Field Notes


Imagine you're Stephen Hawking, the renowned physicist whose body has been wasting for years from Lou Gehrig's disease. Let's say that doctors have determined your organs have so degenerated that you have only a year to live, even though your mind is fully functional--nay, brilliant. Might there be some other way to keep you alive?

Robert J. White, the director of the Brain Research Laboratory at the Case Western Reserve University School of Medicine, thinks there is--or could be, if scientists would get off their collective duff. The answer, he says, is brain transplantation: severing Hawking's head and reattaching it to a headless donor body. White maintains that doing this with monkeys is already possible and envisions a day when victims of fatal head injuries might be harvested not for their organs--but for their entire bodies.

White did not come upon this recycling scenario recently. In fact, between 1961 and 1971, White and his colleagues at the Mayo Clinic and Case Western made incremental but tangible breakthroughs in isolating, preserving, and transplanting severed monkey heads. (One such head survived in its new host for about a week. Though the animal was largely paralyzed, White reports, "It would follow us around the lab with its eyes and almost bit off an investigator's finger.") These findings were published in such august journals as Science and Nature. "For the first time in the history of medicine," White recalls, "we proved that the body was nothing more than a power pack." By cooling the brain to 1 C, White was able to dramatically reduce the organ's oxygen requirements during the period of detachment; after surgery, the brain could be warmed without sustaining damage. More critically, the brain proved to be an "immunologically privileged" organ--much less persnickety than, say, the liver when it comes to rejecting a new host. The major hurdle remaining, White says, pertains not to switching brains but to restoring severed spinal cords. (That's a big problem, of course: Curing quadriplegia may well be impossible.)

Not surprisingly, White's rather grisly experiments strike many as repugnant. In the Seventies, animal-rights activists denounced him. And today, there is probably not a teaching hospital in the country whose research-review boards would stomach a return to brain transplantation, even for monkeys.

But White is no Dr. Frankenstein. At seventy-one, he is a respected neurosurgeon, still practicing and holding high office at a leading medical school. Both he and his colleagues say his unusual sideline never hurt his career path. Indeed, he recently received a humanitarian award from the American Association of Neurological Surgeons for his pro bono services in his hometown, Cleveland. And White, a devout Roman Catholic with ten children, has even received a papal knighthood and served as an ethics adviser to the pope.

Yet, lately, White has launched a contentious campaign to revive interest in brain-transplant research. Last year, he published a historical overview of brain-transplant experiments in Neurological Research, ending with the assertion that, "with time, these unique, neurosurgically designed preparations will find their appropriate place in the broad spectrum of neuroscience investigation."

White says he has no problem reconciling his scientific and religious beliefs. "I would like first to have a more ongoing discussion of the moral and ethical aspects of brain transplants, so we could put behind us the notion that one is violating some Judeo-Christian principle," he says. "Also, I would like to be provided with the necessary financing to bring forth these studies, not at a pure-science level but as an appropriately designed human operation. But to do that, you'd have to show that monkeys could live significantly after the procedure."

White acknowledges the controversy that carrying out his research would ignite today, which is why he suggests it might only be feasible in places such as the former Soviet Union, where less government oversight would be a plus. Still, with the advancement of genetic studies, people have some extravagant biomedical dreams--and with so much discussion of the legitimacy of human cloning, it's fair to ask exactly how reprehensible brain transplantation is. Let's say, for instance, that Ross Perot's body was dying but his brain was fine, and he was willing to buy a desert island, build a fully equipped hospital, and pay Dr. White and other consensual physicians to do the surgery. Would there be anything wrong with that?

Arthur Caplan, the University of Pennsylvania bioethicist, says that White's ideas--however nobly intended--are burdened by what Caplan calls a high "yuck factor." But it's not just that people are grossed out by the concept. Caplan adds that brain transplantation calls the entire notion of personal identity into question; to put it in Cartesian terms, it forces us to ponder the assertion "I am (only) a brain, therefore I am." Another problem he sees is the safety of the patient in a risky, experimental procedure: Even if both parties gave prior approval, the government or the medical profession might have good cause to prevent brain transplants, just as they now prevent most human vaccine tests and raising children in Skinner boxes.

Of course, the experiment also conjures up the troubling, if thrilling, possibility of immortality--or, at the very least, greatly expanded lifetimes. "One of the values of life is that it's finite," Caplan notes. "If we extend it unnaturally, we begin to cheapen life and make it become bizarre."

Indeed, to Caplan, brain transplantation is massively more troubling than cloning. "Objections to cloning rest on the conclusion that we are our DNA, but to me, DNA is merely a program, and there are a lot of factors between what my genes say and who I am," he says. "But with brain transplantation, you're directly altering the essence of who we are."

Most crucially, the main obstacle to brain transplants may come from the demand side. Indeed, there has not exactly been a groundswell of support from people with spinal injuries or Lou Gehrig's disease. "This idea has not been suggested to me by a patient, not even as a fantasy," says neuroscientist Naomi Kleitman, the scientific liaison for the Miami Project to Cure Paralysis. "It's their own body that they want to see fixed. If you ask what they want most, it's not to walk--it's more bowel or bladder control, or an end to pain, or a little more use of their arms. They're looking at incremental improvements. As a scientist, that tells me we have to start with that."

So as a practical matter, brain transplantation may be a dead issue--lingering on only in the pages of philosophy books. But White still dreams of sewing up a brain stem or two. Any takers?

Lou Jacobson

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