Complete Head Transplants

Early this year an old friend, a professor of neurology, sent me an article from a medical journal, “Surgical Neurology International," at first glance, predictably, a concoction of specialist language. The “Turin Advanced Neuromodulation Group” is describing “Cephalosomatic Anastomosis” (CSA), to be performed with “a nanoknife made of a thin layer of silicon nitride with a nanometer sharp-cutting edge.”

Only slowly it becomes clear they are talking about something rather unexpected: “Kephale,” Greek for head, “Somatikos,” Greek for body, “Anastasis,” Latin for resurrection—that prosaic CSA stands for...a complete head transplantation. And that reverberated with me, the implications being literally mind-boggling.

There is that "most interesting" aspect: the thought of a functioning brain reconnected to an entirely new body does open up any number of speculations. And has done so in countless SciFi books and B movies. But there is a lot to consider.

The author, Italian surgeon Sergio Canavero, announced a few months later that he had a suitable donor for the head part, and suddenly made it sound quite real, adding tangible details: the operation was to be done in China, requiring a team of 150 specialists, taking 36+ hours and costing $15+ be performed in 2017.

Then it really hit the mass media. Many responses revolved around the ethics of such an action, using the F-word a lot (and I mean “Frankenstein”) and debating the scientific details of the spinal cord fusion.

My stance on the ethical side is biased by a personal moment: In the mid-90s I visited Stephen Hawking in Cambridge for a project and he later visited in Santa Barbara—both interactions, up-close, left me with an overpowering impression. There was that metaphor of "the mind being trapped in a body," playing out in all its deep and poignant extreme—the most intelligent of minds weighed down so utterly by the near useless shell of a body. A deep sadness would overcome anyone witnessing that, far beyond the Hollywood movie adaption.

There is the rub then: who could possibly argue against this man choosing to lengthen his lifetime and gain a functioning body, should such an option exist? Could anyone deny him the right to try, if medicine were up to the task?

In reality Hawking is not a candidate even in theory, his head being afflicted by the disease as well, but he does serve as a touching and tragic example of that ethical side.

Another personal connection for me is this—imagine: critical voices called it “playing God.” Human hubris. Where would all the donors come from? Is this medicine just for the rich?

Now consider: the first operation leads to the recipient dying after eighteen days. It is being repeated and the subsequent 100 operations lead to nearly 90 percent of the patients not surviving the two-year mark.

No, that is not a prognostication for CSA, but I am recalling the events from nearly fifty years ago: It was December, 1967 when Christiaan Neethling Barnard performed the first human heart transplantation, the eyes of the world upon him, his face plastered on magazine covers across the globe. I was ten and remembered his double-voweled name as much as the unfathomable operation itself. He was met with exactly the same criticism, the identical ethical arguments.

After the dismal survival rate the initial enthusiasm turned around and a year later those condemning the practice were gaining. Only after the introduction of Cyclosporine to vastly improve the immune rejection issues did the statistics turn in his favor and tens of thousands such operations have since been performed.

I consider that an important aspect in this: every stage of progress has had critical voices loudly extrapolating curves into absurdity—back then, as now, there is immediate doomsday talk of “entire prison populations harvested for donors,” and such.

Sadly, watching videos of Canavero on the Web is rather cringeworthy. Slinging hyperbolae of "the world will never be the same," naming his procedure heaven and gemini, then squashing a banana representing a damaged spinal cord versus a neatly sliced one to illustrate his ostensibly easy plan. He repeatedly calls it "fusing spaghetti" and even assessed the chances for his Russian donor at "90 percent to walk again."

The Guardian mentions “he published a book, Donne Scoperte, or Women Uncovered, that outlined his tried-and-tested seduction techniques.” It seems rather clear that there is little place for levity when he belittles the details and glosses over the reality: millions of quadriplegic victims are eyeing very closely what the chances are to truly re-fuse spinal cords. That alone is probably worth a great deal of energy, effort, time and expense.

The story here is not about one celebrity poser. In my view it cannot happen by 2017, by far. But 2027, 37, 47? Looking backward you can see the increase in complexity that makes it almost inevitable to think: this will be possible. And then the truly interesting questions come into play...

If phantom limbs bring serious psychological issues, what would an entire phantom body conjure up? The self-image is such a subtle process, the complexity of signals, fluids, and messenger chemistry, how could it all possibly attain a state remotely stable, let alone "normal"?

Christiaan Barnard, who asked why anyone would choose such a risky procedure, said:

 For a dying person, a transplant is not a difficult decision. If a lion chases you to a river filled with crocodiles, you will leap into the water convinced you have a chance to swim to the other side. But you would never accept such odds if there were no lion.

Me, I dread even just the waiting room at the dentist. But thirty years hence, maybe I would opt for the crocodiles as well. If Hawking can survive longer—by all means, he should. Some other characters I can think of—their best hope lies in acquiring a new head. Thus, I am of two minds about complete head transplants.