The question is not where one is born, because birthplace—whether a country or continent—is never chosen by oneself, but always determined by others and the surrounding environment.

Nor is the question where one lives, because even though the place, country, or continent may seem self-chosen, it is often influenced or guided by others and external circumstances.

The real question is where one belongs, because the feeling of belonging—to a place, country, or continent—may arise within, even though it may still be shaped by others and the environment.

Hence, the question of where one dies—often beyond one’s control—becomes a question of where one wants to return. This return, to land, water, air, or space, whether through eco-friendly or ritualistic burial or cremation, signifies the return of one’s dark/non-dark matter and dark/non-dark energy to the greater cosmos. Yet the place of decomposition may not coincide with the place of birth.

So, does it matter to decide where one’s dark/non-dark matter and energy should return after death?

Is it too great an investment of resources to fulfill such wishes or honor such wills—perhaps an attempt to immortalize one’s legacy beyond the mortality of the body?

Interestingly, extracorporeal cardiopulmonary resuscitation (eCPR), which combines CPR with extracorporeal membrane oxygenation (ECMO), is already used not only to improve neurological outcomes in cardiac arrest survivors but also to enhance organ viability in post-death donations.

Is it too much to imagine a future where mechanical compressors replace manual ones to buy time for initiating eCPR—not only in those likely to regain circulation slowly, but also in those likely to become eligible for organ donation quickly?

Could emergency medical services (EMS) triage patients undergoing CPR in transport to eCPR-ready facilities?

Might advanced cardiovascular life support (ACLS) protocols include time goals for initiating eCPR—similar to the time-sensitive protocols of the National Institute of Neurological Disorders and Stroke (NINDS) for stroke care, or those for coronary syndromes?

And could there be time goals for organ retrieval from eCPR-supported patients who had known, registered, or pledged wishes for organ donation?

If eCPR can be used to transport bodies globally for cryonic preservation in the hope of future revival, could it not also be used to fulfill organ donation wishes tied to specific places, countries, or continents?

Isn’t there hope for fulfilling such futuristic wishes or honoring such living wills, especially when modern economics allows the allocation of untapped resources for postmodern possibilities?

One could imagine a futuristic wish or living will—entirely funded by one’s own estate—where, after legal death or imminent death, one is placed on ECMO.

Then, with ECMO maintaining organ viability, one’s body could be transported via air ambulance across states, countries, or continents to the chosen place of return.

There, the body could undergo eco-friendly or ritualistic burial or cremation—after the organs are retrieved for donation.

Perhaps this “globe-trotting” to fulfill a wish or will may be legally and ethically simpler if initiated before legal death, even though scientifically the process with ECMO remains the same before or after death.

Futuristically, one may only hope that one’s estate and heirs will act in time to seek ECMO—if affordable—and return one home to where one belongs, regardless of birthplace or residence.

Deepak Gupta is an anesthesiologist.