Consciousness Beyond Life: The Science of the Near-Death Experience (46 page)
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Authors: Pim van Lommel
Memories of a previous life can be explained with the idea of a nonlocal consciousness because it posits a nonlocal connection with the consciousness of somebody who has died, that is, somebody who was previously alive. The same concept explains encounters with deceased persons during an NDE and perimortem and postmortem experiences. While some see the possibility of contact as proof of reincarnation, I regard it as an indication of the nonlocal aspect of endless consciousness. This does not exclude the possibility of reincarnation of one or more aspects of a nonlocal consciousness, resulting in memories of a previous life. I am disinclined to believe that people return in a body with their entire personality, which is associated with their current sense of self or ego. However, I have come to believe that memories of a previous life are possible.
Organ Donation: What Is the Debate About?
After my NDE lectures, and not just in the Netherlands, I frequently receive pressing questions about brain death and organ transplantation: Does brain death really equal death? How can somebody be declared dead when nearly 100 percent of the body remains warm, intact, and seemingly functional? What is the difference between coma and brain death? Does brain death mark the start of the process of dying, which normally takes hours or days to complete, and how is this process affected by the removal of organs such as the heart and lungs? What is the state of consciousness during brain death and the process of dying? And what to make of the stories about changed thoughts and feelings following a heart transplant, so-called transplanted memory? I want to explore these questions in considerable detail because brain death and organ transplantation constitute a clear and practical example of some of the ethical and medical questions raised by contemporary health care.
Let me start by saying that I am not in principle opposed to organ transplantation, on the condition that the decision to donate an organ was made with due consideration and with loving intentions, with the full understanding that the operative removal of organs has an impact on and accelerates the process of dying. Inadequate and often one-sided information hampers any well-considered choice, especially when people are expected to fill out a donor registration form while lining up to renew their driver’s license. When they fill out their form, few people recognize the true significance of the brain-death diagnosis and its practical consequences for the family of a potential donor who has been certified brain-dead.
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Ignorance about the true meaning of organ donation only becomes apparent when a loved one is on a ventilator and the doctor informs you that your husband, wife, brother, sister, or child is actually dead and asks permission for organ donation. At this emotional moment, 70 percent of next of kin, uncertain about their brain-dead relative’s views on the issue, refuse permission for donation. But even when patients are registered donors, the family often withholds permission. The sight of a relative attached to a ventilator and fluids, unconscious but with the body still warm, often triggers an intuitive uncertainty about whether brain death really equals death.
Pressing Questions
Most of the questions I receive are also formulated in the following two letters, which were written in response to a Dutch government debate on the introduction of a new system for organ donation under which all Dutch residents would automatically be registered as donors unless they express their objections and opt out:
Isn’t it about time for us to shift the focus of this recurring debate to the question why people don’t “simply” make this choice? Where is the scientific evidence that organ transplantation doesn’t interfere with the process of dying? The word
process
indicates phases, and the organs are removed at the start of this process. Why is “the dead person” put under general anesthetic before the organs are removed? Physicians speak of patient reflexes, but is this what they really are? Why do criteria for brain death differ the world over? What is the relationship between the body, soul, and mind? Who studies the psychological consequences for a parent forced to say good-bye to a warm and breathing child? What about the many publications on near-death experience in situations when brain death was diagnosed and yet the patient regained consciousness and lived to tell the tale? There are many other questions that may well be too big for our limited human understanding and that get in the way of a simple yes or no. An aggressive government campaign will only fuel distrust. Everybody should be free to choose in their own time.
Another letter reads:
For fifteen years I carried an organ donor card, never thought twice about it. After hearing the following story from one of my students, I ripped it up.
While she was thought to be in a deep coma, without any apparent brain activity, her specialist and husband were having a conversation by her bedside. The specialist predicted that his patient would be a “vegetable” for the rest of her life and asked the husband to consider taking her off the equipment that was keeping her alive. The husband was still hopeful of a recovery, so she was kept on the ventilator. Several months later the woman woke up. It emerged that she had been able to hear throughout most of her coma and had overheard the conversation between her doctor and husband about passive euthanasia! She said how awful this had been and that while she had been trying to shout that she was still there, that she wanted to live, be with her husband and children, they were discussing her possible demise. In principle, I still support organ donation, but I haven’t yet filled in my donor card. Why not? Because there are too many unanswered questions. The government campaign has focused primarily on the donor shortage and the need for people to register as donors.
Inadequate and One-Sided Information
One problem with current donor policies is that they are often publicized with inadequate and one-sided information. This is what it says on the Dutch donor registration form:
Waiting times for donor organs are long. People who could have been saved by an organ transplant die unnecessarily. That is why we need donor organs. You can help! Join the donor register. Let us know your wishes and help save lives.
Under current Dutch law, donor registration is possible from the age of twelve, and there are plans to give young people of fourteen and over a donor registration form when they collect their identity cards. The government campaign focuses only on recruiting more donors and not on providing objective information about the background to “postmortem” organ donation, that is, donation after somebody has been declared dead. The debate centers almost exclusively on the organ shortage, but this shortage will always exist, irrespective of the number of donors and the number of organ transplants.
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In other words, the emphasis is the positive aspects of donorship (noble, heroic, life-saving) at the expense of the negative ones.
A few examples of the inadequate information:
1. Despite the many information campaigns, most people remain ignorant of the major difference between organ donation and tissue donation. They do not know that tissue donation is still possible when the dead body has been at the mortuary for twenty-four hours. Tissue donation covers skin, heart valves, bone and muscle tissue, and the eye’s cornea. Postmortem organ donation involves the removal of organs from so-called brain-dead patients, whose warm bodies are still in a deep coma on a ventilator. These organs include the kidneys, liver, heart, lungs, pancreas, and parts of the intestine. Any contraindications for organ donation, such as malignant diseases, arteriosclerosis, chronic infections, HIV, and recent piercings, are rarely mentioned.
2. The receipt of a new organ does not guarantee a normal life expectancy. Organ recipients require intensive medical checkups for the rest of their lives because of the risk of rejection and the side effects of immunosuppressant medication, and they are at a greater risk of malignant diseases, high blood pressure, diabetes, and serious infections.
3. There is no mention of the potential physical and psychological side effects of an organ transplant. The “tyranny of the gift” puts immense psychological pressure on recipients: they often suppress any negative feelings for fear of being labeled ungrateful.
4. The information lacks any kind of reference to the necessary measures to keep organs in a fit state for donation even before the donor is diagnosed as brain-dead and permission for organ donation has been obtained.
When Is Somebody Brain-Dead?
With the technical expertise to transplant organs, such as the first kidney transplant in 1965 and the first heart transplant in 1967, came the problem of obtaining suitable organs. In 1968 an ad hoc committee at Harvard Medical School decided after lengthy deliberation that henceforth
Coma dépassé
(long-term, irreversible coma) would be called death, thus creating the possibility to obtain transplant organs from “dead” patients. There is a difference between brain death and coma. During a coma, also known as “apparent death,” electrical activity can still be registered in the brain. The heart beats normally, blood pressure is regulated by medication, the patient receives artificial respiration, and there is usually some brain function left. A “permanent coma,” by contrast, is a state in which a large part of the cerebral cortex and brain stem have sustained serious damage, and if there is any indication of irreparable damage the diagnosis will be “brain death.” A coma brought on by loss of cerebral cortical activity, but with a functioning brain stem, can last for years in exceptional cases because brain-stem reflexes such as breathing and swallowing are still possible; this is known as a “vegetative state” or sometimes also as a “locked-in” syndrome.
According to international organ transplantation guidelines (the Netherlands, Europe, United States), any confusion between permanent coma and brain death is out of the question because in the latter case the brain is devoid of any measurable electrical activity and the brain stem is irreparably damaged.
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But I am often asked how accurate such measurements are. And what to make of the many reports of consciousness during a period of coma with demonstrable loss of brain function? The Dutch organ transplantation guidelines, like other international guidelines (United States, United Kingdom), have this to say about brain death:
The brain needs a constant supply of oxygenated blood. If the brain…is deprived of oxygenated blood for more than a few minutes, it is irreparably damaged. The result is irreversible loss of brain function. Continued treatment is futile. The brain-dead patient has died.
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This raises a question about the process of dying, which can last hours or even days and which the guidelines ignore. What is more, when brain death has been diagnosed, 96 percent of the body is alive and is being kept alive whereas the patient is legally dead. When, according to the Dutch and other international guidelines, is somebody brain-dead?
Somebody is brain-dead in the case of irreparable and complete loss of brain, brainstem, and medulla oblongata function. The person in question can no longer breathe independently. All brain function has ceased and the body is incapable of regulating blood pressure and body temperature.
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About artificial respiration, the Dutch (and other international) guidelines say:
Donor organs need oxygenated blood. That is why the brain-dead donor receives artificial respiration until the organs are operatively removed. This can only be done at the hospital’s Intensive Care Unit (ICU). Because of the artificial respiration, the brain-dead donor does not look dead. He appears to be asleep, has normal skin tone, and feels warm. The monitor shows his heartbeat. And yet he is dead!
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This is why the law speaks of “the respiration of the dead body” even though every doctor and every layperson knows that it is impossible to give artificial respiration to a “real” dead body from the mortuary.
About brain activity, the protocol says:
An electro-encephalogram (EEG) is the registration of the electrical activity of the cerebral cortex. A “flat” EEG, i.e., a straight line, shows that any electrical activity in the cerebral cortex is absent.
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A flat EEG plays an important role in the diagnosis of brain death although a flat EEG during a cardiac arrest does not rule out any immeasurable activity in the brain. The EEG provides no information about the brain stem. “When an EEG is impossible (in the case of a crushed skull, for example)…doctors inject a contrast fluid into the blood vessels in the brain to see whether there is any blood circulation in the brain.”
Following serious head trauma or a massive brain hemorrhage, swelling in the brain usually causes high tissue pressure, which makes it difficult to demonstrate blood circulation in the brain, whether with contrast fluid or with isotope analysis. These cases often prompt the erroneous conclusion that there is no more blood circulation in the brain. Cooling the brain (hypothermia therapy) reduces the cerebral swelling and offers the patient a chance of recovery. This type of treatment is still rare, however.
Does Brain Death Equal Death?