Organ Donation and Brain Death from Buddhist's Perspectives 

Modern scientific and technological developments have contributed to mass production. There have arisen many issues which affect human health both physical and mental are related, regarding to ethical criteria in physical medicine. This paper will discuss brain death and organ transplantation from Buddhists perspectives. There are three different sets of criteria for deciding when someone is brain dead: the physician’s, the Theravada Buddhist’s, and the Mahayana view. According to modern doctors, brain death means that the brain stem has ceased to function. In early Buddhist theory, there are no scriptural mentions of brain death; the Buddha defines death as the absence of three things: vitality, heat, and consciousness. Organ transplants are referred to as “the gift of life” for those patients who are on the waiting lists. Mahayanists realize that the body is borrowed in this life: when one is born as a human being prolongs at least one hundred years or depends on one’s karma. 

Thus, one can follow the bodhisattva vows by organ donation to help others to be healthy, and happy in this life, in order to fulfill one’s perfections to become a future Buddha. The research for this paper will collect the data from present modern physical reports, Buddhist writing such as articles, newspapers, and some video clips on You tube relate to this topic. Concept of Brain death Brain death means that the brain stem has ceased to function. It is a term occurred in the modern life with the first recorded in 1965 to 1970. Due to many accidents of patients who indicated with brain injury or kinds of brain sickness cause incurable. According to British Dictionary, “brain death” means that irreversible cessation of aspiration due to irreparable brain damage, even though the heart may continue beating with the aid of a mechanical ventilator: widely considered as the criterion of death. It is also called brain dead as cerebral death, irreversible coma, local death or somatic death. In science perspective, the permanence brain damage resulting in loss of brain function, manifested by cessation of breathing and other vital reflexes, unconsciousness with unresponsiveness to stimuli, and absence of muscle activity. The patient who is brain death may still exhibit normal function of heart, lungs, and other vital organs if they are receiving artificial life support. 

According to the medical discoveries, the cause of death varies by the area and the age. Death can occur when the breath entirely ceases; the heartbeat and the pulse stop; the person is entirely unresponsive to stimulus, the eyes may be fixed in directions, the pupils are dilated and fixed to light, the eyelids may be opened or closed; a loss of control of urine, etc. In this case, brain death is out of the above definition of death due to heartbeat, and breath are still function. There are two reasons being reach to brain death with brain damaged: in the vegetative state and coma. Damian Keown, in the “Buddhism and Brain Death: Classical Teachings and Contemporary Perspectives”, re-examines that last twenty years he spent his time to do research in the Brain Death area convinced that brain dead is truly death meaning in human being when he reached into that stage. In the recent years, when he regards this issue to Buddhist ideas this does not mean totally death for patients who face with this sickness. “Brain death usually heralds the imminent demise of the patient, it does not equate to death itself” Most criteria for brain death diagnosis do not acknowledge that this is not the only way of diagnosing death. If the concept of death on neurological grounds is accepted, the brain death diagnostic criteria can be applied only in patients under life support assistance in intensive care units. 

Does this mean that when a physician diagnoses death in a patient on a regular ward applying cardio circulatory and respiratory diagnostic criteria, or when a forensic specialist diagnoses death in a body under criminal circumstances, are we denying a brain-oriented concept of death? Buddhist views on death Death is a part of life, it comes to everyone without exception. The uninvited one comes to the world and the unbidden one leaves therefrom. But when and how one will die is absolutely unpredictable. Some people die in their prime, others in the middle and still others in old age. Again, someone dies due to sickness, some due to accident, and so on, but all people must die. a. Original Buddhist view on death From a Theravada Buddhist perspective, death is defined as the absence of three things: warmth, heartbeat, and breath. In the Foam discourse, the Buddha taught death’s factors of criteria “Āyu usmāca viññānaṃ, yadā kāyaṃ jahantimaṃ Apaviddho tadā seti, parabhattam acetanaṃ Etādisayaṃ santāno, māyāyam bālalāpinī Vadhako eso akkhāto, sāro ettha na vijjati” From the Abhidhamma perspective, death has two forms, one is the continual dissolution of mind and matter, which is invisible; and the other is physical or conventional death which is the visible form characterized by the vanishing of the life element, the heat element and the consciousness. 

The conventional death can occur through any one of the following four causes, namely, “through the expiration of the life span (āyukkhayamaraṇa), through the expiration of the productive kammic force (kammakkhayamaraṇa), through the expiration of both, the life span and the kammic force (ubhayakkhayamaraṇa), and through the intervention of a destructive kamma (upacchedakamaraṇa)”. Cac tang thien dinh, vang mat hoi tho, suc nong vaf nhip tim nhung hanh gia van con song vai thang den vai nam cho den khi hanh gia xuat thien Mahayana’s view on brain death The Mahayanist point of view pay attention of unconsciousness carefully especially being in the coma or vegetative state. In Yogacara tradition believed that being possess eight consciousnesses: five sensory consciousnesses and mind-consciousness, added two consciousness which differ from Traditional Buddhism: superficial ego consciousness (māna) and storehouse consciousness (ālayavijñāna) which layer in the latent lying consciousness is also called the foundation consciousness. Being in brain death state who still can have mind’s working that we would not define by modern machine or technical development of physicians. 

In the culture of Buddhists practice, the concept of brain death is not accepted. The researcher also disagrees with the idea of organ transplantation from being in the brain death state. Medical researches and physicians are not pay attention to patient’s consciousness though relying on their experiences and modern machines. Interpretation of organ transplantation Organ transplantation is to remove one’s part of body to others patient. --without the patient either in writing beforehand in a living will or at the time if the patient is conscious the organ may not ethically be taken. Mahayana views on organ transplantation A Mahayana view is that one can follow the bodhisattva vow by organ donation. There is consciousness in the phenomena of brain death which negatively impact the donor during organ transplantation. Consciousness of donor is overlooked in organ transplantation in the case of brain death patients. This performance may lead patients to the poor abodes because they attach to their body and life-span which not ready to go beyond. Thus, Organ transplantation in the brain death stage is synonymous to killing from a Buddhists Perspectives. Corollary the idea of brain death is always continuing debate subject in the modern day, instead of that people have to rely on the ethic to be final decided to patients and the physicians and relatives of patients have to be more patient waiting for the chance has come into real life. by doing so, patients are ready to go beyond their path without any hesitation. 

Where is the spirit of being who offered his organs to others? With attachment of his body, then one can lead to unwholesome states. As a researcher in Buddhist studies, I wonder about the patients who offer his body or organs can lead to freedom states or not? In the Buddha’s teaching, being after death is no longer belong to this world, he can offer his organs as “the gift of life” to others who need his part. It is not very easy for those who are even Buddhist practice, and more difficult for the normal people who are not understand much about the life after death that who can make sure their spirit rest in peace states or he keeps observing where his organs or body’s place. Looking after his organ transplanted to others, and he still attaches to his belonging. Then this problem cannot be solved very well with his donation or good deeds have been done in this very life. I believe that the voluntary consent of the donor is necessary. The living will is desirable for clarity about the donor’s wishes Therefore, there are three different sorts of criteria for deciding when someone is brain dead: from modern physician’s view, Theravada Buddhist view, and Mahayana view, and I follow the Mahayana view. The way of practice to offer organs Most people, especially religious ones, hope and wish to face death calmly and peacefully for themselves as well as for their kith and kin. Though having such hope, not all achieve the goal due to various conditions. Some people die peacefully, while others die with terrible worry, fright, pain, and so on. From the light of the Buddha’s teaching, to face death calmly and peacefully is not a matter that cannot be fulfilled. There are the methods of practice that lead to happy life and peaceful death, viz. the practice of charity (dāna), morality (sīla), and mediation (bhāvanā), and so on. Dāna literally means ‘charity’, ‘giving’ or ‘offering’, which is the donation of something to other people. Although dāna or charity is not the factor of the Noble Eightfold Path nor a requisite for enlightenment, it claims a special place of eminence in the Buddha’s teaching, being the beginning of the path to liberation. 

When doing charity, there are four factors that should be completed, viz. the donor, the volition, the material of the offering, and the presence of recipients. When these four are available, the charitable work is fulfilled. Of them, volition (cetanā) is considered as the most important factor, the root cause without which no act of giving can be accomplished. It is like the seeds without which there is no crop to plant as the crop depends on the seed quality. The results of the giving also depend on the quality of the volition of the donor. There are three kinds of volition, i.e., volition before giving (pubba-cetanā) that occurs in the donor’s mind during the time of preparation of giving or offering; volition at the time of giving (muñca-cetanā) that appears at the very time of giving; and volition after giving (apara-cetanā) that occurs after giving, whenever this action is recollected, the mind feels very happy.