[daguy]

Final part....
Tibetans, in any case, reason that it is important not to touch or distract a dying person, lest the person become upset or distracted and the death experience be disturbed. Greed for possessions, grasping at loved ones, and especially anger are to be avoided at all costs. Once the pulse and breathing have stopped, it is thought best to leave the body quiet and alone; prayers and positive thoughts for the person's welfare may be generated from another room. Interestingly, the law in California and a number of other states allows a body to be left in repose for three days after clinical death. In fact, we find that most religious traditions tend to leave the body lying in state for some days, and a period of three days is quite common.

If we accept, then, that consciousness does not end at the time of death, that a "person" may have valuable spiritual work to do in the intermediate period before the next life, and that it is best not to touch the body of a person undergoing this transition, we are faced with a dilemma. On the one hand, it is beneficial and an act of compassion to donate one's eyes, liver, and kidneys. On the other hand, it is important to evolve spiritually and to achieve a positive rebirth in order to benefit others physically and mentally. We are faced with the irony that, while a full-fledged bodhisattva may easily give up the entire body with no hesitation, a bodhisattva-in-training who has not perfected this selfless resolve may be wiser to avoid risking a disastrous rebirth due to undergoing organ transplantation at the time of death.

When I first asked Lama Karma Rinchen, the spiritual director of Kagyu Thekchen Ling in Honolulu, whether he thought it was a good idea to donate one's organs at the time of death, he immediately answered in the affirmative. " Definitely, " he said, " That is an excellent compassionate bodhisattva action. " When I questioned him as to whether the dying person's consciousness might not be disturbed by getting an organ cut out, he said, " That's OK. The doctors can wait for a few days. " When I said the doctors have to cut the organ out immediately in order to save the organ recipient, he gasped, appalled. " Fresh? They want it fresh ?!? " In the end, he concluded that for an ordinary person who believes the mind dies with the body, it is fine to go ahead with donating the organs. But for a Buddhist practitioner, it might be better to wait until the bodhicitta resolve is strong and stable. He himself would like to donate his organs anyway.

Admittedly, it is the quality of life that is critical, not necessarily the quantity. Tibetans say that virtuous people should live long, but that a short life is better for non-virtuous people, since there will be less time to commit negative actions. This leads to reflection on the quality of life of the organ recipient, the motivation for wishing to extend life, and the person's state of mind while waiting for a suitable organ to become available. If greed, grasping, and attachment are motivating factors in wishing to extend life, these unwholesome mind states will affect the recipient's quality of life and quality of death. Can we imagine the mental state of a recipient whose transplant is unsuccessful ? Moreover, honestly speaking, it must be a great temptation for medical practitioners to terminate the life of an organ donor prematurely in order to ensure a successful transplant.

Possibly in reaction to the extraordinary methods currently being used to prolong life artificially, there are many who advocate natural death, death with dignity, and mindful dying. Venerable Prabhasa Dharma Roshi of the International Zen Institute in Los Angeles, among others, has long dreamt of creating a Buddhist hospice setting which provides facilities conducive for spiritual practice at the time of death. She envisions creating a serene, meditative environment for the dying person and a nirvana hall simulating the Pure Land where a person can calmly make the transition to an enlightened realm undisturbed by medical paraphernalia.

This discussion leads to the larger issue of extending life. When we speak of using extraordinary means to extend life, what does extraordinary mean? Does that include blood transfusions? Who makes the decisions? Who physically pulls the plug?

Medical professionals make decisions such as these on a daily basis. For example, although it is general practice to attempt saving the life of a dangerously premature infant, there are a number of variables that enter into the equation. For the parents these factors may include the number of other children in the family, expense, and even gender. Economic variables may include whether necessary surgeries are being performed at private or public expense. Might it be that expensive surgeries are justifiable when the insurance company pays, but not in welfare cases? What about cases of multiple health problems? If an infant requires heart surgery ( to the tune of $100,000 ), it should be warranted regardless of economic status, but what if the child is blind, has Down's syndrome, and has missing limbs as well? What if the father is alcoholic and abusive, the mother is a prostitute with AIDS, and the child needs to be on oxygen indefinitely requiring constant nursing attention? These are some of the sticky wickets that health professionals are required to negotiate every day.

Another complex aspect of this issue that needs to be investigated is the nature of mind, its relation to the physical constituents, and the state of mind ( located at the heart, traditionally, for Buddhists ) in the case of organ transplants. What psychological adjustments or temperament changes are entailed when another person's organ is transplanted into one's own body ? These important bio-ethical questions need to be looked at from various religious and cultural perspectives, as well as the physiological and economic.

Last but not least, the issue of organ transplantation needs to be appraised in the larger global context. The irony of spending $100,000 or more to extend a life when the earth faces disastrous overpopulation cannot be ignored. That is a hefty expenditure to be made for a single human being when 40,000 children starve to death every day and the number continues to increase exponentially. What is the wisest and most compassionate way of dealing with these harsh realities? What would the Buddha say?

• Karma Lekshe Tsomo is an assistant professor of Theology and Religious Studies at the University of San Diego, California teaching classes in Buddhism and World Religions. She studied Buddhism in Dharamsala for 15 years and completed a doctorate in philosophy at the University of Hawaii with research on death and identity in China and Tibet.

She specializes in Buddhist philosophical systems , comparative topics in religion, gender issues in Buddhism, and Buddhism and bioethics. Her work includes research and publications in the areas of women in Buddhism, death and identity, Buddhist monasticism, Buddhist/Christian dialogue, and the western adaptation of Buddhism