Your head in his hands

Stitching a man's head to a new body sounds like fiction, but Robert White believes it is possible - as does the paraplegic who has volunteered for the operation. Tim Cornwell reports

Robert White and Craig Vetovitz are both rugged individualists, united by a common idea. White is an eminent American neurosurgeon, veteran of about 8,000 brain operations and one of the few Westerners to lay his hands on Lenin's brain. Vetovitz is a self-educated, plain-speaking 48-year-old paraplegic who won a Nasa research contract - not because he was disabled, he growls, but because "I used my damned mind". But when his body fails, as with many paralysed people it typically will, Vetovitz wants his head transplanted. White might just be the doctor to do it.

When Christiaan Barnard completed the first heart-transplant operation in South Africa in 1967, the patient lived only 18 days before his body rejected the organ. Now three-quarters of recipients survive five years or more; one of Dr Barnard's patients lived 23 years before dying of diabetes. Transplants crossed a new frontier last year, with the first hand transplant in France followed by one early this year in Kentucky.

The trouble with head transplants, according to White, is not so much surgical as spiritual. Since the 1960s, he has carried out a series of experiments involving some 30 head transplants of rhesus monkeys. Two thirds of these were successful, in that the transplanted brain was functional. The operation, he says, would be technically easier to do on humans. But some people question whether he is transplanting the body, the brain, the mind, or the soul. "I find that interesting," he says. "We are going to acknowledge that the soul is an expression of the brain only."

It is not the first time that White, former co-chairman of neurosurgery at an Ohio medical school and an alumnus of Harvard and the Mayo Clinic, has talked up head transplants. "I've always stated very forcefully the relative practicality of carrying out the operation," he says. But his ideas gelled recently, in part when he was asked to contribute an article on head transplants to a Scientific American special issue on "Your bionic future". He went back to the drawing board, and designed the operation. He reviewed his own team's animal experiments, checking out his ideas on the autopsy and operating tables, along with the uses of deep hypothermia to extend the operating time on the brain, and the crucial step of making the appropriate blood vessel connections. "It is a doable procedure," he says. "I don't need a new drug, I don't need new equipment."

White appears to be serious when he says he wants to carry out, or at least oversee, a head-transplant operation. The question, he says, is not "can we?", but "should we?".

The operation he outlines would cost about $2 million. Working simultaneously, two teams of surgeons would remove the heads from two bodies - one, the body donor, brain dead - carefully exposing carotid arteries, jugular veins and spine. Critically, the brain to be transplanted would be cooled to a low temperature, using "deep hypothermia" to extend the time it could survive without a blood flow from a few minutes to an hour. Implanted electrical systems would monitor the brain waves. After separation of the spine and spinal cord, the head would first be connected by tubes to the new body, then sewn into place, and secured in position with metal plates.

There is a catch, and not merely the necessary level of immuno-suppressant drugs to prevent the body rejecting the brain. Modern medicine is still far from learning how to heal a severed spinal cord, how to reconnect the live wire of the human body. So White is not proposing that his operation will necessarily end with anyone walking away. At very best it might give the ability to think, speak, and eat to a quadraplegic whose body is finally failing - using the second body as a battery pack for the brain, in what is really a head-saving body transplant.

But who would volunteer for such an operation? Vetovitz, paralysed at 19 by a dive into a backyard swimming pool, has. Proudly, he describes how he died and was revived three times - at the scene of the accident, in the emergency room and on the operating table. The two men's paths crossed when Vetovitz's parents took White a copy of his X-rays, and they have stayed in regular contact.

Vetovitz describes the indignities and frustration of living 20 years in a wheel chair, almost totally paralysed from the neck down, with some movement of his hands and a ticklish sensation in his feet but little else. It is clear that he dreams of getting back on his feet, riding a motorcycle or tossing a ball with his two grown children whose childhood games he missed. He believes repairs of the spinal cord are not far off. However, he insists, the only way the operation will happen is "getting someone like me that's ornery to go at it 100 per cent". White will wait, he says, "until my organs are really getting weak. I have problems with my kidneys, that's it. The heart and everything is doing quite well."

As early as 1812, there were documented attempts to revive life in animals' decapitated heads by restoring the blood flow. In 1908, American Charles Guthrie grafted the head of a small dog onto the neck of a larger one. More recently, in one of many visits to Russia, White found himself in the lab of the noted experimental surgeon, Vladimir Demikhov.

Demikhov was a pioneer of transplants, though apparently more interested in the surgery than the immunology necessary to avoid rejections of the new organs or limbs. His famous two-headed dogs, produced by grafting the upper half of a small dog on to the neck of a larger one, appeared in a set of sensational photographs in Life Magazine in the early 1960s. Some lived nearly 30 days. "When I got there, there was a dog that indeed had the small puppy sewn into its neck. I never had any doubt that he had produced a two-headed animal," White recalls. "There it was. It wasn't very well the day I was there but at least the puppy was able to drink some milk, as was the recipient. But they didn't look particularly well." Much admired in the former Soviet Union, Demikhov's funding ran out because people could not see the practical applications, White says.

White and his associates took part in 34 animal experiments. In 1970 they claimed the first successful transplant of a mammalian head on to a mammalian body that had had its head removed. The rhesus monkey regained consciousness, showing aggressive behaviour, an ability to eat and to follow people with its eyes. The scientists were researching the isolation of the brain and exploring how a body given a new brain is very slow to reject it as an organ. In a head transplant, White says, the organs more likely to cause rejection trouble would be the facial tissue and tongue.

In the 1970s, White's team was not concerned with keeping the animals alive, so did not use immuno-suppressant drugs or equip a veterinary intensive care unit. Despite this, some lived as long as eight days.

White has spent most of his life operating on people and teaching students, mostly at Ohio's Case Western Reserve University, where he is a professor. He has impeccable credentials as the author of about 800 articles and a former editor of Surgical Neurology, the leading medical journal of his field. A Catholic, he has been honoured with a papal knighthood and membership of the Pontifical Academy of Scientists. He is the only foreign member of both the Russian and Ukrainian neurosurgical academies. When he handled sections of Lenin's brain at the Institute of the Brain in Moscow, he recalls thinking: "My God, has anybody in the world caused more trouble than this tissue I've got here?" A former colleague, Maurice Albin, a professor of anaesthesia and neurosurgery at the University of Texas, rates White's surgical skills as "superb". "He has an extraordinary ability to know what the limits of surgical approaches can be, that you can't always operate successfully," Albin says.

For many, head transplants are the stuff of science fiction. In 1982, British author Peter Nieswand penned a best-selling thriller, Fallback, in which a scientist finds out he has terminal cancer. The answer, of course, is to transplant his head. Nieswand drew on White's work for inspiration, but the reality, in the not so distant future, may just end up overtaking the fiction.