Stiff (25 page)

In his book
Experimental Transplantation of Vital Organs
, Demikhov includes photographs of, and lab notes from, Experiment No. 2, on February 24,1954: the transplantation of a one-month-old puppy's head and forelimbs to the neck of what appears to be a Siberian husky. The notes portray a lively, puppylike, if not altogether joyous existence on the part of the head:

09:00. The donor's head eagerly drank water or

milk, and tugged as if trying to separate

itself from the recipient's body.

22:30. When the recipient was put to bed, the

transplanted head bit the finger of a member

of the staff until it bled.

February 26,18:00. The donor's head bit the

recipient behind the ear, so that the latter

yelped and shook its head.

Demikhov's transplant subjects were typically done in by immune reactions. Immunosuppressive drugs weren't yet available, and the immune system of the intact dog would, understandably enough, treat the dog parts grafted to its neck as a hostile invader and proceed accordingly. And so Demikhov hit a wall. Having transplanted virtually every piece and combination of pieces of a dog into or onto another dog,
[1]
he closed up his lab and disappeared into obscurity.

If Demikhov had known more about immunology, his career might have gone quite differently. He might have realized that the brain enjoys what is known as "immunological privilege," and can be kept alive on another body's blood supply for weeks without rejection. Because it is protected by the blood brain barrier, it isn't rejected the way other organs and tissues are. While the mucosal tissues of Guthrie's and Demikhov's transplanted dog heads began swelling and hemorrhaging within a day or two of the operation, the brains at autopsy appeared normal.

Here is where it begins to get strange.

In the mid-1960s, a neurosurgeon named Robert White began experimenting with "isolated brain preparations": a living brain taken out of one animal, hooked up to another animal's circulatory system, and kept alive. Unlike Demikhov's and Guthrie's whole head transplants, these brains, lacking faces and sensory organs, would live a life confined to memory and thought. Given that many of these dogs' and monkeys'

brains were implanted inside the necks and abdomens of other animals, this could only have been a blessing. While the inside of someone else's abdomen is of moderate interest in a sort of curiosity-seeking, Surgery Channel sort of way, it's not the sort of place you want to settle down in to live out the remainder of your years.

White figured out that by cooling the brain during the procedure to slow the processes by which cellular damage occurs— a technique used today in organ recovery and transplant operations—it was possible to retain most of the organ's normal functions. Which means that the personality—

the psyche, the spirit, the soul—of those monkeys continued to exist, for days on end, without its body or any of its senses, inside another animal.

What must that have been like? What could possibly be the purpose, the justification? Had White been thinking of one day isolating a human brain like this? What kind of person comes up with a plan like this and carries it out?

To find out, I decided to go visit White in Cleveland, where he is spending his retirement. We planned to meet at the Metro Health Care Center, downstairs from the lab where he carried out his historic operations, which has been preserved as a kind of shrine-cum-media-photo-op. I was an hour early, and spent the time driving up and down Metro Health Care Drive, looking for a place to sit and have some coffee and review White's papers. There was nothing. I ended up back at the hospital, on a patch of grass outside the parking garage. I had heard Cleveland had undergone some sort of renaissance, but apparently it underwent it in some other part of town. Let's just say it wasn't the sort of place I'd want to live out the remainder of my years, though it beats a monkey abdomen, and you can't say that about some neighborhoods.

White escorts me through the hospital corridors and stairways, past the neurosurgery department, up the stairs, to his old lab. He is seventy-six now, thinner than he was at the time of the operations, but elsewise little changed by age. His answers have the rote, patient air you expect from a man who has been asked the same questions a hundred times.

"Here we are," says White, NEUROLOGICAL RESEARCH

LABORATORY, says a plaque beside the door, giving away nothing. To step inside is to step back into 1968, before labs went white and stainless.

The counters are of a dull black stone, stained with white rings, and the cabinets and drawers are wood. It has been a while since anyone dusted, and ivy has grown over the one window. The fluorescent lights have those old covers that look like ice tray dividers.

"This is where we shouted 'Eureka!' and danced around," recalls White.

There isn't much room for dancing. It's a small, cluttered, low-ceilinged room, with a couple of stools for the scientists, and a downsized veterinary operating table for the rhesus monkeys.

And while White and his colleagues danced, what was going on inside the brain of that monkey? I ask him what he imagined it must have been like to find yourself, suddenly, reduced to your thoughts. I am, of course, not the first journalist to have asked this question. The legendary Oriana Fallaci
[2]
asked it of White's neurophysiologist Leo Massopust, in a
Look
magazine interview in November 1967. "I suspect that without his senses he can think more quickly," Dr. Massopust answered brightly. "What kind of thinking, I don't know. I guess he's primarily a memory, a repository for information stored when he had his flesh; he cannot develop further because he no longer has the nourishment of experience.

Yet this, too, is a new experience."

White declines to sugar-coat. He mentions the isolation chamber studies of the 1970s, wherein subjects had no sensory input, nothing to hear, see, smell, feel, or taste. These people got as close as you can come, without White's aid, to being brains in a box. "People [in these conditions] have gone literally crazy," says White, "and it doesn't take all that long."

Although insanity, too, is a new experience for most people, no one was likely to volunteer to become one of White's isolated brains. And of course, White couldn't force anyone to do it—though I imagine Oriana Fallaci came to mind. "Besides," says White, "I would question the scientific applicability. What would justify it?"

So what justified putting a rhesus monkey through it? It turns out the isolated brain experiments were simply a step on the way toward keeping entire heads alive on new bodies. By the time White appeared on the scene, early immunosuppressive drugs were available and many of the problems of tissue rejection were being resolved. If White and his team worked out the kinks with the brains and found they could be kept functioning, then they would move on to whole heads. First monkey heads, and then, they hoped, human ones.

Our conversation has moved from White's lab to a booth in a nearby Middle Eastern restaurant. My recommendation to you is that you never eat baba ganoush or, for that matter, any soft, glistening gray food item while carrying on a conversation involving monkey brains.

White thinks of the operation not as a head transplant, but as a whole-body transplant. Think of it this way: Instead of getting one or two donated organs, a dying recipient gets the entire body of a brain-dead beating-heart cadaver. Unlike Guthrie and Demikhov with their multiheaded monsters, White would remove the body donor's head and put the new one in its place. The logical recipient of this new body, as White envisions it, would be a quadriplegic. For one thing, White said, the life span of quadriplegics is typically reduced, their organs giving out more quickly than is normal. By putting them—their heads— onto new bodies, you would buy them a decade or two of life, without, in their case, much altering their quality of life. High-level quadriplegics are paralyzed from the neck down and require artificial respiration, but everything from the neck up works fine. Ditto the transplanted head.

Because no neurosurgeon can yet reconnect severed spinal nerves, the person would still be a quadriplegic—but no longer one with a death sentence. "The head could hear, taste, see," says White. "It could read, and hear music. And the neck can be instrumented just like Mr. Reeve's is, to speak."

In 1971, White achieved the unthinkable. He cut the head off one monkey and connected it to the base of the neck of a second, decapitated monkey.

The operation lasted eight hours and required numerous assistants, each having been given detailed instructions, including where to stand and what to say. White went up to the operating room for weeks beforehand and marked off everyone's position on the floor with chalk circles and arrows, like a football coach. The first step was to give the monkeys tracheotomies and hook them up to respirators, for their windpipes were about to severed. Next White pared the two monkey's necks down to just the spine and the main blood vessels—the two carotid arteries carrying blood to the brain and the two jugular veins bringing it back to the heart.

Then he whittled down the bone on the top of the body donor's neck and capped it with a metal plate, and did the same thing on the bottom of the head. (After the vessels were reconnected, the two plates were screwed together.) Then, using long, flexible tubing, he brought the circulation of the donor body over to supply its new head and sutured the vessels.

Finally, the head was cut off from the blood supply of its old body.

This is, of course, grossly simplified. I make it sound as though the whole thing could be done with a jackknife and a sewing kit. For more details, I would direct you to the July 1971 issue of
Surgery
, which contains White's paper on the procedure, complete- with pen-and-ink illustrations. My favorite illustration shows a monkey body with a faint, ghostly head above its shoulders, indicating where its head had until recently been located, and a jaunty arrow arcing across the drawing toward the space above a second monkey body, where the first monkey's head is now situated. The drawing lends a tidy, businesslike neutrality to what must have been a chaotic and exceptionally gruesome operation, much the way airplane emergency exit cards give an orderly, workaday air to the interiors of crashing planes. White filmed the operation but wouldn't, despite protracted begging and wheedling, show me the film. He said it was too bloody.

That's not what would have gotten to me. What would have gotten to me was the look on the monkey's face when the anesthesia wore off and it realized what had just taken place. White described this moment in the aforementioned paper, "Cephalic Exchange Transplantation in the Monkey": "Each cephalon [head] gave evidence of the external environment….The eyes tracked the movement of individuals and objects brought into their visual fields, and the cephalons remained basically pugnacious in their attitudes, as demonstrated by their biting if orally stimulated." When White placed food in their mouths, they chewed it and attempted to swallow it—a bit of a dirty trick, given that the esophagus hadn't been reconnected and was now a dead end. The monkeys lived anywhere from six hours to three days, most of them dying from rejection issues or from bleeding. (In order to prevent clotting in the anastomosed arteries, the animals were on anticoagulants, which created their own problems.)

I asked White whether any humans had ever stepped forward to volunteer their heads. He mentioned a wealthy, elderly quadriplegic in Cleveland who had made it clear that should the body transplant surgery be perfected when his time draws near, he's game to give it a whirl.

"Perfected" being the key word. The trouble with human subjects is that no one wants to go first. No one wants to be a practice head.

If someone did agree to it, would White do it?

"Of course. I see no reason why it wouldn't be successful with a man."

White doesn't think the United States will be the likely site of the first human head transplant, owing to the amount of bureaucracy and institutional resistance faced by inventors of radical new procedures.

"You're dealing with an operation that is totally revolutionary. People can't make up their minds whether it's a total body transplant or a head transplant, a brain or even a soul transplant. There's another issue too.

People will say, 'Look at all the people's lives you could save with the organs in one body, and you want to give that body to just one person.

And he's
paralyzed
.' "

There are other countries, countries with less meddlesome regulating bodies, that would love to have White come over and make history swapping heads. "I could do it in Kiev tomorrow. And they're even more interested in Germany and England. And the Dominican Republic. They want me to do it. Italy would like me to do it. But where's the money?"

Even in the United States, cost stands in the way: As White points out,

"Who's going to fund the research when the operation is so expensive and would only benefit a small number of patients?"

Let's say someone did fund the research, and that White's procedures were streamlined and proved viable. Could there come a day when people whose bodies are succumbing to fatal diseases will simply get a new body and add decades to their lives—albeit, to quote White, as a head on a pillow? There could. Not only that, but with progress in repairing damaged spinal cords, surgeons may one day be able to reattach spinal nerves, meaning these heads could get up off their pillows and begin to move and control their new bodies. There's no reason to think it couldn't one day happen.

And few reasons to think it will. Insurance companies are unlikely to ever cover such an expensive operation, which would put this particular form of life extension out of reach of anyone but the very rich. Is it a sensible use of medical resources to keep terminally ill and extravagantly wealthy people alive? Shouldn't we, as a culture, encourage a saner, more accepting attitude toward death? White doesn't profess to have the last word on the matter. But he'd still like to do it.