iMedPub Journalshttp://journals.imedpub.com

2016Vol. 1 No. 2: 9

Short Communication

© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://neurosurgery.imedpub.com/archive.php 1

DOI: 10.21767/2471-9633.10009

Insights in Neurosurgery ISSN 2471-9633

Joshua A Cuoco1* and John R Davy2

1 NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine,OldWestbury,NewYork11568,USA

2 UniversityofVirginiaSchoolofMedicine,Charlottesville,Virginia22908,USA

Corresponding author: JoshuaAaronCuoco

jcuoco@nyit.edu

MS,NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine,OldWestbury,NewYork11568,USA.

Tel: 631-682-6781

Citation: CuocoJA,DavyJR. OperationFrankenstein:EthicalReflectionsofHumanHeadTransplantation.Neurosurg.2016,1:2.

IntroductionNearlyeveryorganofthehumanbodyisfrequentlytransplantedproviding transient or permanent relief from a pathologiccondition. Althoughorgan transplantation canprolong life, thequestionarises as towhether it is ethical for anyorganof thehuman body to be transplanted, especially that of the humanhead.Planshaverecentlybeenannouncedtoperformthefirsthumanhead transplantationwithin thenext fewyears.Abriefdescription of the proposed neurosurgical procedure entailsremovingtheheadofanindividualsufferingfromadebilitatingdisease and attaching it to a donated cadaveric body. For thisdiscussion, we will assume the technical aspects of such aprocedure to be feasible. Although the neurosurgical protocolhasbeenoutlined,toourknowledge,theethicsofhumanheadtransplantationhavenotbeenformallyaddressed[1,2].Here,wepresentseveralethicalconcernsofahumanheadtransplantationprocedure, focusing on bioethical considerations, psychologicalconsequences,andreproductiveimplications.

Bioethical ConsiderationsFrom the historic axiom of bioethics, ‘Primum non nocere:first,donoharm’, theprincipleofnonmaleficencemaybe themost applicable principle of medical ethics to human headtransplantation.Severalquestionscanberaisedconcerningthisprinciple in addition to the principles of beneficence, justice,and autonomy. The procedure of head transplantation shouldbe considered as a last resort for individuals suffering fromdebilitating whole body diseases such as amyotrophic lateralsclerosis (ALS). Although no pharmacologic therapies or cures

currently exist for these diseases, it is important to consideremerging therapies of the near future prior to implementingheadtransplantationprotocols.Forexample,Zhangetalrecentlydemonstrated a potential molecular basis of ALS that may betargetable by pharmacotherapeutic intervention [3]. Shouldthemedical community consider head transplantation prior toexhausting our efforts in terms of pharmacotherapeutic curesforALSandsimilardebilitatingdiseases?Theproperallocationof research funding and resources should be maintained inthe view of guiding research towards the scientific goal ofbest outcomes. Furthermore, the scientific community shouldconsidertheramificationsofreallocatingtreatmentmoniesfrompotential pharmacotherapeutic interventions for ALS to headtransplantationresearch.

Currently, there is a sparsity of basic science research in theliterature demonstrating a successful head transplantationprotocol in animal models. Results of pre-clinical animalexperimentation would be beneficial prior to human surgery.Adequatepre-clinicalanimalexperimentationmaybeconsideredas specimen exhibiting ‘normal’ behavior or behavior closelyresembling the behavior observed prior to the procedure,post-operative homeostatic physiological functioning, as well

Received: March05,2016; Accepted: March28,2016;Published: April04,2016

Operation Frankenstein: Ethical Reflections of Human Head Transplantation

Abstract Practically every human organ is commonly transplanted providing temporaryorpermanentrelieffromapathologiccondition.Althoughorgantransplantationcanprolong life, thequestionarisesas towhether it isethical foranyorganofthehumanbodytobetransplanted,particularlythatofthehumanhead.Planshaverecentlybeenannouncedtoperformthefirsthumanheadtransplantationwithin the next few years; however, the ethics of human head transplantationhavenotbeenformallyaddressed.Here,wepresentseveralethicalconcernsofahumanheadtransplantationprocedure,focusingonbioethicalconsiderations,psychologicalconsequences,andreproductiveimplications.

Keywords: Transplantation ethics; Neuroethics; Neurosurgery; Neurology;Neuroscience

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asspecimendeathresultingfromnaturalcauses(i.e.,not fromprocedural complications nor from the head immunologicallyrejecting the body or the body immunologically rejectingthe head). Recovery time is another important issue thatshould be addressed in an animal model. Although currentlyunknown, spinal cord recanalizationmay require a substantialamountoftimeforfullrecovery.However,evenwithpromisinganimal model experimentation data, the first human headtransplantationmayexhibitaplethoraofunknownsthatmaynotberecognizedoraddresseduntilaftersuchasurgeryhastakenplace.Forexample,itmaybedifficulttoaccountforthementalissuesahumanmayencounterpost-transplantwithinananimalmodel.Atbest,ananimalmodelmayaccountformentalstabilityby analyzing normal social behaviors (e.g., a dog recognizingits owner, displaying affection, and responding to commands);nevertheless,subconsciousissuescannotbeaccountedforwithinan animal model. Every procedure has a first; however, theseuniqueunknownspresentapredicamentforthefrontrunnersofheadtransplantation.Supposingthatpatientconsentisacquired,is itethical foraphysiciantosubjectapatienttoarguablyoneof themost complex human surgerieswith an overabundanceofunknownvariables and factors awaiting the surgeons in theoperatingroom?

Ethicsoforgandonationmayalsobeapplicablewithregardtothenear100,000individualsonwaitinglistsfororgantransplantsintheUnitedStates[4].Theprocedureofheadtransplantationrequires a cadaveric donation in its entirety with the hope ofincreasing the quality of life of an individual suffering from adebilitating disease; nevertheless, how many individuals maydie with one less donor to provide them with a heart, lung,kidney,et cetera?Transplantationethicsencouragesthemedicalcommunity to consider the most good being done with thelimited resource of tissue donation such that the ethicality ofhuman head transplantation ought to be considered in thecontextofutilitarianism.

Psychological ConsequencesThe procedure of human head transplantation dangerouslypresupposes that transplanting an individual’s head will alsotransplant an individual’s mind including consciousness,personality, andmemories.On the contrary, cognitive scienceshavesuggestedthathumancognitiondoesnotsolelyoriginatewithinthebrainparenchyma;rather,humansexhibitanembodiedcognitionwhereourbodyparticipates in the formationof self.PsychologistEleanorRoschhasdescribedembodiedcognitionascognitionthatfirstisdependentontypesofexperiencethatderivefromhavingabodywithavarietyofsensorimotorcapabilities,andsecond,thatsuchsensorimotorcapabilitiesareintrinsicallyapartofamorecomprehensivebiological,psychological,aswellasculturalcontext[5].Therefore,anindividualundergoingaheadtransplantationproceduremayconfrontsubstantialpsychologicaldifficulty in adjusting to the new body provided to them. Thisadjustment is something that cannotbe testedorexperiencedbefore the procedure and, thus, represents another significantunknown factor in transplant. Furthermore, the individual’spersonality and memories may be dramatically altered. Thus,the procedure of human head transplantationmay potentially

serveasanexchangeofadebilitatingdiseaseforpsychologicalconfusionandinstability,whichmayleadtoseriouspsychologicalcomplications, such asmood disorders, suicidal tendencies, orpsychosis.

Reproductive ImplicationsThe procedure of resecting a living head of an individual witha debilitating disease and relocating it on a cadaveric donorbodywillprovidetherecipientthedonor’sbodyincludingtheirreproductive organs. For the sake of this discussion, we willconsider the head as the definition of human identification orpersonhood. Thus, we define the ‘recipient’ as the individualwhose head is being transplanted and the ‘donor’ as theindividual who is donating their body. Several ethical issuesarisewithanindividualreceivingadonor’sreproductiveorgans.First,therecipientcannevertrulyreproduce;rather,thedonorbodywill reproduce upon the recipient’swill to do so. Shouldtherecipientbeabletogivethedonorchildreneventhoughthedonor is technically deceased? A difficult conversation wouldbe informing a recipient’s ‘child’ that their biological father ormotherwasdeceasedlongbeforetheywereconceived.Ifhumanheadtransplantationistobedeemedasethicalthenthemedicalcommunityought to comprehensively inform thedonorof thereproductive implications with body donation as well as thefamilialramificationsofrecipient‘reproduction’.

Supposingthatrecipient‘reproduction’isdeemedethical,theagegapbetweenarecipientanddonormayneedtobeaddressed.Ayoungerrecipient(e.g.,30yearsold)receivinganolderdonorbody (e.g., 90yearsold)maynowbecome infertiledue to thetransplantation procedure. Moreover, the opposite may holdtrue: an older recipient receiving a younger donor body maynowbecomefertile.Furthermore,suchagegapsbetweenheadandbodymaycontributetothepotentialpsychologicaldistressarecipientmayexhibitpost-headtransplantation;nevertheless,an older recipient receiving a younger donor body may givetherecipientthebestchanceof longtermsurvival.Althoughitmaynotbeidealfortherecipient,donorbodysterilizationpriorto head transplantationmay help to solve someof the ethicalpredicamentsofreproductioninhumanheadtransplantation.

Furthermore, the medical community should consider theimplicationsofsuchaprocedurebeingsubjecttoslipperyslopeargumentation.Currently,same-sexhumanheadtransplantationseems to be a challenging surgical procedure in and of it.However, if such a surgery becomes common practice in thefuturewouldn't the logicalprogressionof this surgerybringustoopposite-sexhumanheadtransplantationprotocols?Genderreassignment head transplantation surgery may sound absurdtodaybutwe should consider theethical ramificationsof sucha procedure if it becomes available in the future. Althoughimprobable from a neurochemical standpoint, opposite-sexhuman head transplantation could theoretically allow anindividualtotransitiontotheoppositesexandparticipateinthereproductiveactivitiesassociatedwith thisnew sex.Moreover,contingentuponthefirstsuccessfulheadtransplantprocedure,what canpreventademand fordesignerbodiesoradesire toutilizethisproceduretoprolongone’snaturallife?

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ConclusionsHuman head transplantationmay be a novel treatment in thenear future for individuals suffering from debilitating diseases;nevertheless,therearenumerousethicalissuesconcerningthisprocedurethatshouldfirstbeconsidered.Wehavediscussedtheethical prerequisites to this procedure in addressing bioethicalconsiderations. Frontrunners of this procedure may need todemonstrate that this operation is absolutely necessary forindividualswithdebilitatingdiseases,showfavorablepre-clinicaldata inanimalmodels, indicate that thebenefitsoutweigh theplethoraof unknownsof this procedure, and justify thedenial

of transplantable organs to many individuals in trade for anentirecadavericbodydonationforoneindividual.Furtherethicalramifications will exist for a recipient and a deceased donorpost-transplantation. Embodied cognition demonstrates thathead transplantation may result in a variety of psychologicalconsequencesfortherecipient,especiallyifthereisasignificantage gap between the recipient and donor. Reproductiveethics becomes pertinent as this procedure can provide thecapacity of a recipient to ‘reproduce’with a deceased donor’sreproductive organs. Indeed, these quandaries are difficult toanswer;nonetheless,determiningtheethicalityofahumanheadtransplantationprocedureisdependentuponthem.

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Insights in Neurosurgery ISSN 2471-9633

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2 CanaveroS(2013)HEAVEN:TheheadanastomosisventureProjectoutlineforthefirsthumanheadtransplantationwithspinallinkage(GEMINI).SurgNeurolInt 13:S335-S342.

3 ZhangK,DonnellyCJ,HaeuslerAR,Grima JC,Machamer JB, et al.

(2015) The C9orf72 repeat expansion disrupts nucleocytoplasmictransport.Nature525:56-61.

4 Caplan A (2008) Organ Transplantation, in From Birth to Deathand Bench to Clinic: The Hastings Center Bioethics Briefing Bookfor Journalists,Policymakers,andCampaigns.TheHastingsCenter,Garrison,NY.

5 VarelaK,ThompsonE,RoschE(1991)Theembodiedmind:cognitivescienceandhumanexperience.MITPress,Cambridge,MA.