, especially as skin grafts. The treatment is only used as a last resort in chronic wound cases. Products such as Grafix shows a huge potential in helping to heal chronic wounds that without it the possibility for the wound to heal is very low. [12]

Media coverage on placental products

In September 2013, Food and Drug Federation, FDA America has ordered that all products based on placental tissue released by MiMedx are to be withdrawn from the market. The company that is situated in Georgia produced products based from placental tissue that was processed into powdered form and was sold as a formulation for injections. Denying the need for research, the company claimed that placenta is a natural product thus it is safe to be consumed by humans and there is no need for research and development. FDA disagrees as it states that products based from placental tissues have side effects and need to be approved by the agency first. It also adds that there are no products based on placental tissue that has been approved to the market at the time. [13]

To date, recent media reports from Canada and the United Arab Emirates reported warnings from authorities regarding the usage of placental based products, especially human’s placenta. Products available on the market right now are mostly labelled as food supplements but claims to have practical benefits with no scientific proof.

Placental based products, whether in the original form of placental tissue or in extract form has a great potential to be used in the future. However, to date, the potential is still limited to the usage inside the laboratory and small clinical trials. There is no commercially available product that has been proven effective or safe for the time being. Until these two problems are solved, the usage of placental based products without consulting a doctor is dangerous and should be avoided.

Medication from what is permitted

In Islam, there are a few requisites to medicate and one of it is the medication must be from what is pure. If the medication or treatment uses something that is religiously considered as impure (najis), the original ruling would be it is prohibited if there are other pure things to replace it. Allah SWT states in the Quran:

وَمَا لَكُمْ أَلاَّ تَأْكُلُوا مِمَّا ذُكِرَ اسْمُ اللَّهِ عَلَيْهِ وَقَدْ فَصَّلَ لَكُمْ مَا حَرَّمَ عَلَيْكُمْ إِلاَّ مَا اضْطُرِرْتُمْ إِلَيْهِ وَإِنَّ كَثِيراً لَيُضِلُّونَ بِأَهْوَائِهِمْ بِغَيْرِ عِلْمٍ إِنَّ رَبَّكَ هُوَ أَعْلَمُ بِالْمُعْتَدِينَ

“And why should you not eat of that upon which the name of Allah has been mentioned while He has explained in detail to you what He has forbidden you, excepting that to which you are compelled. And indeed, do many lead [others] astray through their [own] inclinations without knowledge. Indeed, your Lord - He is most knowing of the transgressors.”

Sural Al-An’am (119)

Abu Darda’ RA narrated, the Prophet PBUH said:

إِنَّ اللَّهَ أَنْزَلَ الدَّاءَ وَالدَّوَاءَ وَجَعَلَ لِكُلِّ دَاءٍ دَوَاءً فَتَدَاوَوْا وَلاَ تَدَاوَوْا بِحَرَا

“Allah has not sent a disease without its remedy and made each disease with its remedy, thus make use of medical treatment but do not seek what is prohibited to you,”

Sunan Abu Dawud (3874)

From Abu Hurairah RA, the Prophet PBUH said:

نَهَى رَسُولُ اللَّهِ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ عَنْ الدَّوَاءِ الْخَبِيثِ

“The Prophet PBUH prohibits to medicate using impure medicine,

Sunan Abu Dawud (3870)

Imam al-Nawawi in al-Majmu’ (9/53) when explaining about what is permitted when medicating using najis said: “And the evidence that our madhhab (Syafie) that we refer to is the Uraniyyan hadith [16] that is narrated in al-Sahihain [17] as such as stated before, the permissibility depends on the necessity of drinking it for the purpose of medicating, just as stated in the hadith. As for the hadith “Don’t seek remedy for what is prohibited for you” [18] means when there is no necessity for what is najis and when there are other pure things that can fulfil the need (which can quicken the process of healing and have less side effects) then the najis changed to be of the same position as other pure medications. These are the answers for both (Abu Dawud) hadiths. Al-Baihaqi said: “If both hadiths are sahih, the meaning is, it is prohibited to medicate using something that is intoxicating and prohibited in non-exigent situations (harmonizing) these hadiths and hadith by Uraniyyin.”

The following we state the purity status of each compounds according to Islamic law:

  • Human placenta is pure while animal’s placenta is najis (impure)

Referring to the book Hasyiah Qalyubi wa Umairah(1/395), the author said : “Placenta that is named al-khalas, the Islamic ruling for it is the same as part of the body (limbs) since it is separated from the child. Thus, it is part of it. However, the placenta when the fetus is still in it, is not part of the mother or part of the child,”. The same is stated in the book Hasyiah al-Bujairimi (1/101): “The placenta that blankets the child is ruled pure (if the origin) from humans and najis if it is from other than humans”.

  • Amniotic fluid is najis

Imam Ibn Hajar al-Haitami said in Tuhfah al-Muhtaj (1/301): “And whatever that comes out of a woman’s vagina is najis (except fetus), such as the water that comes out with a new-born baby,

  • Hormones such as estrogen, progesterone and stem cells are pure if they are not foul smelling (smells like pus) if taken from humans and animals that are permitted to be eaten after slaughtering them. The ruling is the same as sweat, saliva and liquid from dead body. Refer al-Majmu` Syarh al-Muhadzdzab(2/558) by Imam al-Nawawi.

It is prohibited to use najis for medical purposes and beautification if there are other alternatives for the treatment. Refer Irsyad Al-Fatwa Series-30: The Ruling on Vaccination from Islamic perspective.

Humans’ honour

Apart from the purity of the substance, the factor of humans’ honour should be taken into account when taking medications based from placenta. There are certain cultures where they eat the placenta following the nature of animals. It is said that this diet is good to restore strength and health for mothers who has just given birth. This opinion is controversial and still unproven and there are studies from experts that discourage this act in fear of its negative effect on one’s health. [19] From Islamic perspective, it is prohibited to eat any part of a human as humans are honoured by Islamic law from being eaten. Allah SWT states:

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ وَحَمَلْنَاهُمْ فِي الْبَرِّ وَالْبَحْرِ وَرَزَقْنَاهُمْ مِنَ الطَّيِّبَاتِ وَفَضَّلْنَاهُمْ عَلَى كَثِيرٍ مِمَّنْ خَلَقْنَا تَفْضِيلًا

“And We have certainly honoured the children of Adam and carried them on the land and sea and provided for them of the good things and preferred them over much of what We have created, with [definite] preference.”

Surah Al-Isra’ (70)

Allah SWT states:

أَيُحِبُّ أَحَدُكُمْ أَنْ يَأْكُلَ لَحْمَ أَخِيهِ مَيْتًا فَكَرِهْتُمُوهُ

“Would one of you like to eat the flesh of his brother when dead? You would detest it.”

Al-Hujarat (12)

Imam Fakhrurazi in Mafatih al-Ghaib (28/110): If it is wrong to eat human flesh then it must be wrong to “chew” on their dignity, for it is a greater wrong because it is more painful.”

Due to this, Lajnah al-Ifta’ Jordan issued a ruling (fatwa) that prohibited the usage of human placenta for the purpose of beautification or medication. However, there is exception for medical purposes if there are no other alternatives with the same effects. [20] They cited the statement of Imam al-Khatib al-Syarbini in Mughni al-Muhtaj(6/160): “For someone who is in exigent or desperate situations, it is permitted for him to eat a part of another human when there no other carcasses available for the honour of a living person is greater than the honour of a dead person.”. This is in accordance with the decision of 13th Majma` al-Fiqh al-Islami Conference under OIC or Organization of Islamic Cooperation in 1992 which state the usage of placenta for medical purposes is permitted. Refer al-Qararat al-Majma` al-Fiqh al-Islami bi Makkah al-Mukarramah (pg. 283).

However, if the placenta is from animal sources and from the permissible animals to be eaten and has been slaughtered following the conditions of the Islamic law, then in Lajnah al-Ifta’ Jordan in fatwa number 2797 said that it is permitted for beautification or medical purposes. [21] However, if the placenta is najis then it can only be used for other than beautification or medical purposes only.

Conclusion

After analysing the statements above, we can conclude that:

  • Cosmetic treatment using human placenta is prohibited to avoid the exploitation and invasion of humans’ honour.
  • However, if there is a medical need to treat diseases using human placenta then it is permitted only in exigent or desperate situations.
  • The usage of permitted animal placenta that has been slaughtered according to Islamic law is permitted for beautification or medical purposes. See Irsyad Al-Fatwa Series 265 : The Ruling of Injecting Collagen to Appear Beautiful in front of Husband to see the guidelines that we have set.
  • The usage of animal placenta that are najis is prohibited for cosmetic purposes or beautification but permitted in exigent or desperate situations. See guidelines in Al-Kafi 635: Eating Crocodile’s Meat for Medical Purposes.

May the above explanation benefit us all.

Endnote:

[1] Umamaheshwara Raju S. et al. 2017. Comparative study of topical application of nanosilver and human placental extract on wound healing in rabbits. International Journal of Basic and Clinical Pharmacology. 6(8). Retrieved on 4 January 2019. https://www.ijbcp.com/index.php/ijbcp/

[2] Hong JW et al. 2010. The effect of human placenta extract in a wound-healing model. Annals of Plastic Surgery. Jul;65(1):96-100. Retrieved on 4 January 2019. https://www.ncbi.nlm.nih.gov/pubmed/20548228

[3] Pal P et al.2002. A human placental extract: in vivo and in vitro assessments of its melanocyte growth and pigment—inducing activities. International Journal of Dermatology. 41(11):760-767. Retrieved on 4 January 2019. https://europepmc.org/abstract/med/12452998

[4] Hye yeon Choi et al. 2014. Alpha-Fetoprotein, Identified as a Novel Marker for the Antioxidant Effect of Placental Extract, Exhibits Synergistic Antioxidant Activity in the Presence of Estradiol. PLOS ONE. Retrieved on 4 January 2019. https://doi.org/10.1371/journal.pone.0099421

[5] Youn Son Kim et al. 2010. Preventive and therapeutic potential of placental extract in contact hypersensitivity.International Immunopharmacology. 10(10): 1177-1184. Retrieved on 4 January 2019. http://www.ifctp.org/download/Placenta%20Extract%20Therapy/Preventive%20therapeutic%20potential%20of%20placenta.pdf

[6] Kang-Kon Lee et al. 2011. Efficacy and Safety of Human Placental Extract Solution on Fatigue: A Double-Blind, Randomized, Placebo-Controlled Study. Volume 2012. Retrieved on 4 January 2019. http://dx.doi.org/10.1155/2012/130875

[7] Mihee Kong and Sat Byul Park. 2012. Effect of Human Placental Extract on Health Status in Elderly Koreans. Evidence-based Complementary and Alternative Medicine. Retrieved on 4 January 2019. http://10.1155/2012/732915

[8] Jin Young Choi et al. 2014. Efficacy and Safety of Human Placental Extract for Alcoholic and Nonalcoholic Steatohepatitis: An Open-Label, Randomized, Comparative Study. Biological and Pharmaceutical Bulletin. 37(12): 1853-1859. Retrieved on 4 January 2019. https://doi.org/10.1248/bpb.b13-00979

[9] Kong, Mi-Hee et al. 2008. Effect of human placental extract on menopausal symptoms, fatigue, and risk factors for cardiovascular disease in middle-aged Korean women.Menopause: the Journal of North American Menopause Society. 15(2); 296-303. Retrieved on 4 January 2019. http://10.1097/gme.0b013e3181405b74

[10] Kitanohara M et al. 2017. Effect of porcine placental extract on the mild menopausal symptoms of climacteric women. Climacteric: PubMed. 20(2):144-150. Retrieved on 4 January 2019. http://10.1080/13697137.2017.1279140.

[11] Genevieve l. Buser et al. 2017. Notes from the Field: Late-Onset Infant Group B Streptococcus Infection Associated with Maternal Consumption of Capsules Containing Dehydrated Placenta. Centers for Disease Control and Prevention, CDC. 66(25); 677-678. Retrieved on 4 January 2019. http://dx.doi.org/10.15585/mmwr.mm6625a4

[12] Gary W. Gibbons. 2015. Grafiz, a Cryopreserved Placental Membrane, for the treatment of Chronic/Stalled Wounds.Advances in Wound Care. 4(9): 534-554. Retrieved on 4 January 2019. http://dx.doi.org/10.1089/wound.2015.0647

[13] Sydney Lupkin. 2013. FDA Cracks Down on Placenta Products. ABC News. Retrieved on 4 January 2019. https://abcnews.go.com/Health/fda-cracks-placenta-/story?id=20298827

[14] Beware of consuming human placenta products. Health Canada. 2018. Retrieved on 4 January 2019. https://www.ctvnews.ca/health/beware-of-consuming-humanplacenta-products-health-canada-1.4194638

[15] Warning: Deer Placenta extract harmful for human consumption. 2018. Gulf News. Retrieved on 4 January 2019. https://gulfnews.com/uae/health/warning-deer-placentaextract-harmful-for-human-consumption-1.2186529

[16]See hadith discussion through the link: http://muftiwp.gov.my/ms/artikel/irsyad-fatwa/irsyad-fatwa-umum/2767-irsyad-al-fatawi-siri-ke-268-hukum-meminum-air-kencing-unta-bercampur-dengan-susu-unta?highlight=WyJ1bnRhIl0=

[17] The hadith narrated in Sahih al-Bukhari and Sahih Muslim is stronger in terms of the narration compared to Sunan Abi Daud. Wallahua’lam.

[18] From al-Zuhri, Abdullah bin Mas’ud said:

إِنَّ اللَّهَ لَمْ يَجْعَلْ شِفَاءَكُمْ فِيمَا حَرَّمَ عَلَيْكُمْ

“Indeed, Allah did not make a remedy for you from what He has prohibited for you.”

Sahih al-Bukhari, Chapter Drinking of al-Halwa (sweet things) and honey.

[19] https://www.webmd.com/baby/news/20150604/new-moms-gain-no-benefit-from-eating-placenta-studies-show#1

[20] http://www.aliftaa.jo/Question.aspx?QuestionId=2796#.XC8WiVwzaM9

[21] http://www.aliftaa.jo/Question.aspx?QuestionId=2797#.XC8WelwzaM9