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A neuroscientific model of near-death experiences

Nature Reviews Neurology volume 21, pages 297–311 (2025)Cite this article

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An Author Correction to this article was published on 12 June 2025

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Abstract

Near-death experiences (NDEs) are episodes of disconnected consciousness that typically occur in situations that involve an actual or potential physical threat or are perceived as such, and the experiences are characterized by a rich content with prototypical mystical features. Several explanatory theories for NDEs have been proposed, ranging from psychological or neurophysiological to evolutionary models. However, these concepts were often formulated independently, and, owing to the fragmented nature of research in this domain, integration of these ideas has been limited. Lines of empirical evidence from different areas of neuroscience, including non-human studies, studies investigating psychedelic-induced mystical experiences in humans, and research on the dying brain, are now converging to provide a comprehensive explanation for NDEs. In this Review, we discuss processes that might underlie the rich conscious experience in NDEs, mostly focusing on prototypical examples and addressing both the potential psychological mechanisms and neurophysiological changes, including cellular and electrophysiological brain network modifications and alterations in neurotransmitter release. On the basis of this discussion, we propose a model for NDEs that encompasses a cascade of concomitant psychological and neurophysiological processes within an evolutionary framework. We also consider how NDE research can inform the debate on the emergence of consciousness in near-death conditions that arise before brain death.

Key points

  • The emergence of a rich phenomenology in near-death experiences (NDEs) during acute physiological crises might be attributed to a cascade of concomitant neurophysiological and psychological processes, including phylogenetically preserved threat responses.

  • From a neurophysiological perspective, NDEs can result from impaired cerebral blood flow causing systemic hypotension, hypoxia and hypercapnia resulting in acidosis, and from increased neuronal excitability causing dysregulation of key neurotransmitter systems.

  • From a psychological perspective, NDEs might be partially shaped by top–down processes and facilitated by non-pathological cognitive traits such as dissociation propensity.

  • The evolutionary roots of NDEs are thought to be linked to survival and coping mechanisms, with serotonin probably mediating calming effects through 5-HT1A receptors and contributing to hallucinogenic aspects through 5-HT2A receptor hyperactivation.

  • Understanding the slow recovery of brain activity after resuscitation might provide a valuable opportunity to explore the neural correlates of NDEs.

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Fig. 1: Timeline of key events and theories in the near-death experience research field.
Fig. 2: Neurotransmitter systems involved in the generation of near-death experience features.
Fig. 3: The Neurophysiological Evolutionary Psychological Theory Understanding Near-death Experience (NEPTUNE) model.

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Acknowledgements

The authors are grateful to A. Deward (Illumine) for conceptualizing and designing the original Figure 3 and to J. Delroisse (Zoology Laboratory, Université de Mons, Belgium) for his precious phylogenetic insights. This work was supported by the BIAL Foundation. O.G. is a research associate and N.L. is a postdoctoral specialist at Fonds de la Recherche Scientifique, Belgium.

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Author notes

  1. These authors contributed equally: Charlotte Martial, Pauline Fritz.

Authors and Affiliations

  1. Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liège, Liège, Belgium

    Charlotte Martial, Pauline Fritz, Olivia Gosseries & Nicolas Lejeune

  2. NeuroRehab & Consciousness Clinic, Neurology Department, University Hospital of Liège, Liège, Belgium

    Charlotte Martial, Pauline Fritz, Olivia Gosseries & Nicolas Lejeune

  3. Anaesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, GIGA Institute, University of Liège, Liège, Belgium

    Vincent Bonhomme

  4. Department of Anaesthesia and Intensive Care Medicine, University Hospital of Liège, Liège, Belgium

    Vincent Bonhomme

  5. Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Daniel Kondziella

  6. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Daniel Kondziella

  7. Department of Neurology, University of Kentucky, Lexington, KY, USA

    Kevin Nelson

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N.L., P.F. and C.M. conceptualized the Review, wrote the article and edited the manuscript before submission. All authors contributed substantially to the discussion of the content and reviewed and edited the manuscript before submission. All authors approved the version to be published.

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Correspondence to Charlotte Martial.

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V.B. has had or continues to have financial relationships with Medtronic, Edwards Medical, Orion Pharma, Grünenthal and Elsevier. He is Deputy Editor-in-Chief of Acta Anaesthesiologica Belgica. The other authors declare no competing interests.

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Glossary

Agonal

A phenomenon occurring in the final stages of life, typically associated with severe physiological distress or the process of dying.

Atonia

A clinical sign characterized by a reduction in or complete loss of tone and contractility, most often referring to muscle tone.

Aura

The initial symptom of a focal epileptic seizure, reflecting localized abnormal brain activity before it potentially spreads.

Default-mode network

(DMN). A set of brain regions that show correlated functional activity and are typically active during the resting state.

Dissociation

A psychological state in which an individual experiences a disconnection between their thoughts, sensations, memories or sense of identity.

Ego dissolution

A temporary state characterized by the blurring or loss of boundaries between the self and the external world, often accompanied by disruption of self-identity.

Entropic brain hypothesis

A theory suggesting that the subjective quality of a specific experience is reflected in the measurement of brain entropy (greater diversity of brain activity patterns), positing that increased complexity of brain activity correlates with an expansion in some key property of consciousness.

Experiencers

People who have recalled a near-death experience.

Glomus cell

Specialized cells located in the carotid and aortic bodies that act as peripheral chemoreceptors, sensing changes in blood oxygen, CO2 and pH levels and helping to regulate breathing.

Out-of-body experiences

(OBEs). Subjective experiences in which the self is perceived as existing outside the boundaries of a body (disembodiment), sometimes accompanied by the perception of one’s body from an extrapersonal space (autoscopy).

Phenomenology

The lived, first-person experience of reality as it is directly perceived, including sensory, emotional and cognitive elements, shaped by personal context and perspective.

Self-representation

The mental process or cognitive ability by which individuals represent themselves, including their characteristics, values and role within the social and physical environment.

Thanatosis

A behaviour in which an animal ‘plays dead’ by entering a state of immobility or paralysis, typically in an attempt to avoid predators.

Vasovagal syncope

A common type of fainting caused by a sudden drop in heart rate and blood pressure, leading to reduced blood flow to the brain.

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Martial, C., Fritz, P., Gosseries, O. et al. A neuroscientific model of near-death experiences. Nat Rev Neurol 21, 297–311 (2025). https://doi.org/10.1038/s41582-025-01072-z

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