The noise level in the transplant community has reached a crescendo with the proposed head or whole body transplant venture called ‘HEAVEN’ (Head Anastamosis Venture). The technical feasibility and ethics of ‘Head’ and ‘Whole body’ transplantation are being questioned
The success of organ transplantation has been called one of the least expected events in the history of medicine. In 1961, Nobel Laureate Burnet commenting on organ transplantation in the New England Journal of Medicine wrote ‘On the whole, the present outlook is highly unfavorable to success’. Even though the first successful kidney transplant was done in 1950, it was the introduction of immunosuppression medication in the early 1960’s that helped weaken the immune system of the recipient and prevent organ rejection that opened up the world to transplantation. This led to successful transplantation of lung (Hardy, 1963), pancreas (Lillehei, 1966), liver (Starzl, 1967), small intestine (Lillehei, 1967), heart (Barnard, 1967) and much later, the uterus (Brannstrom, 2012). The success of hand transplant (Breidenbach, 1999) and face transplant(Devauchelle, 2005) ushered in the era of ‘Composite Tissue Allograft’ transplantation. Through all this, organ transplantation has never ceased to intrigue and amaze humanity. The sequence of ‘it cannot be done’, initial failure, criticism, success and awe has been repeated time after time for transplantation of every organ.
The question now being asked is whether it is possible to transplant the entire ‘head’ or ‘whole body’? As the proposed deadline for the project of December 2017 approached, the noise level in the transplant community reached a crescendo. Is it possible to transplant a new body into a person paralysed from neck downwords but whose mind is active and vibrant? The technical feasibility and ethics of ‘head’ and ‘whole body’ transplantation are being questioned.
The human head transplant project, known formally as the “Human Head Anastomosis Venture” (HEAVEN) was devised by Sergio Canavero, Chief of Turin Advanced Neuromodulation Group, Italy in 2013, and basically involves a head-exchange between two bodies. A new body is obtained from a donor who has been declared brain dead. The recipent will be a patient paralysed from neck downwards but with intact mental faculties. The patient’s body is cooled down to 15 degees Celsius and then with a nano-sharp blade, the head of both patient and donor is severed at the same time. The patient’s head is then placed on to the donor body with the help of a special dolly and chair which allows alignment and placement with precision. The spinal cord is joined with polypropylene glycol, a chemical “glue” which seemingly can repair damage to the transected spinal cord. Muscles and the blood vessels would then be stitched together while the patient is put into a coma for about three weeks to allow healing. During this time the patient receives small electric shocks to stimulate the spinal cord and strengthen the connections between the head and the new body. As the patient is brought out of medically-induced coma, it is hoped they he/she will be able to move, feel their face, and even speak with the same voice.
Canavero’s laboratory announced in 2015 that the first whole body transplant will be carried out in December 2017. His team was initially based in Turin, Italy, but his maverick plans were publicly criticised by at least one international church. A medical ethicist writing in Forbes called his proposal “rotten”. As the Italian medical establishment turned against him, Canavero took heart from medical pioneers who were outcasts and fringe-dwellers in their day. Louis Pasteur was called crazy for suggesting illnesses could be caused by microbes. Doctors now wash their hands because of Ignaz Semmelweis but he ended up poor and ostracised in an asylum.
As his University refused to renew his contract, Canavero, seeking new funding for the project, found a home at Harbin Medical University China, where he was joined by Xiaoping Ren. In November 2017, a successful head transplant reherasal was carried out between two human cadavers that took 18 hours. ‘Today we stand on the brink of a revolution, not only in medicine but in human life as well’ Dr Canavero announced at the press conference. He now plans to transplant a human head between two brain-dead bodies before moving on to the actual procedure. Valery Spiridonov, a 30-year-old millionaire Russian computer programmer suffering from paralysis of all 4 limbs due to a spinal muscular atrophy called Werdnig-Hoffmann Disease, has volunteered to undergo the first surgery. Canavero fondly calls him “Gagarin’ based on Yuri Gagarin, the first man in space. As the Canavero-Xiaoping Ren team moves closer to the first whole body transplant, several issues are worth consideration.
Firstly, is it possible to slice through someone’s neck at C5-C6 vertebra and then join the head to another body with reasonable anatomical and physiological success? The GEMINI spinal fusion protocol has been validated in mice, dogs and monkeys and has been called ‘near miraculous’ by journalists who witnessed the same in 2016. A dog could walk and wag its tail at 3 weeks after its spine was transected and re-joined. Cooling of tissues to 15 to 19 degrees Celsius keeps the head and body viable for 45 to 60 minutes, giving the surgeons enough time to join the two with reasonable neuroviability. However, while the technique can restore some motor function, the degree to which sensory and autonomic functions are restored is yet to be seen. Canavero’s famous words to the first prospective recipient enrolled for whole body transplantation were ‘I may not make you run, but I will make you walk ‘
The second important aspect is immunosuppression. Normally, when an organ is transplanted, the recipient’s body tends to reject the organ. Since the head constitutes only 8 percent of the total body weight it is likely that the head will be rejected by the body rather than vice versa! The immunosuppression protocol to be employed in HEAVEN is similar to the more established approaches to face and limb transplants. The possibility of populating the donor bone marrow with the myeloid cells of the recipient, leading to full or partial chimerism that may obviate the rejection process, is being considered.
Thirdly, psychological screening and support is an important aspect of organ transplantation as accepting a foreign body as one’s own requires long-term psychological resilience. This is best highlighted by the experience in face transplantation. Some critics predict that HEAVEN recipients will experience mind–body dissonance of such magnitude that insanity and death are possible. The Enteral Nervous System (ENS) from the gut, called the ‘second brain’, produces more than 30 neurotransmitters including 95% of the serotonin in the body and may have significant influence on our emotional state. Accordingly, the extent of influence of the donor body on the recipient’s mind is not known. Stool transplant from the donor’s discarded body into the recipient body may be an option. The use of hypnosis and Immersive Virtual Reality (IVR) is being explored for HEAVEN.
Fourthly, the long list of legal and ethical issues emerging is daunting. If we transplanted Steve Jobs’ body into Stephen Hawkins, the human created will be Stephen Hawkins, Steve Jobs or Stephen Jobs? If the head constitutes only 8% of the body mass, and my head was transplanted into another body, the resulting hybrid will be identified as me or him? The head will be mine but the fingerprints would be his! The testes and private parts will be his, so the children borne after this strange marriage will be genetically mine or his? Who will be the offspring’s official next of kin, his family or mine? Will I be able to sign like my original signature with his hands and body? What if he was left-handed when I am right- handed? The point is that if you have someone else’s DNA running through your system, then who are you? Since there is no accepted protocol for the procedure and insufficient evidence on the risks involved, the credibility of informed consent for the procedure itself becomes questionable.
Lastly, the estimated cost of 10 million dollars and allocation of resources for this medical procedure is being questioned when thousands die waiting for organ transplantation. A body transplanted to the recipient’s head carries with it a heart, lungs, kidneys, liver, small intestine and pancreas. Thus the failure of this high-profile, low-priority procedure aimed at improving the quality of life of a wealthy recipient, could effectively deny 8 other individuals a chance to live.
Should the whole body transplant be allowed to proceed? Experience tells us that today’s standard of care was yesterday’s experimental medicine and before that the vision of one man who dared to dream. However, Dr. Frankenstein himself had serious ethical concerns regarding his creations. Whether head transplant is HEAVEN in the making or will HEAVEN fall, only time will tell.