Saturday 21 December 1996
Two brains
Alasdair Palmer meets the Pope's professor who wants to perform the
first human head transplant
"THE Holy Father has never voiced any objection. As far as I know, there
isn't a problem with the operation from a theological or an ethical point
of view." Dr Robert White, Professor of Neurosurgery at the Case University
in Cleveland, Ohio, speaks with authority, both on surgery and on the Pope.
A frequent visitor to the Vatican, Dr White is a member of the Pontifical
Academy of Sciences. He helped to set up the John Paul II committee on
medical ethics. It is therefore something of a surprise
to discover that "the operation" to which Dr White refers is the removal
of one person's head and its surgical attachment to someone else's body.
The most common reaction to the idea of a head transplant is simple: it is not merely a question of how could anyone do that? but why would any sane person want to?
"Yes, I am aware of that," says Dr White, a spritely and very healthy-looking
man of 70. "But that's a very uninformed reaction. We really have to grow
up - and we will. There was a very similar reaction
when organ transplants first became possible nearly 40 years ago. And
I have no doubt that within the next 50 years head transplants will be
as common as kidney transplants are today."
Dr White is not joking. He believes that he could perform the operation
successfully now. "It is more than 20 years since I successfully transplanted
the head of one monkey on to the body of another. The
monkey could see. His eyes followed you round the room. He could eat,
and if you were stupid enough to put your finger in his mouth, he would
have bitten it off."
Unfortunately, the monkey could not move. He was paralysed from the neck down. "How to connect up the spinal cord to the new head is a difficulty I haven't tried to solve. It's an immensely complex problem. But it will be solved, in my view, and before too long."
You might think that in the absence of knowing how to "connect up the spinal cord", the ability to transplant heads would not be of much use. But you would, according to Dr White, be profoundly wrong. "When I was working on transplanting the heads of monkeys in the Seventies, my interests were those of pure research: it was the only way to study various important aspects of brain-functioning and chemistry. For instance, I discovered the enormous benefits to the brain of temperature reduction. At normal temperature your brain would die in about three minutes if starved of oxygen. But at 15¡C, I could shut off oxygen and blood for half an hour and there would be no adverse effects. In fact, when we did this to some monkeys, they actually performed better at intelligence tests after their cooled brains had been starved of oxygen in this way."
Understandably, animal rights activists are not fond of Dr White. There have been threats to his life, and he has had to have FBI protection. "I do not accept any criticism from those people. They have behaved disgracefully to me and my family. I cannot accept that animals are comparable to people."
You can recognise that point, yet still feel uneasy when looking at
the footage of the transplanted monkey's head. The information Dr White
gained from that experiment was clearly interesting but hardly significant
enough, in terms of the possible benefit to humans, to demonstrate that
yuk is not the appropriate response to it. "But the operations were not
simply useful in gaining data," says Dr White.
"They have real life-saving potential."
Noticing the incredulous expression on my face, Dr White pauses. "Let me explain. A few years ago I gave a lecture on my work in England. Listening in the audience was a man who was paralysed. He was quadraplegic, only able to move his head. He came up and said: 'The doctors tell me my body is failing, but my brain is perfectly good. I'm going to die because of my failing body. Why can't I have a new one?' And suddenly the thought occured to me: you could!"
Dr White believes that "total body transplantation", as he prefers to call it, could benefit quadraplegics enormously. "They die from multiple organ failure. They are not thought to be suitable targets for organ donation. If we could give them a new body, then they could live much longer."
Already, people have put their names down for Dr White's operation, in the hope that some day soon, he will be allowed to perform it. Craig Vetovitz is one. A diving accident has left him paralysed from the neck down. "A body transplant? Yes, I'd like to be the first," says Vetovitz, who stresses that he is "well aware of the risks. But if it can promote and accelerate this type of research . . . I'd be prepared to do it."
While Vetovitz and others like him might be willing to undergo Dr White's pioneering surgery, no one in authority will let him perform it, at least not in the United States. "Surgery of this kind has to be passed by various ethics committees," sighs Dr White. "Currently, there is no chance of those committees approving it." Dr White does not think this is because the operation raises serious ethical issues. "It does not. The surgical procedure is available. I would not be performing experiments on people. I have already done the appropriate dissections on human cadavers. Anatomically, this is familiar territory."
So what does he think the problem is? "The media circus that would surround the operation if it was performed in America. That and the fact that we do not yet know how long someone with a total body transplant would survive - that is a great unknown. But they didn't know how long the first beneficiary of a heart transplant would survive when that operation was first performed. You can't ever know until you actually do the surgery for real."
Dr White might simply decide to perform the operation outside the United
States. He has been invited to the Ukraine. "They have very fine neurosurgical
facilities," he notes. They also do not have ethics
committees. "Sure," adds the ever-optimistic Dr White. "But ethics
are really not the issue. We're talking about saving lives here."
Others are not so sure. Brian Jennett, who recently retired as Professor
of Neurosurgery in Glasgow, is sceptical of the value of Dr White's operation,
and of his research. "As far as I can see, this kind of
operation, whether on animals or humans, does not have much value in
terms of furthering knowledge. It's really a purely technical challenge.
And the crucial question is what is its practical result in terms of
benefit to the patient? I haven't seen any evidence that there is a significant
benefit."
Dr White is not too bothered by that kind of scepticism. "It is always the same with any innovative technique."
But as a committed Catholic, Dr White would be deeply concerned if the Catholic Chuch was opposed to head transplants. It is unlikely to be a problem, he says. "The Church accepted the concept of brain death. It is now recognised that if the brain is unable to function at all, then the person is clinically dead, even if his or her body is intact, and can function. Brain-dead people will be the source of the bodies to be transplanted on to new heads."
If it could be made to work - and it is a big if - is there any reason why we should not allow "total body transplantation", as Dr White calls it? From a secular point of view, it would seem not - always assuming that it provided the benefits Dr White predicts, and we could get over the initial feeling of revulsion.
But what about God? "Head transplantation does not violate any fundamental theological principle," says Dr Helen Watt, of the Catholic Lincare Centre for Medical Ethics. "There's no doctrinal problem. The religious objections are essentially practical. They centre on such things as the effects on the donor's relatives of his body being attached to a different head."
It does not require much imagination to see that those effects could
be traumatic. It would, at the very least, be extremely disorienting to
have (say) your wife's body used in a head transplant operation -
particularly if the problem of connecting up the spinal cord was solved,
so the new individual could be as mobile as the old one. Who would the
new person be? Your wife with a new head? Or a different person who had
been given her body? If she got pregnant, who would count as the mother?
The question who exists after the head transplant raises profound questions about the nature of personal identity. Dr White does not have much time for them. "I think everyone accepts," he says, "that personality lies in the brain. That's where your memory, your character, your individuality, lies."
He also recognises that a person's identity is not exhausted by his brain. But this is not because he thinks that a person's body is important. "The soul defines identity."
Hadn't Dr White's work as a scientist made it hard for him to retain his faith? "No, not at all. Science has to fit in with the Christian religion, because they're both true."
However basic the contradiction may seem to others, he does not experience
any tension between his religious and scientific outlooks. "Operating on
the brain is an almost mystical experience," he says.
"When you start to understand it, you just cannot regard it as a wholly
natural product. When I look at this three-and-a-half-pound lump of white
jelly, and think what it can do . . . it amazes me."
dan@southeast.net
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