Italian surgeon Sergio Canavero says he will change medical history as soon as 2017 – he even has a volunteer. Can it be done?

Outside a large concrete hospital in Turin, Sergio Canavero speaks in formal Italian, trying to persuade a pair of security guards to let us use the staff car park. It is hot. The guards sit inside a shaded hut and peer out at Canavero, who is 51, short and fit, dressed in T-shirt and sandals, tufts of grey hair around his head giving way to a bald, caramel-coloured dome on top. “Allora,” Canavero begins, explaining to the guards that he used to be employed at the hospital, a surgeon in the neurology department, and is back for a visit.

At the end of his speech, he moves a stiff hand across his neck, a cut-throat gesture that would represent a threat if made by almost anyone else. The guards grin in recognition and wave us through. “I told them I’m the guy who’s going to do the first human head transplant,” Canavero tells me. “Italians are suckers for a celeb.”

Earlier this year, Canavero became famous around the world when he enlarged on plans, long cherished, to remove the heads of two people. One would be alive, with an ailing body (a paraplegic, say), the other newly dead or doomed (perhaps the braindead victim of an accident). After that, as Canavero explained in academic papers and speeches, he planned surgically to attach the first head to the second body, fusing the spinal cords so that the owner of the first head might enjoy the functional use of the second body. In medical terms, it would be a cephalosomatic anastomosis, the first of its kind. It might be best understood as a “body transplant”, but the wider world has tended to settle on the more sensational phrase.

“Head transplantation, body transplantation, whatever,” Canavero says as we walk around the busy hospital. “Technicality!”

He once thought the first head transplant would be performed here, at the hospital in Turin. Canavero arrived as a medical student in the 1980s, and had been employed on its wards for much of his professional life. Then he went and caused “the brouhaha”, as he now calls it – publishing papers on head transplants in the medical journal Surgical Neurology International, giving TED talks in Limassol and Verona, making headlines, becoming that “celeb”. Canavero’s plans were publicly criticised by at least one international church. A medical ethicist writing in Forbes called his proposal “rotten”. And, Canavero says, the Italian medical establishment turned against him.

Last February, he and the hospital that had employed him for so long agreed to rescind his contract. “I’ve become a pariah,” he says, making sure I notice the frosty reception he receives from some of his former colleagues in the neurology department. “You see? No hugs.”

With Italy out of the question as a host nation, he has had to look abroad for somewhere to stage his surgery. He tells me that, after lengthy negotiation, it will take place in China, in the northern city of Harbin. The Harbin Institute of Technology will provide assistance, he says, as will Harbin Medical University, which has made him an honorary professor in anticipation. With the Chinese “providing the hospital and personnel”, his operation will be ready to go sooner than anybody might have expected – as early as Christmas 2017, he thinks. “We are on track. Barring the end of the world, nuclear explosions, meteorites.”

Canavero has a very clear picture of this surgery in action, having outlined it in two TED talks, in a keynote address delivered last summer at an American conference of neurosurgeons, and in a book, Il Cervello Immortale (The Immortal Brain), published next month in Italian and English. He describes it to me in detail: the operating theatre of the near future, where two bodies will be clamped tight in special frames. One will be the anaesthetised patient, the other a braindead donor. Using either “a specially fashioned diamond microtomic snare-blade” or “a nanoknife made of a thin layer of silicon nitride” (he isn’t sure yet), the bodies will be severed at the neck between the C5 and C6 vertebrae.

“I know what squeamish is,” Canavero says when I ask if he’s familiar with the English word. “This is beyond squeamish. This is gory.” He collects vintage American comic books, as well as vintage American slang, with which his speech is coloured: “Right on the money, take a leak, bull!”

Before the anaesthetised patient is decapitated, he or she will have been cooled to 10C. Then, after the cuts, the frames that are clamping the two bodies will begin to separate, their upper parts rotating and taking the two heads with them. The patient’s head will be deposited atop the donor’s body. “They’re not interfaces that will just click together, but…”

Next, a marathon of surgery, somewhere between 36 and 72 hours long and requiring a crew of 150 medics. About 80 of them, Canavero thinks, will need to be surgeons. “At first, it will be expensive,” – around €15m, or £11m, he guesses, admitting that private sponsors are still needed. “Later, as the technique gets perfected, the costs will be slashed.”

Facebook Twitter Pinterest ‘This is beyond squeamish. This is gory,’ says Canavero. Photograph: Piero Martinello/The Guardian

In the operating room, those 80 surgeons will relay in and out as expertise dictates. The head-body arteries will be joined first, so that blood recirculates around the brain. As for the other connections required (windpipe, gullet, spine, everything that links a human’s head to the rest), Canavero says he will stand aside until it comes to the spinal cord. Functional neurosurgery, or that relating to movement, is his field.

In order that his patient regains movement in the end, some of the millions of nerves that exist inside the two spinal cords will need to connect. Canavero has novel ideas about ways to “sprout” such connections during the surgery, including delivering small electric shocks to the spinal cord at the point of fusion, and by flushing in a substance called polyethylene glycol, or PEG, something he believes will super-charge the process. Not all the nerves in the spine will need to regrow and join, Canavero thinks, for the patient to regain some movement. Say, 10% or 20% of them.

After the operation, the patient will be kept in a coma for about three weeks, in part to inhibit movement. Then rehab, months of it. Canavero expects this will involve some kind of virtual-reality simulator, to help the patient acclimatise to the unfamiliar body. There might be hypnosis. Afterwards, he anticipates recovery, a press conference and (“Why not?”) a Nobel prize. “For the next 100 years it will be on TV. It will be much more than landing on the moon, I’m pretty sure about that… This will be the greatest revolution in human history. If it pans out as I expect it to.”

Facebook Twitter Pinterest ‘I want the world’s first head transplant’ - video

One very tangible piece of the plan is in place. At the meeting of American surgeons last summer, Canavero introduced to the stage a man named Valery Spiridonov. A 31-year-old graphic artist from Russia, Spiridonov has severe muscular atrophy and has been a wheelchair user all his life. He’d put together the graphical presentation that accompanied Canavero’s speech. Spiridonov has volunteered, whenever Canavero is ready, to be a test patient: the first guy to go under the microtomic knife.

“I call him Gagarin,” Canavero says.

***

Head transplants have been attempted before – on Russian puppies in the 1950s, on an American monkey in the 1970s, on hundreds of Chinese mice between 2013 and 2014. The puppies lived less than a week, the monkey just over that. The mice tended to linger about a day. But in all of those cases, proof of concept was the aim, less so patient survival. It is a regrettable truth that very little innovation takes place at the sharp, scalpel end of medicine without a lot of animals getting killed first.

“Heart transplants, kidney transplants: all were based on years and years of animal work,” says Henry Marsh, a senior British neurosurgeon who recently wrote a bestseller about his career, Do No Harm. Many of those who are sceptical about Canavero’s scheme, Marsh among them, have wondered: where are his carcasses?

Canavero tells me he is morally opposed to experiments on animals. “I don’t want to kill any more animals. We’ve killed enough. We don’t need more animal data.”

But if it would help persuade people to follow him in this plan, would he put aside those feelings?

Pointless, he says. “Human anatomy is not the same in monkeys. It’s not the same in rats. You do all manner of animal experiments and you come up with nothing. Ninety-five per cent of all animal experimentation is for nought, goes nowhere.”

But wasn’t it through experimentation on animals that we came to heart transplants, kidney transplants? “I said 95%.”

Canavero believes that the necessary research for his surgery has already been done, anyway. In disparate studies over a century, he says; not just those experiments on puppies, monkeys, mice. Canavero has dug up dusty papers relating to an American woman who in 1902 had her spinal cord severed by a gunshot; also a skier, similarly injured in an accident on the slopes in 2005. In both cases, the patients’ spines were successfully re-fused by surgeons, leading to recovery of limited movement.

I put this to Marsh. “Ancient old papers, people haven’t been looking, all that usual conspiracy crap,” he says. “In science, there have always been a few mavericks who’ve been successful. But surgery of this sort is hugely complicated and requires a large range of expertise. I don’t know that any one individual, however brilliant, could solve all the problems.”

Xiaoping Ren, the Harbin-based doctor who introduced Canavero to the Chinese city he expects will host his operation, agrees that the surgery will be very complex. For two decades, Ren has made his own investigations into head transplants, performing those operations on mice in 2013 and 2014. But, he says, the scale of the project makes a maverick individual such as Canavero all the more important. “It will need a big group,” he says, “and it will need a leader.”

China has poured astonishing amounts of money into medical research in recent years. Western doctors I speak to agree that the country’s apparent involvement makes Canavero’s scheme much more plausible. Michael Sarr, editor of the American medical journal Surgery, had guessed that if Canavero’s transplant were to take place, it would have to be “in China, India, South America or Russia”. When I tell him about Harbin, he says, “China is the wild west, in some respects. The rules there are much less strict than they are elsewhere.”

When I ask Ren about Canavero’s intention to perform the surgery in Harbin in 2017, he laughs nervously. “If he’s ready, I’d be glad to be involved.”

He doesn’t think Canavero will be ready? Ren isn’t sure, but he says that if anybody can make it happen, Canavero can. “Sergio is very insistent.”

Canavero plans to leave his home town for Harbin soon, to embark on two years of intensive work, leading up to Christmas 2017. His wife, Francesca, and their teenage children, Marco and Serena, will stay behind. “I’m giving up everything,” Canavero says. “But what is two years of your life, in return for changing the world?”

***

Canavero has dreamed of this since he was a schoolboy. He remembers reading in a newspaper about the head transplant attempted on a monkey in America, and immediately thinking about being the first to perform such surgery on a human.

He was poor at the time, his upbringing “rough”. “It steeled me,” he says. Turin was overpopulated in the 1960s and his first years at school took place in a converted grocery shop. “My father told me, ‘Either your grades are good or you go to work.’ I was best in class at the end of elementary school, ottimo. At the end of junior high, eccellente.” At 18, he enrolled at medical school, and within a couple of years was submitting papers to academic journals. “I already had a head transplant in my sights.” In the mid-1980s, he moved to the hospital in Turin and began to train as a functional neurosurgeon.

What did his peers make of him back then?

“I’ve always been a loner,” he says.

But he had friends?

“Of course, from time to time you interacted. I would stick to that word. I interact when I have to learn, then I go my way. You can only go alone on such a path.”

Facebook Twitter Pinterest ‘Some people are geniuses and some people are cranks,’ says Valery Spiridonov, who wants to be Canavero’s first patient. ‘And you might never know before the project is finished.’ Photograph: Piero Martinello/The Guardian

Canavero is aware of his idiosyncrasies. “I’m not normal,” he says as he takes me on a tour of Turin that includes his medical school, his secondary school, his primary school, the building he grew up in. “I have no problem admitting that. Even if I didn’t admit it, you would probably notice, right? You’d sense something?”

Perhaps. In the corridors of a museum, he seizes me by the neck to demonstrate a jiujitsu chokehold. (He is a keen practitioner at his local dojo.) Inside his old medical school, he introduces a former tutor by recalling that, decades earlier, the guy had docked him two marks on an anatomy test. Later, he cheerfully describes winning his wife away from another man, who was taller.

When I ask whose body he would pick, were he to undergo a transplant himself, Canavero considers the question carefully and says: “Have you seen the movie Thor?” Over his decades as a doctor and an academic, he has completed influential studies on central pain syndrome and Parkinson’s disease. But around the same time, he published a book, Donne Scoperte, or Women Uncovered, that outlined his tried-and-tested seduction techniques: “In Italy, when they found out I published that, all hell broke loose.”

Canavero says he put the book together on a whim in the late 1990s, when he was bed-bound with a foot injury. “I’m not really a feminist, so, sorry to the girls.”

Can you see, I say, that it’s this sort of thing that makes it difficult for people to invest faith in you?

“Look. You tell the truth, you make enemies.”

Canavero likes to talk about medical pioneers who were outcasts and fringe-dwellers in their day. Louis Pasteur, he says, was called crazy for suggesting illnesses could be caused by microbes. “And Ignaz Semmelweis, he saved your life, doctors wash their hands because of Semmelweis. Semmelweis ended his life poor, ostracised, shanghaied to an asylum.”

What about those people who fully believed they were pioneering something and then…

“Crashed. Cratered.”

Yeah.

“Of course there will be ideas that crater. The history of mankind is trial and error. But we have to be dreamers. If you don’t dream, you’re not going anywhere. You might call me a bit crazy. A kook. I am! You have to be if you want to change everything.” Society’s challenge, Canavero thinks, is “to tease apart the kooks from the super-kooks. And maybe you can only know that after the caper.”

It is a theory echoed by Spiridonov, the man who’s offered to risk his life to be Canavero’s first patient. “Some people are geniuses and some people are cranks,” Spiridonov says. “And you might never know before the project is finished.”

Spiridonov has been a part of this project for just over two years. In 2013, he was browsing the internet at home when he came across an interview with Canavero. “I always wanted to be in science. In Russia, it’s hard to work in a lab, the environment isn’t good for disabled people. But I always dreamed about being a part of some big scientific research, you know?” It took him no more than 15 minutes on Google to find Canavero’s email address, by which time he’d made a decision.

Spiridonov was the first person to offer himself for trial, Canavero says. “We started chatting on email, then we Skyped. I talked to him more and more, and at a certain point I decided he was the right guy.” There was no psychological testing, no outside assessment? “Valery has one hell of a disease, you know. Spinal muscular atrophy, there’s nothing to assess there. And psychologically – like I said, we talked a lot. He is a strong man.”

Canavero explained to Spiridonov what he could expect post-op. “You’ll be able to walk. I don’t know if you’ll be able to run. Are you happy with that?” Spiridonov said he was. As the Russian put it to me, “I do not wish for something really special for myself after surgery. I wish for an ordinary, normal life. Today I have complications. I face lots of limits. I hope in the future I’ll face less.”

How realistic is that hope? Henry Marsh has misgivings. “Will you be left with a Christopher Reeve situation,” Marsh wonders, “with somebody who is totally paralysed and requires permanent ventilation? Is that a useful achievement?” Ren, in China, says, “It’s hard to give a percentage. Valery is a brave man.” When I ask Michael Sarr, the editor of Surgery, what he thinks of Spiridonov’s chances of survival, he says: “98%, 99%.”

Sarr, based in Minnesota, was a surgeon for 35 years before he retired last spring. He has edited Surgery since the 1990s. When the Italian first submitted papers to Surgery, Sarr recalled, “We didn’t trust him. Thought it was something out of Star Wars. That it was nuts. We blew him off.” Canavero persisted, however, suggesting Sarr look at the old medical studies that had inspired his thinking. Sarr “pulled the papers” and started to warm to Canavero’s proposal.

Facebook Twitter Pinterest ‘Society must prepare itself for a major tectonic shift,’ says Canavero. Photograph: Piero Martinello/The Guardian

Sarr can see, as most surgeons can, that the transplanting of one head to another body is possible as an idea. The reattachment of head‑body arteries, muscles, windpipe, gastrointestinal tract, these have become routine surgeries, albeit ones usually carried out in isolation. Reattaching all of them at once, Sarr recognises, “would be a major tour de force. But each of those individually have been done, and though they have their own inherent risk, they work.” Even spinal cord fusion, if the initial cut is clean enough, has succeeded. Sarr has decided to publish a symposium about head transplants in Surgery, broadly in support of Canavero’s theory.

“Granted, I’m retired,” Sarr says, “but what do you have when you die other than your reputation? I’m confident that at least in theory the operation will work. The science is there. I wouldn’t risk my reputation otherwise.” He continues: “Is Sergio Canavero a bit of a showboat? Yeah, he probably is. But you know, you might need a showboat. Somebody’s going to do this. And somebody has to do it first. And let me tell you, he’s taking a risk of his own. If this doesn’t work, he will be considered a charlatan for the rest of his life.”

***

Canavero and I have been exploring Turin for hours when I suggest we sit down for some food. Canavero hasn’t eaten all day. One of his mottoes, he tells me, is, “Let’s run at walking pace.” He expects to appreciate life in China, “where, as you know, they put up buildings in days”.

Sitting in a cafe, I ask about China’s involvement in all this. Does Canavero, who acknowledges his first choice of location for the procedure would have been in Europe or America, have any misgivings about his benefactor nation? He has said many times that he’s committed to the procedure being open to public view at all stages – scrutinised. I point out that China isn’t famous for that.

“China’s China. The media’s state-controlled. But China will want you to know about this, just to spite the west. There is no question of it being a secret enterprise.” The surgery, he thinks, might even be televised.

He admits, suddenly, that in all likelihood Spiridonov won’t be the first patient to undergo the procedure. “Actually, he will not be the absolute number one. Probably the Chinese will want to do that on a Chinese patient.” Canavero expects it will be somebody with terminal cancer. “Someone with minimal life expectancy, in order to test it, like Apollo 10. Valery will be Apollo 11.”

He says all this so casually. Does he really have no ethical qualms?

“There is no way I’m accepting any sort of criticism about the medical reasons for doing it,” he says. “The only person who can decide to undergo this surgery is the man who will benefit. Not you. Not society. The patient decides.”

If the surgery goes wrong, is there still value in it?

“Absolutely. Absolutely. Let’s say it goes south, why not? I’m totally confident. But when rubber hits the road? Perhaps this goes bonkers? Valuable things will still come out of it.” He points out that the first heart transplant patient died after two weeks. It was still a breakthrough.

If Spiridonov recovers, gets used to his new body and goes on to have children, whose children will they be?

“Not his,” Canavero says. “That’s the only ethical question you might ask. But imagine: you have a child, and this child one day is involved in a car crash, brought to the hospital, declared braindead. There’s nothing that can be done. But now imagine this: I’m the doctor on call. I come down and tell you, ‘For the brain of your child I have no solutions. But if you grant me his or her body, and one day that body, with a new head, will reproduce. And those children will be your grandchildren. Life will not end!’”

This is a great theme of Canavero’s. He started thinking about it when his children were born. “I put two children into this world,” he says. “I promised myself I would do my best to make them live longer.”

Should his surgery work, he sees obvious potential for a future in which the procedure comes to be offered commercially. He thinks it will eventually contribute to human life extension. Those optimists who had their heads put in freezers after their deaths? “This is the breakthrough they’ve been waiting for,” he says.

When it comes to the implications of all this, Canavero doesn’t really consider them to be his problem. Scientifically, “what can be done, will be done”. All Canavero feels obliged to do is encourage people to ponder the implications. If we are to live longer, for instance, what about overpopulation? He guesses we’ll have to think about conquering other planets. When I ask how there’ll be enough bodies to support all the transplants, he says, “Cloning will come into play.”

I must show my exasperation, because he looks at me with concern. “I know it’s hard,” he says. “It’s hard to swallow, I understand that, it’s crazy. Sometimes, when I look at it, I say, ‘Will mankind be able to handle this?’ I don’t know! But society must prepare itself for a major tectonic shift.”

Doesn’t it bother him that so few people believe he’ll even make the initial step?

“Humans are stupid,” he says. “That’s probably why aliens never landed for good – they didn’t want to know us. Scientists are stupid, too. The history of science tells us that anyone who came along with a groundbreaking idea was met with opposition. This is humans being human. Nothing new.”

Canavero shrugs, sanguine. Soon he will go to China. And he cannot help but imagine, deliciously, the people he will prove wrong from there. “When the first head transplant materialises in China,” he says, “all the western experts, all the western journalists who wrote that it was impossible, they’ll have a very hard time. One day I will publish a book full of what they wrote.”

He shows me, holding two fingers an inch apart. “It will be this thick.”