Head Transplants: Severing the Mind-Body Link

Nobody knows what makes us who we are. A risky surgery planned for 2017 may give us the answer.

By Shelby Hartman

“I think, therefore I am”

– René Descartes, Discourse on the Method

In 1637, mathematician and philosopher René Descartes famously concluded that he only knew one thing for certain: he exists because he thinks. He decided to question everything he believed to be true in an essay that went on to become one of the most influential pieces of modern philosophy ever written. After much contemplation, he determined he was just a mind — or a “thinking thing” as he called it. It was even possible, he said, that his thoughts could exist without a body altogether.

Now, more than 350 years after Descartes’ discourse, very few philosophers take such an extreme position, but the jury is still out on what makes us who we are.

While neurologists have created all types of fancy scanning equipment (MRIs, fMRIs, PETs, EEGs) to study the brain and developed treatments for extraordinarily complex disorders, there is still no consensus on where identity originates. Does it come from the body? The mind? The brain? And what’s the difference between the mind and the brain, anyway?

In December 2017, Italian neurosurgeon Dr. Sergio Canavero believes he will finally provide the answers to this millennia-old mystery when he performs the world’s first head transplant. The head of a man or woman will be placed on the body of a brain dead donor. (If successful, it has the potential to help patients who are severely disabled around the world receive more functional bodies). The procedure, which has received international attention since Canavero announced his plans at the American Academy of Neurological and Orthopedic Surgeons’ annual meeting in June 2015, is scheduled to take place at a still-to-be-determined hospital in China with a team of about 150 medical professionals at an estimated cost of $15 million to $20 million dollars.

“This is going to be the revolution we’ve been waiting for. This is going to change life as we know it.”

– Dr. Sergio Canavero

“This is going to be the revolution we’ve been waiting for. This is going to change life as we know it,” Canavero says on video chat from his office in Turin, Italy. He declares that one day everyone will be able to have their heads transplanted onto younger, cloned versions of themselves.

Dr. Sergio Canavero/ ILLUSTRATION BY DANIEL MARIN MEDINA

Canavero looks a bit like a bionic man himself. He’s a fit 51 years old, with a shiny, bald head; a silver goatee; and perfectly round, Einstein glasses. He exudes an unshakable confidence, thoroughly convinced that his scientific and philosophical theories are sound. And they better be — not just for his patients’ sake.

Canavero’s going up against prominent academics who consider his plans improbable, insane — or both. Neuroscientists are debating the feasibility of the procedure. The majority of doctors agree that science has not yet figured out how to safely fuse a spinal cord to connect a head with a body. Bioethicists are debating the morality of the surgery (should it even be attempted?). The procedure is outlawed in Canavero’s home country of Italy, for example, because if a head-transplant patient were able to reproduce he or she would give birth to the children of the body donor.

Philosophers are continuing to have the same debates they’ve been having for at least 2,000 years. And yet there is a twist this time: since these theories may soon be put to test, the potential consequences of their stances are a whole lot more grave. If who we are — our personality, our memories, our hopes, our moods, our tastes — is primarily contained in our heads then someone who receives an entirely new body would still act and feel like themselves. But, if a significant portion of who we are is not simply in our heads, but contained in our bodies, then someone who receives a head transplant could wake up very confused potentially to the point of insanity.

“The interesting thing about these head transplants is that, at least from my point of view, it’s somehow making more real what has been theoretic up to this very moment,” says Dr. Giuliano Mori, a philosophy historian and fellow for the Foundation for Baroch Arts and Culture.

Mori meets with Canavero multiple times a week. He recently wrote a paper for the head-transplant surgery, summarizing the various philosophical perceptions of personal identity. Mori, however, will not take a stance. “I mean, you can take a theoretical position about the relationship between mind and body,” Mori says. “It’s a bit like saying ‘what’s your favorite color?’ My favorite color is blue. Does that really mean anything about colors? I don’t think so.”

The possibilities for how a brain might react to a new body are so numerous and uncertain that, until now, head transplants have merely been fodder for science fiction. James Giordano, chief of the Neuroethics Studies Program in the Pellegrino Center for Clinical Bioethics at George University, believes that we can learn from these pop-culture representations. “…[F]ictionalized accounts and the fears they evoke should not be taken lightly: they tend to reveal important dimensions of public perception and emotion,” Giordano wrote in an American Medical Association Journal of Ethics article about new technologies that could alter the mind and self.

The 1962 sci-fi film “The Brain That Wouldn’t Die”

The potentially terrifying consequences of new neurotechnologies include mind control using deep brain stimulation in which a medical device, or “neurostimulator,” is implanted in the brain to treat, say, Parkinson’s disease or Tourette’s syndrome; or the body of a head-transplant patient rejecting the new head in the same way that bodies sometimes reject transplanted organs. (The plan is to put the patient on very powerful immunosuppresants.)

For this reason, Giordano helped to create a neuroethics code for the medical community. One of the most important principles in most medical research is patient consent, but there is disagreement about what that entails.

According to Giordano, consent is “based upon the provision of the greatest extent of information possible.” Patients can agree to unknown risks, like they often do in clinical trials, but the question remains: At what point does the medical community have a responsibility to say the unknowns are too great?

“On balance, you have to look at [head transplantation] with the same standards that you apply for any new medical technology,” says Emory University senior neurosurgery resident Jordan Amadio. “If you ask me, ‘Have we met those minimum standards?’ I think the answer is no. I don’t think there have been the requisite preclinical or animal studies done in order to justify doing this in humans at this point.”

Canavero is partnering with Chinese surgeon Ren Xiaoping, who last year decapitated and reattached the heads of two rhesus monkeys successfully. It’s worth noting, though, that the monkeys were never awoken and their spinal cords were not reconnected. Canavero says that wasn’t the point. Xiaoping merely wanted to prove, and according to Canavero he did, that a brain can be cut off from circulation without suffering damage.

In January 2016, Canavero also announced that South Korean surgeon Dr. C-Yoon Kim had successfully used his technique to cut and then refuse the cervical cords of eight rats that within three weeks could breathe and walk. Their survivability was not tested since they were euthanized after about a week, which is standard procedure in such experiments.

Now, Canavero says, “the animal stage is behind us.” Xiaoping performed the first head transplant using two dead human bodies in the fall, just to prove that reconnecting a head to a human body was feasible. In May, Canavero will travel to China to help a team led by Xiaoping to practice on two brain-dead donors.

In Canavero’s opinion, the team is on track to prove that he has discovered the missing ingredients for performing head transplantation. He will use an ultrasharp nanoblade to sever the spinal cord and then temporarily hold the pieces together with a microconnector. The key to regrowing the nerves will be the delivery of small electric shocks at the point of fusion and application of a substance called polyethylene glycol (PEG). PEG is a common ingredient in many skin creams, lubricants, and even toothpastes. Neuroscientist George Bittner discovered the substance in 1986, but only recently — after Canavero’s announcement that he would use it for head transplantation — did Bittner begin publishing academic papers saying PEG may be a game-changer for spinal paralysis. Canavero considers Bittner’s papers a huge indicator that he’s finally getting through to some medical professionals. But many dissenting voices remain.

Every step toward transplantation progress has been met with criticism. First, it was blood transplantation in the late 19thcentury. Then, it was kidney, heart, and liver transplantation in the mid-20thcentury. Most recently it’s been face transplants, which involve replacing all or part of an individual’s face using tissue from a dead donor. Canavero invokes renowned psychology scholar Steven Pinker’s article in The Boston Globe when addressing pushback. According to Pinker, bioethicists halt innovation, and the proper scientific response to them should simply be: “Get out of the way.”

Yet, no one denies that there are unique considerations in this case. Even if successful head transplants are performed on monkeys who can breathe, move, and live for extended periods of time, there will be no way to answer questions about the effects the surgery will have on personal identity until its performed on a human. “Will it allow for some remapping [of the brain] and will this individual feel that they’re reintegrated?” Giordano asks. “There’s no way we can know that with animals.”

Dr. Canavero estimates that 80 percent of the personality of the head-transplant patient will transfer with the surgery. But he willingly admits he’s just guessing. He believes some memories are contained in parts of the body such as the microbiome.

Canavero points out, though, that personality changes are inevitable with or without a head transplant, referencing the ancient Greek philosopher Heraclitus’ mantra: “Panta Rhei” or “everything flows.” It is Heraclitus to whom Plato’s Cratylus attributes the famous quotation: “Everything changes and nothing remains still…and…you cannot step into the same stream twice.”

Philosophy is Canavero’s “foremost driver” and he claims consciousness lives neither in the brain nor the body. In fact, “the self” altogether, he says, is an illusion. “You must be a deeeeep thinker” in order to understand this, he tells me while pointing aggressively to his forehead.

After practicing meditation for more than 30 years, Canavero came to the conclusion that we are just individual expressions of a universal consciousness (a similar idea is espoused by many philosophies including Buddhism). This consciousness, he explains in his book “Immortal: Consciousness Does Not Live In The Brain,” is merely “filtered” through the brain. He refers to the seemingly inexplicable cases of patients whose hearts have stopped completely from cardiac arrest, but were able to recount everything that occurred during that period after they were revived.

Canavero believes the head-transplant patient will also have experiences that he or she remembers even when his or her head is completely disconnected from their body. “There will be a few minutes where the head will be detached, no blood. They will be clinically dead, as dead as it gets,” he explains. When the patient wakes up and tells of the experiences he or she had in that moment: “We will prove no death. We are immortal. Absolutely.”

When Valery Spirodonov of Russia heard Canavero speak about the head-transplant procedure on television three years ago, he contacted the surgeon immediately. Spirodonov, 31, uses a wheelchair due to severe spinal muscular atrophy. Spirodonov’s request was simple and direct: he wants to receive the world’s first head transplant. Some media outlets have reported that Spirodonov will be the first patient, but Canavero admits the Chinese government will want him to choose a citizen of their country. The Chinese government will help decide who that person is, and then it will approach the family of a brain-dead donor for approval to use the whole body.

“If I have this [body] removed, I believe my personality will just feel better and everything else will stay the same”

– Valery Spirodonov

Still, Spirodonov’s decision to participate makes the procedure all that more real. He jokingly calls himself Canavero’s “media darling.” He’s been speaking to audiences and journalists around the globe about why he wants to receive a head transplant.

“I believe that after the surgery we will have all the answers about the soul, about the personality and where it lives. We just have to do this and see what happens,” Spirodonov explains via video chat from his home in Vladimir, Russia.

He has lived in this ancient city, about 100 miles from Moscow, for the last 20 years. “I have lots of stuff to do everyday,” he says. “That’s why I completely enjoy my life and I’m not some sick guy that’s like, ‘Please help me in any way; I have a terrible life.’” That said, Canavero regards Spirodonov’s condition as serious. He should have died when he was young, and he relies on others to help him get up in the morning, to shower, and to complete other necessary tasks. “It’s kind of depressing to be so dependent,” Spirodonov says.

Despite his condition, Spirodonov describes himself as ordinary. He works full-time designing computer education programs for schools in Russia. In his spare time, he likes to eat sushi or pizza and hang out with friends. He’s also a huge fan of the Stars Wars movies and can’t wait for the latest installment to come out on DVD.

More than anything, Spirodonov loves science. He always fantasized as a kid about working in a laboratory, but he was unable to do so because of his physical limitations. Computers were second best. He sees the head transplant as an opportunity to finally fulfill his lifelong dream to be a part of something significant.

The graphic from Valery Spirodonov’s fundraising website

“This is not just about saving one guy like me, no? It’s about creating new technology to save lives and to make breakthroughs in science,” Spirodonov explains. “When I had the possibility to take part in this kind of experiment, I was like ‘Wow! This is like flying to the moon and back.’”

According to Spirodonov, he, Canavero, and the Chinese surgeon Ren Xiaoping are a team. He fully trusts their judgment. When asked about the neurosurgeons who believe that Canavero’s science doesn’t add up, he chuckles and says dismissively, “You know, there are always people who refuse to believe that something can be done. We just have to do this. We do not have to reason with anybody. And when it’s done, everyone will see ‘Wow! It’s working!’” His sentiment echoes Canavero’s, who says bluntly that Western science has “fucking failed.”

Spirodonov admits, however, that he doesn’t really understand the science behind the transplant. Which, of course, brings up concerns about whether he’s qualified to consent.

“I certainly don’t think this individual [Spirodonov] could understand, because the scientific community doesn’t understand what the risks are,” Emory University senior neurosurgery resident Dr. Jordan Amadio says.

Certainly, members of the public don’t understand either. Anita Silvers, chair of the philosophy department at San Francisco State, says that despite all the headlines announcing Canavero’s endeavor, the complexity of the procedure makes it difficult for the average person to fairly judge whether it’s ethical.

Silvers says we must differentiate between critical ethical questions and what bioethicists refer to as “the yuck factor.” Just because people intuitively feel something is grotesque does not mean it’s wrong. “As the yuck factor stops distracting, you can start focusing more on this patient and what we know about the prospective outcomes,” Silvers says. She proposes using comparisons to help make rational judgements on the ethics of a head transplant.

“Let’s say [the patient is] replacing his body, not by transplanting another body, but instead by putting his head on a robot’s body,” Silvers says. “The issue now is amputation. Is it ethical to amputate parts of a body that are dysfunctional in order to make room for a more functional prosthesis? For legs, we do it all the time.”

She continues, “You can tell that I’m not against simply replacing parts of the bodies with other bodies, even a full body. I don’t think it’s necessarily a rejection of disability, because people with disabilities use prosthesis all the time.”

Arthur Caplan, the bioethicist who coined the term “yuck factor,” came out in Forbes adamantly against the head transplant calling it “rotten scientifically” and “lousy ethically.” He believes the “yuck factor” isn’t necessarily just a distraction, it can indicate a potential moral problem.

Caplan says he’s familiar with the Chinese medical community and that if the science isn’t there–he believes it won’t be–that the procedure “ain’t gonna happen.” Speaking hypothetically, though, about a patient on whom the head transplant would be performed, he says, “I think you’d wake up terrified and fearful because you wouldn’t know who you were.” He draws this conclusion based on his personal experience with face transplant patients who have had extraordinary difficulty readjusting after surgery.

No one, including Canavero, knows for certain what will happen if the head transplant goes forward as planned in December 2017. “It would be incredibly interesting from a theoretical point of view to see what happens if the transplant is successful, which means the patient wakes up, opens his eyes, and is able to speak, perceive stimulus, and he’s able to remember,” says philosophy historian Giuliano Mori. “That would have huge implications for, of course, all aspects of philosophy. That could be an actual rebirth of philosophy.”

Canavero has no doubt. He will succeed and he will change the world. He compares the head transplant to the Copernican Revolution. At the end of a TED talk he gave, he reminded the audience that pushback to groundbreaking discoveries like the one he is working on is inevitable.

“We must all remember the words of a great revolutionary: Gandhi,” he said. “First, they ignore you. Then, they laugh at you. Then, they fight you. Then, you win.”

Shelby Hartman is PrimeMind’s associate editor. Follow her on Twitter.

Daniel Marin Medina is a Colombian-born, Bronx-based illustrator. He uses queer theory as inspiration for drawing bodies and portraits. Follow him on Instagram.