[Buddha-l] Heart of the matter?

[Dan Lusthaus]

> I have read an article some time ago in Japanese where a Buddhist scholar
> argued that brain death is not death. Death is only when the heart
> completely stops and the breadth is no more. In Japan, apparently this is
> the official definition of death. This definition severely the pool of
> useful organs available for transplant. Even if the deceased had willed
that
> all his/her organs be donated for medical transplants purposes, doctors
> cannot act till after the heart stopped. I was told by doctors that this
> will severely reduce the window of opportunity for successful transplants.

It is more complicated than that. The problem reported by the doctors would
only be the case if the heart is kept beating artificially and as a result
one cannot declare death. In the States, the "medical definition" of
death -- established by the Harvard School of Medicine back in the 70s, is
flat eeg (brain waves) for 24 hours. Of course, rarely does anyone wait 24
hours to declare time of death -- that definition comes into play when
someone is being kept "alive" by artificial supports.

A long time ago, death was decided by lack of respiration (e.g., hold a
mirror up to the nostril to see if there is condensation), but that resulted
in many premature burials (Poe got several good stories out that). Then the
determinant became the heart. No pulse or detectable heartbeat = dead. But
too many cases in which the heart stops, and then resumes or is
resuscitated -- especially after CPR, etc., became widespread -- 
accumulated, so this also became an ureliable, premature sign. Brain waves
could also cut out, and then resume, hence the Harvard definition of 24
hours of flat waves. That is only used for comatose patients whose other
organs are only functioning due to life-support machines.

Under natural circumstances, once the heart stops, it takes awhile (several
minutes or longer) for the brain to cease measurable functioning.

The problem for transplants is that they want to harvest functioning,
healthy organs, and once the heart stops, the other organs, apart from the
brain, rapidly deteriorate (that starts almost immediately, as if the heart
sends out a signal to start decomposing). If one waits for brain death, the
other organs would be unusable. So typically someone who is a candidate for
organ donation is put on life support to keep the heart beating, nourishing
the other organs that will be taken, until they are removed (it's a bit more
complicated, but that's the general procedure). If one allows the heart to
stop, most organs would be unusable. One cannot cut someone open, poised to
remove an organ, and then stand around playing cards waiting for the heart
to stop. Nor would one have time after the heart stops to then cut someone
open and hope to find a healthy organ.

As for the out-of-body experiences, back in the late 70s, a cardiologist
named Dr. Sabom wrote a book (can't remember the name) that detailed how he
went from being a materialist skeptic, to a believer in consciousness apart
from the body. As a cardiologist, he had had many patients with NDRs (near
death experiences) -- all vital signs for a certain amount of time, and then
restart, with the patient reporting having had various experiences during
the interim. He discounted these with the usual "explanations" (oxygen
deprivation, hallucination, etc.) until the reports gave him details that he
found to be more "empirical." Patients who were clinically dead (no vital
functions) were reporting that they felt they were floating in the room;
they could recount the conversations the Drs. were having, could read the
numbers, etc. on the medical equipment, and -- most compelling for Sabom -- 
could leave the room and travel to other parts of the hospital, accurately
reporting on who was in the waiting room and other such details.

Dan