by Theo Schall

 

 

Last Friday, I went to hear Dr. Sergio Canavero announce his plan to transplant a human head as early as 2017. It wasn’t boring.

 

Dressed in a guru-chic mauve tunic, Canavero paced a stage flanked by two enormous screens as he talked through a hundred years’ advancement in neurosurgery, electrotherapy, and regenerative medicine. It took more than an hour before it became clear that Canavero was just laying out a problem, and then another before he finally made his pitch: with the financial backing of “American billionaires” interested in life extension, he hopes to recruit a team of cross-disciplinary surgeons who will work fulltime on the project for several years.

 

 

Is this for real? Life extension?

 

After revulsion, most people’s first response to the idea of a human head transplant is to ask whether it’s possible. The answer is no, or at least, not yet. Canavero’s “protocol” is a theory that remains to be proven. It’s not even a holistic theory of head transplantation, just the neurosurgery piece. A vascular surgeon interrupted to point out that Canavero doesn’t yet know what to do about cutting right through a major artery. Canavero shrugged and said that was one of many problems he hopes to solve with the help of other experts.

 

Other problems include the side effects that arise with long-term use of immunosuppressant drugs and the lack of proof in animal models. But I don’t think Canavero is as interested in these practical problems as he is in the implications of a successful head transplant. This man considers himself a post-humanist visionary. He sees us cloning replacement bodies, rejuvenating our aging heads by harnessing the biological processes that drive pregnancy, and employing electrotherapy for enhanced healing. Head transplantation is a step towards an entirely reimagined medicine.

 

Life extension and head transplantation aren’t necessarily related, but Canavero has apparently seen them as linked since early in his career. It’s an odd fixation for someone who claims to believe that there is no “self” and that personhood does not reside in the head. I’m not sure how Canavero squares a passion for cheating death with his skepticism about personhood – if there is no “self,” why bother preserving anyone past a “natural” lifespan? – but his philosophy was presented about as cohesively as his science. There are a lot of lingering questions.

 

At one point, Canavero asked Xiaoping Ren, the Chinese surgeon recently in the news for performing nominally successful head transplants on mice, to stand and be recognized as a fellow “Frankenstein.” The import of either man’s work remains to be seen, but they’re undoubtedly on the cutting edge… of something. The American Academy of Neurological and Orthopaedic Surgeons invited Canavero not because they necessarily believe his work will come to fruition, but because they were looking for controversy. Controversy can be good for science by drawing interest and support. Even if everyone’s head stays on, this media frenzy will likely have been good for neurosurgery.

 

It would be easy for critics to dismiss Canavero as a media-savvy kook, except that it doesn’t seem to be the case. Even a cursory PubMed search seems to refute NYU bioethicist Art Caplan’s claim that Canavero has only published in open-access journals without peer review. Canavero has at least a hundred articles indexed, most of which come from peer reviewed publications. If he’s a kook, he’s a kook with some scientific chops. The problem is more interesting if we take him seriously, anyway – there are already enough fictitious Frankensteins. What would it mean for this guy to be the real deal?

 

A lot of criticism has been based on dismissal of head transplantation’s feasibility. Perhaps the challenge here is defining “success.” The experiments done in mice and monkeys suggest that it’s possible to keep a mammal alive for a short time, up to a few days, with a new body. If Canavero succeeds in funding a huge team of experts, that timeframe might be advanced to weeks, months, even years. But at what cost, and to what end?

 

Whose head?

 

 

The head in question is that of Mr. Valery Spiridonov, a 30-year-old Russian man who suffers from Werdnig-Hoffmann disease, or spinal muscular atrophy. Mr. Spiridonov sat next to the stage that Canavero paced as he presented. While he remained quiet for most of the afternoon, Spiridonov’s been interviewed a number of times in the past few months. From all accounts, he’s a thoughtful, scientific man well aware of the risks and heavily invested in the potential benefits for others. His health is slowly failing and he’s unhappy with how dependent he already must be on others. If there’s a situation in which head transplantation might be a rational choice, Spiridonov’s certainly looks to be it.

 

Dr. Hunt Batjer, the president elect of the American Association for Neurological Surgeons, has been quoted as saying that he wouldn’t wish a head transplant on anyone and wouldn’t allow it done himself because “there are a lot of things worse than death.” Caplan came to a similar conclusion in an Op-Ed he wrote for Forbes, that “the most likely result is insanity or severe mental disability.” These are dubious assumptions. If the procedure is successful and the only remaining problem is the integration of a brain with a new body, I don’t see why insanity must result. Life and consciousness are delicate, but they’re also resilient. Head trauma patients can find happiness as new selves. We’ve all heard stories of dementia patients finding new love in their twilight years. Human beings can survive and thrive even as they experience tremendous personal change.

 

At one point, Canavero knelt down in from of Spiridonov to ask him about the claim that the outcome of the surgery could be “worse than death.” Isn’t Spiridonov’s current condition, he asked, sufficient to cause insanity? The prospective patient replied that he feels crazy “every day.” I think “crazy” was meant colloquially as a way to express frustration with suffering, but we must ask questions about capacity. Are there states of suffering so severe that they are effectively coercive? If his condition makes Spiridonov crazy in a legal sense, how can he give informed consent to such a risky procedure?

 

Is it worth it?

 

There’s a utilitarian argument to be made against the pursuit of this particular goal. Is this really the best way to spend money on health? Couldn’t we spend the same amount to provide so much more happiness to so many more people?

 

In the brief question period after Canavero’s session, another surgeon asked why, if Canavero believes he can make great progress on spinal fusion, he’s not working on fixing spinal injuries. Canavero responded in a few ways. First he distinguished the precision of cutting a spine from the trauma of spinal injury (a point he’s previously illustrated with a banana). Then, he pointed at Spiridonov and said “I want to help him. This one patient.” Canavero concluded that work on head transplants would likely have an indirectly beneficial effect on other areas of neurosurgery.

 

 

Spinal injury is a big problem. According to the National Spinal Cord Injury Statistical Center (pdf), it’s estimated that around 12,500 new spinal injuries occur each year in the United States. The World Health Organization estimates the number of new cases at 500,000 per year globally. These figures are just for injuries – the number of people living with spinal injury is much higher. The need for advancement in spinal cord injury treatment is great. The need for successful head transplants is difficult to measure (we can’t assume that everyone who has Spiridonov’s condition would even want such a procedure), but arguably lesser.

 

While Canavero’s claim that he’s only interested in helping Spiridonov sounds noble on its face, circumstances contradict it. It was only after Spiridonov announced his intention to perform a head transplant that Spiridonov emailed him to volunteer. Canavero is in this for the glory and the challenge. There are good reasons to encourage this spirit of scientific advancement, but they do tend to butt up against ethical imperatives, like doing good for millions of injured people. His personal project is important, but so are those of people with spinal cord injuries.

 

The technical difference between a precise severing of the spinal cord and the complexity of trauma does seem substantial, at least to a nonscientist like me. Maybe Canavero’s theories don’t apply to victims of neck trauma. But the surgeons in the audience seemed to feel that there would be implications for trauma victims and that Canavero might better focus his energies on healing the injured. One might argue that Canavero has the right to choose his own areas of scholarly pursuit and that by publicizing his efforts, he’s bringing funding into neuroscience that might otherwise not be available. On the other hand, he’s not planning to work on this alone. This project will require that a huge team of surgeons and specialists leave their own research and clinical work for several years of fulltime work. Given the enormous number of injured people and the unknown benefits of head transplantation, the moral calculus does not favor Canavero’s goal.

 

What next?

 

Spiridonov isn’t interested in the surgery until it’s “99 percent certain that it will be safe.” Canavero’s not planning on cutting anyone’s spinal column until he knows he can reattach it. There’s a lot of basic research to be done before this announcement means much. While I think this is a potentially wasteful use of funding and medical talent, the money would come from a private funder and probably not displace other research. There’s a not-insignificant chance that Canavero’s work would indirectly benefit many more patients than his own.

 

I expected to leave the session feeling strongly about Canavero’s proposition. Instead, I find myself curious to see what will happen next. I’m not sure if the good of head transplantation would outweigh the bad, but I look forward to continuing to follow the controversy that surrounds Canavero and his work.

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Theo Schall