By Charlotte Laycock
Almost 200 years ago, the German surgeon Carl Bunger performed the first successful organ transplant, where he took skin from a person’s inner thigh and grafted it onto their nose. It wasn’t until almost 100 years later that the first transplant of skin between two different people occurred. The science behind the surgery, and the techniques used, have developed in the time since, with plastic surgeons very recently carrying out the most extensive face transplant to date: the scalp, ears, and eyelids were taken from a deceased individual and grafted onto a firefighter with third degree burns on his entire face.
However, this could now go one step further. Sergio Canavero, the hugely controversial Italian surgeon, has stated that he wants to perform the world’s first head transplant by December 2017. Valery Spiridonov, a 30 year old Russian who suffers from Werdnig-Hoffmann disease has volunteered to become the first recipient of this type of transplant. His condition slowly wastes away muscles without affecting the brain, and is eventually fatal. The donor will likely be a brain-dead individual with a healthy body.
There will be many obstacles along the way, but the surgeon has provisionally set a date and appointed a team who will help him during the 36 hour surgery. Spiridonov’s body, along with that of the donor, would need to be cooled and then both heads are removed from the neck. The head from the diseased body will be transferred to the healthy body, and the spine, blood vessels, and nerves reconnected within an hour.
If successful, Spiridonov would be put into a chemically induced coma that would allow the connections to seal. Canavero believes that polyethylene glycol glue (PEG), combined with electrical stimulation will help the reconnection, and that the head should gain full control of the body. In experiments on rats with severe chronic spinal cord injury, implantation of PEG led to tissue recovery, regeneration of neuron axons, and improvement of hindlimb locomotor function. An invasion of beneficial cells and elongation also occurred, showing that spinal cord axons can regenerate into a suitable matrix.
It may seem far-fetched, but the Italian states that head transplants have been successfully carried out on rats. Although unverified, Canavero has also claimed that scientists led by Xiaoping Ren at Harbin Medical University, China, have attempted the procedure on a monkey, although they did not try to fuse the spinal cord. It was revealed that the monkey’s brain showed no signs of injury, with the monkey itself surviving for 20 hours before being put down for ethical reasons.
Many doctors strongly oppose the surgery, believing that there is a strong likelihood that Spiridonov will die as the donor’s immune system will reject the head. Arthur Caplan, Director of Medical Ethics at New York University’s Langone Medical Centre, stated that even if the surgery was a success, the patient “would be overwhelmed with different pathways and chemistry than they are used to and they would go crazy.” Even if possible, head transplantation poses huge ethical concerns, especially considering the person donating the body would be unable to consent. There is a worry that China may use prisoners, as they have previously been known to use organs of executed prisoners. Additionally, there is the issue of cost as the operation will not come cheap; it is estimated the surgery will come to around 11 million dollars, meaning financing will need to be secured.
If what Canavero says is true, and transplants have been successful on monkeys and rats, the procedure could be a real possibility for humans. However, the long term effects and many ethical issues throw into question whether 2017 is a realistic target, and many argue that even if medical advancement enables us to do it, that doesn’t mean we should.
Photograph: U.S. Navy via Wikimedia Commons