HOTA (Human Organ Transplant Act): Opt-In Or Opt-Out?

By Tan Keng Leck of Ean Keng Si Buddhist Temple
(For You Information, Issue 293)

As Buddhists, we of course believe in charity and giving. And we were taught that generosity is the cause of wealth and detachment is of virtuous disposition. We also learnt how the Buddha offered his body to feed a hungry tigress willingly when he was a Bodhisattva in a previous life. The act of giving by itself accumulates merits and paves the road to liberation and enlightenment. Even if the desire to give is stained with self-interest, for example, with a desire for fame or good karmic reward, it does not diminish its merit. However, things are not so straightforward when it comes to the issue of donating one’s organs, as the procedure for organ transplant occurs or has to occur during the most crucial period of our life, that is, the ending of our present life cycle. Therefore, this Human Organ Transplant Act (HOTA), which our Singapore parliament had passed way back in 1973 and since then had undergone some important amendments is a rather complicated issue and evokes different responses from different Buddhists.

As most of us probably have read or come to know that HOTA now covers all Singapore citizens and permanent residents from the age of 21 onwards. Initially, it was an opt-in scheme, but now it is an opt-out one, meaning, if you do not file to opt-out, you are automatically included if you fall within the prescribed categories. What then is the Buddhist perspective on this issue? Should we rejoice at or reject this imposed act of generosity?

To give it more thought, we must first understand the differences in the definition of ‘death’ between secular medical science and the Buddhist teachings. In medical terms, one has definitely died when one’s heart has stopped beating and that breathing has ceased. But even if one’s heartbeat and breathing are still ongoing, one can still be considered to have died if one is certified ‘brain death’ (by two neurosurgeons), and then goes the act of organ transplant. But what is ‘brain death’? And why is ‘brain death’ considered to be the end of life? There are a lot of definitions available on the Internet on ‘brain death’ and I quote one here: ‘For practical purposes outside the world of academic debate, three clinical tests commonly determine brain death. First, a standard electro-encephalogram (EEG) measures brain-wave activity. A “flat” EEG denotes non-function of the cerebral cortex – the outer shell of the cerebrum. Second, auditory evoked potentials, similar to those “clicks” elicited by the ear-speakers measure brain stem viability. Absence of these potentials indicates non-function of the brain stem. And third, documentation of no blood flow to the brain is a marker for a generalised absence of brain function.’ But why is ‘brain death’ considered the end of life even when other bodily functions still persist? It is because in medical science or science in general, the brain is considered to be the seat of the consciousness and of being. Once it ceases to function or when its functionality drops to a barely noticeable level, science concludes automatically that the individual or being ceases to exists and therefore removing his or her organ is of no consequence to him or her. Organ transplant hence constitutes a ‘no-loss’ to the donor but instead a win to the recipient.

First of all, we must understand that the Buddhist notion of consciousness is not brain-based. It is a body-mind continuum that continues from life to life. If there is a seat of this consciousness in the body-mind continuum, it is deemed to be residing in the centre of our heart, not the physical heart but the heart chakra of our subtler body. In Buddhism, dying is not an on/off phenomenon, that one second you are alive and the next you are dead. It is a slow unwinding process (unless with a sudden death which speeds it up). It starts when one’s skandhas (Buddhist notion of being is made of the skandhas [elements] of earth, water, fire, air and ether, embraced by consciousness) begin to dissolve and absorb into another. Earth into water, water into fire, fire into wind element and so on. Our external breathing stops when wind element dissolves into ether, which corresponds to us taking the last breath. But the dying process is still not over, it continues with the ether dissolving into consciousness and the consciousness dissolving into its base which leads to the meeting of the white and red drop in our heart chakra (which otherwise reside on our crown and navel cakra normally) with the dawning of the clear light, etc. (Please read the Tibetan Book of the Death or other books on this topic if you wish to have more information on this fascinating process). To put it more plainly, we are still present in our body even when our breath and heart have stopped. Some accomplished lamas, upon letting out their last breath, would sit upright and become completely still. They are said to be in Tuk Dam – clear light meditation. Only many hours or sometimes a couple of days later do their postures collapse, which shows that their consciousnesses have finally left their bodies.

In Vajrayana Buddhism, there is a so-called Tantric Vow of Fourteen Root Downfalls – one of which is not to disparage the five skandhas, meaning, to hold the body and all that in it as a sacred mandala. Thus, based on this teaching, taking out the organs during the death process is definitely a taboo. In the Tibetan Buddhist tradition, the deceased’s body is not to be touched or moved for three whole days. It is only after that period of time that the body can be cremated or more traditionally, fed to the vultures. In the Chinese Mahayana tradition, it is advised by no less a master like Venerable Yin Guang (印光大师) and Venerable Hong Yi (弘一大师) not to move or touch the body for at least three to eight hours. In any case, the consciousness is believed to be still trapped within the body and any movement would cause the deceased to experience great grievance and pain. This time period is considered extremely important as this is also when the consciousness can depart for the Pure Land of Amitabha Buddha (Amituofo) or even attain enlightenment through recognising its Buddha essence or through the blessing brought forth by prayers (e.g. Namo Amituofo, etc) as well as reminders recited in his presence (bardo thodol) or through transference of consciousness rite (powa) performed by a competent lama. In short, it is crucial during this period not to touch or move the body, much less cutting it up. It is believed that the deceased’s state of mind during the dying process will be the single most important determining factor in his rebirth besides his past karmic deeds. It can aid or hinder his liberation. The bodily apertures, through which the consciousness finally leaves the body, will guide the consciousness to its predisposed destination. It is believed that the best route for rebirth is through our crown, and the worst is leaving from the lower bodily opening or the feet.

It is meritorious to be generous and to offer organs. But if such a giving brings forth dire consequences, then one should take a cautious stand. First of all, one should be truthful to oneself and ask: Have we reached the stage of spiritual attainment that our love for others is greater than the stake of our entire spiritual future? Will we not feel anger or fear seeing the surgical knife cut into our lifelong cherished body? Not forgetting that during this unusual period, our inner experience will probably be amplified a thousand-fold. Have our spiritual practices reached such stability that in our day-to-day living we are not raffled by provocation and our insight into emptiness is so deep and clear that we no longer dream confused dreams? Then, perhaps for such a Buddhist practitioner to experience his heart and liver being taken out, he will create only amusement when he undergoes the organ transplant procedure. But we must be absolutely certain of this. For negative emotions experienced during this crucial period could lead us to be reborn in a lower realm or create a condition for an extremely negative disposition in our future births. For us, average practitioners, it would definitely compromise our chance of going to the Pure Land of Amitabha Buddha or other Pure Lands.

Related Articles:

Some Buddhist FAQs On Organ & Body Donation

Should Pure Land Practitioners Donate Their Organs & Bodies?

Life Support & Organ (& Body) Donation

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