Head case: Surgeon wants to do the first head transplant

By Sharon Kirkey, National Post

Sergio Canavero, the 52-year-old Italian surgeon, relishes being described “crazy as a bat.” He hasn’t watched television since 1993. He doesn’t own a car. He’s felt a deep affinity with Spider Man’s nerdy Peter Parker. He has authored a book on the techniques of female seduction, adheres to a strict Mediterranean diet (“no bovine meat”), meditates and refrains from drink. He practices jujutsu and, in a recent interview, reflected on his “six-pack.”

Sometime next year, if he can find a hospital that will take him, Canavero will oversee the decapitation of the healthy head of one man and its transplantation onto the surgically beheaded body of another. And he doesn’t plan to stop there. In an hour-long Skype conversation with National Post, the eccentric physician outlined his vision to make us immortal.

(Jeff J Mitchell for Getty Images; National Post photo illustration)

“It wasn’t that I just woke up one day and said, ‘I want to do a head transplant,” the physician said, while laying out his procedure that could, he argued, represent the key to everlasting life.

Canavero is the creator of HEAVEN, the “head anastomosis venture” project. His surgical protocol reads something like this: Two teams of international surgeons working together will swiftly and simultaneously lop off the heads of two men — one, the “recipient,” the other, the “donor,” an accident victim, for example, whose brain is dead but whose body is otherwise healthy. They will then shift the recipient’s head onto the donor body using a custom-made swivel crane, reconnect and stitch up the trachea, esophagus, the carotid arteries and jugular veins, link up the spinal cords, sew up the skin and wait for the recipient to re-awaken.

And, most hopefully, move.

Canavero has his first volunteer: 31-year-old Russian computer scientist Valery Spiridonov, who suffers from a devastating muscle wasting disease that has left his body compressed like an accordion.

Valery Spiridonov has volunteered to be a test patient. (Yuri Kadobnov for AFP / Getty Images)

Canavero has his “fusogen,” a black, waxy, glue-like substance that will be used to try to reconnect the severed spinal cord stumps and coax the axons and neurons to regrow across the gap, like logs aligning in a river. William Sikkema, a brilliant young Canadian chemist from Langley, B.C, who still can’t believe he’s become involved in something so scientifically and ethically outlandish, created it.

Sikkema’s material is dubbed Texas-PEG. It has reportedly succeeded in restoring motor control in a rat, two weeks after its spinal cord was completely severed. Three weeks after surgery, the rat was standing on its hind legs. If Canavero’s human head transplant (or, more accurate, body transplant) works, “it will work because of this,” Sikkema said. 

Canavero’s head-grafting venture was initially envisioned as a cure for people living with horrible medical conditions. The field of transplant medicine has evolved light years since the first successful kidney transplant between identical twin brothers in the 1950s. Today, surgeons are transplanting hearts, livers, lungs, wombs, hands, forearms and even faces. Scientists are growing beating heart muscle from stem cells, while advances in immunosuppression have dramatically reduced the risk of rejection.

How a neurosurgeon will perform the first head... 2:23

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Still, decapitation is extremely complex surgery. Once severed, surgeons will have less than an hour to re-establish blood supply to Spiridonov’s head before risking irreversible brain damage.

Most significantly, “nobody has been able to repair a spinal cord that’s been fully transected — cut clean through,” said Dr. Atul Humar, medical director of the multi-organ transplant program at Toronto’s University Health Network, where Canada’s first hand transplant was performed last January on 50-year-old registered nurse who lost her left arm below the elbow in a devastating traffic accident.

According to Canavero, the key to success is a swift, sharp severance of the cords, with minimal damage to the axons in the white mater and neurons in the gray. The typical spinal cord injury is more brutal.

Canavero is a widely published surgeon. He introduced surgical cortical brain stimulation for Parkinson’s disease, wrote a textbook on central pain syndrome and has more than 100 peer-reviewed publications. He’s been working towards head-body transplants for 35 years.

He insists successful head transplantation will push the science of cloning forward. He envisions a day when humans will be able to grow our own clones made from our own DNA, and transfer our aging brains onto our vibrant young “selves” when our own bodies start to wither and fall apart. The old become young, like Benjamin Button.

He isn’t suggesting creating a “you-child,” letting the clone grow to, say, age 20, and then killing it in order to harvest the body. That would be tantamount to murder, he said. “The cloning I refer to, to become available some time in the 21st century, is an accelerated cloning, whereby you clone yourself up to age 20 in one year, without awakening the clone,” he explained.

“So, when you harvest the body, she will have never lived, and it probably would not be murder.”

To date, no human clone has ever been born, though scientists have cloned a monkey, our nearest relative. And, while ever the optimist, Canavero said cloning won’t become an option anytime soon. Still he sees life-extension in HEAVEN. Transplanting an aging head onto a younger but clinically dead body would bathe that old head with fresh, young blood. And he’s not the least bit dissuaded by a newly published study that found young blood doesn’t reverse aging in old mice.

“If you take the head of an aging man, say, 80, like Rupert Murdoch, and you just take his head and connect it with the body of a 20-year-old, look, the head will not have a single drop of Robert Murdoch’s blood. Not a single drop,” Canavero said.

Instead, the media mogul’s head would be “washed — literally washed, over and over — by this continuously flowing young blood. That is where you can really expect a rejuvenation effect that you will never, ever witness when you simply pop some young blood into the circulation of an old man.”

Indeed, he already sees a ready market in those opting to have their bodies and brains cryopreserved in vats of liquid nitrogen in the hope of one day being “re-animated,” their identities and memories whole.

It’s considerably cheaper, and less tricky technically to freeze just a head, rather than an entire body. “And, in order to give them a new life, you have to give them a new body, and a new body means HEAVEN. There will be no other way.”

It’s statements like these that make his critics apoplectic. He is the first to acknowledge he’s been denounced as huckster, phony and crazy as a bat.

(Jeff J Mitchell for Getty Images)

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Then there’s the matter of Spiridonov. Aside from the Frankenstein factor, the procedure’s critics argue Spiridonov could end up demented. Or dead.

There is not nearly enough data to support moving into humans, they argue, and even if Spiridonov survives surgery, there’s no basis for the supposition that his transplanted head — and brain — will retain his mind, personality or consciousness once it’s hooked up to its new body.

Modern cognitive science suggests the body plays a key role in the development of the human “self.” In other words, as the New Scientist recently asked, “Who knows whether the person who comes out of the operating room would be the same as the one who went in?”

Canavero admits his plan raises sticky social and bioethical issues. Is the seat of “self” in the head — the brain — or in the flesh and blood? Would Spiridonov be getting a new body, or would the body be getting a new head? Writing in The Conversation, philosopher Quassim Cassam says, “The person with Spiridonov’s head and someone else’s body would be mentally continuous with Spiridonov, and so would be him.”

Canavero, too, has said his “chimera” would carry the mind of the recipient. However, because the gonads (testis or ovary) belong to the body donor, should the new “being” reproduce, any children would carry the genetic inheritance of the donor.

If anything, Canavero sees this as further justification for pushing ahead, because it would mean the emergence of “life from death.”

Renowned bioethicist Arthur Caplan has assailed Canavero’s “noggin exchange program” as scientifically “rotten” and ethically “lousy.”

Put aside that doctors have never succeeded in rewiring a human spinal cord, said Caplan, head of the division of bioethics at New York University Langone Medical Center, where the most extensive face transplant ever was performed on severely burned Mississippi firefighter Patrick Hardison a year ago. “What’s his rehab plan? You can’t just put a head on somebody and say, ‘oh, look! It stayed on! We’re out of here.’”

Caplan and others argue there is every chance of a mismatch between the neurochemistry of Spiridonov’s brain, and the nervous system of his new body. It’s not like screwing a light bulb into someone else’s socket, he argued. “The mechanicals and nerve impulses are going to be different, and I would predict (result in) severe dementia.”

He also wonders, what’s Canavero’s exit strategy should Spiridonov wind up severely mentally disabled in a body that doesn’t move. “Are you going to kill the patient? Are you going to overdose him?”

Nobody can deny that it is risky, Canavero admits. He said Spiridonov remains “absolutely committed” to surgery. “Here you have a patient who is dying, dying, dying, every single day. What is going to happen if I do nothing?”

And he is unrepentant. He said our sense of self is an illusion that can be manipulated at will. He notes every medical and scientific marvel — the world’s first human heart transplant in 1967, the first test-tube baby in 1978 — was initially greeted with moral outrage. French chemist Louis Pasteur was ridiculed when he proposed microbes could generate disease. “It is standard issue criticism you get all along.”

None of us should have to accept death as a “natural outcome,” he has argued. “In the beginning, it will be like saving people like Einstein — intellectually, high-ranking guys who really can give us more. I mean, Stephen Hawking? Everybody in Britain said, ‘what about Stephen Hawking? Would you save him?’ I said, ‘why not?’ But this is not for me to decide. It’s for you, for society. I’m just a man. I’m a technician. What to do with this, that’s up to you.”

Canavero draws parallels to the ethical drubbing Robert White faced in 1970, when the pipe-smoking American neurosurgeon succeeded in transferring the head of one monkey onto the body of another. The monkey, whose spine was severed at the neck, could still hear, smell and follow objects with its eyes. It lived eight days.

Colleagues at Case Western Reverse called the experiments barbaric. Still, before he died in 2010, White predicted that “what has always been the stuff of science fiction — the Frankenstein legend, in which an entire human being is constructed by sewing various body parts together — will become clinical reality in the 21st century.”

Canavero, who is in contact with White’s granddaughter Samantha, claimed to have received more than 1,000 requests from surgeons worldwide, including from Canada, volunteering to participate in HEAVEN, and said he’s now shopping for a suitable venue. “Right now, I can tell you that I’m working hard on several people who might want to see this happen in their own country.” His preference is a Western one.

“It’s no longer only about me. It’s no longer ‘loony Sergio.’ Now, we are many loonies around the world working on this.”

(Jeff J Mitchell for Getty Images; National Post photo illustration)

He sees the first transplant as a learning experience. When South African surgeon Christiaan Barnard performed the first human-to-human heart transplant in 1967, the patient died after 18 days. The second patient lived 18 months.

He hinted the first head-body swap could occur in the United States. “It might, it might. I can’t tell you anything that is solid enough to publish, and there are people involved right now who don’t want to be made known publicly.”

In the meantime, he’s pitching his plans, working the west, attending medical conferences, like last month’s meeting of brain scientists in Glasgow, where Canavero unveiled the super-sharp, diamond-cut surgical blade and virtual reality system he plans to use for the operation. He’s reading his comic books. Even today, he’s a big fan. “They open your mind,” he said. “You think, ‘hey, this man is flying! This man is doing stuff.’ But, is it really so impossible?”

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FIVE THINGS YOU NEED TO KNOW ABOUT HEAD TRANSPLANTS

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How much time do they have to attach the old head to the new body?

Less than 60 minutes. Once the recipient’s head (cooled to 10 to 15 degrees celsius) is detached, it must be joined to the new body and reconnected to the circulatory blood of the donor within the hour or risk irreversible brain damage.

What would it be like to inhabit a stranger’s body?

Valery Spiridonov, the first planned transplant patient, is undergoing virtual reality training to prepare for “unexpected psychological reactions.” Post-body switch, he will undergo psychiatric assessment and follow up “to ensure the stress or anxiety related to the procedure, recovery and new body is addressed and kept to a minimum,” according to the proposed protocol.

But could he end up an entirely different person? One possibility is that he could awaken with his entire memories obliterated. “The person who wakes from head transplant surgery might have no consciousness of Spiridonov’s past and no sense of himself as Spiridonov,” University of Warwick philosophy professor Quassim Cassam writes in The Conversation. In essence, Spiridonov would no longer exist. “Instead, the surgery would bring into existence a new person who happens to have Spiridonov’s head.”

What’s the risk of rejection?

Aside from the biggest hurdle — re-connecting the severed spinal cords from two different people and restoring brain-motor function — the major obstacle is keeping the body from rejecting its new head. A head isn’t a single organ, like a heart or a liver. It consists of eyes, ears, nose, muscles, skin — and, most importantly, a brain. “We could, in theory give another body, just like you give another face, another heart, another lung,” said Sergio Canavero, the Italian surgeon performing the head transplant. “But in practice, the patient will die.”

Canavero said any body suitable for any other organ donation would work for a head transplant. “So a standard, brain-dead organ donor. The difference is, instead of saying, look, we’re taking the lungs, the skin, the cornea, we’re taking the body in one single go.”

How did we get here?

In 1908, French surgeon Alexis Carrel and American physiologist Charles Guthrie performed the first dog head transplantation, attaching one dog’s head onto another’s neck. The decapitated head was without blood flow for roughly 20 minutes. While the dog demonstrated “aural, visual and cutaneous reflex movements” when it awoke, according to a paper published in Acta Neurochirurgica, The European Journal of Neurosurgery, it was euthanized after a few hours.

In the 1950s, Soviet transplant pioneer Vladimir Demikhov conducted dog head transplants resulting in two-headed dogs, work that inspired Dr. Robert White, who successfully performed a head transplant on a monkey in 1970.

Who’s paying?

Canavero estimates the bill for his head transplant surgery will come in at around US$13million. “I’m asking today Russian billionaires and also foreign billionaires like (Facebook founder) Mark Zuckerberg, who is already sponsoring much of this life extension research, and this is certainly about extending life, to finance, to bankroll the first head transplant in Russia on Valery Spiridonov,” he said earlier this year. “To save Valery Spiridonov, we need Russia to help us!”

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THE CANADIAN CONNECTION — LITERALLY

At 24, William Sikkema may hold the “linchpin” to what could become the most brazen experiment in the history of medicine. The Langley, B.C. native, now a PhD graduate student at Rice University in Houston, Texas, has developed a substance dubbed Texas-PEG composed of graphene “nanoribbons” and a common polymer to help knit severed spinal cords.

In a recent experiment conducted at Konkuk University in Seoul, researchers severed the spinal cords of five female rats, and swabbed the two stumps with Sikkema’s solution. Four rats drowned in a freak lab flood but, two weeks after surgery, the surviving rat could walk without losing balance, stand on its hind limbs and use its front paws to feed itself pellets. The recovery was “night and day” compared to the polymer that maverick Sergio Canavero initially planned to use for the head transplant.

National Post spoke to Sikkema about how he feels about his role in what the maverick Italian brain doctor is planning:

“I had read an article on Reddit (in January) about how Sergio was planning this head transplant, and he had this material called polyethylene glycol that did some (spinal) re-fusion.

“I emailed him, saying, ‘I have this idea, if you’re interested, I could write up a whole proposal and put you in contact with my prof, and we could talk about it more.’ He sent back a three-word email an hour later: “Yes. Do it.

“The hardest part of a human head transplant is reconnecting the spinal cord. And so you really need a solution that would fix that. So I think this will make it work. I think this is the linchpin, the last piece of the puzzle. Sergio has solved most of the pieces of the puzzle. But I think this will make it work.

“I’m actually a little concerned about the (head transplant). I’m a chemist; I’m not a biologist or a surgeon. I get my information from Sergio. But from other surgeons I’ve talked to, they seem relatively skeptical it will work at all.

“Sergio seems pretty confident. The risk is (Valery Spiridonov, the first human volunteer) could die. That’s a pretty obvious risk. But I think if anything, my material mitigates that risk.

“I am conflicted. I’m not sure exactly where I stand. But my feeling is, (Spiridonov) is going to die very soon anyway, and he’s volunteered for the surgery. Sergio is going to do it, regardless of what I do, or what I give him. But I can make it safer. I can lower the risk.

“This is not really science. This is outside the realm of science at this point. I did not think I’d get involved in anything like this when I was starting my undergraduate degree. But then I pursued biomedical nanotechnology, and this field opens up possibilities for things that have never been done before. I’m also working on an artificial retina that will potentially give high-resolution vision to blind people.

“I’m more interested in the potential of Texas-PEG for spinal cord repair. I’m less interested in the whole body transplant Sergio has planned. Even if the head transplant surgery doesn’t work, I think this material holds great promise for the thousands of paraplegics and quadriplegics around the world.

“My dad and mom are both scientists. My dad is a physics prof at Trinity Western University; my mom is a horticulturist. We’ve talked about (the head transplant) a little bit. They just think it’s fantastic this material has the promise to do spinal cord repair, They haven’t told me not to do the science because it’s ‘evil.’ They realize people were opposed to heart transplants and blood transfusions, even, because it sounded weird and strange.

“(When not in the lab) I play the violin. I keep bees. Right now I’m preparing for my wedding (Dec. 28). We’re getting married in Kelowna.

“I hope it will work. If it does work, it would be fantastic for my career. Right now I’m just a grad student. It would be great to have that on my resume, if it works.

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