Heads Will Roll

100% of ad sales from today’s episode will be donated to bail funds.

Today we travel to a future where you can plop your head onto a brand new body. 

Guests:

• Dr. Sergio Canavero — neurosurgeon & aspiring human head transplanter
• Dr. Zaev Suskin — doctor & bioethicist
• Dr. Paul Root Wolpe — director of the Center for Ethics at Emory University

Further Reading:

• American Journal of Bioethics (AJOB) Neuroscience issue on head transplants. 
• HEAVEN in the Making: Between the Rock (the Academe) and a Hard Case (a Head Transplant) 
• Dog running in grass video (in Russian)
• The Audacious Plan to Save This Man’s Life by Transplanting His Head
• Ahead of Our Time: Why Head Transplantation Is Ethically Unsupportable
• The history of head transplantation: a review
• Soviet Scientists Made This Two-Headed Dog (warning, some pretty intense images in this story)
• Russia’s Two Headed Dog (a TIME Magazine article from 1959, again, some very intense photographs in this of dog surgery) 
• Meet the Late Dr. Robert White, Who Transplanted the First Monkey Head
• Can you legally consent to a head transplant?
• Body –to-head transplant; a “caputal” crime? Examining the corpus of ethical and legal issues

Past episodes referenced in this episode:

• Switcheroo
• Snip Snip Snip
• This Is Not A Test
• Micro But Mighty
• Easy Bake Organs

Flash Forward is produced by me, Rose Eveleth. The intro music is by Asura and the outtro music is by Hussalonia. The episode art is by Matt Lubchansky. The voices from today’s future were provided by Liz Neeley, Eler de Grey, Brent Rose, Sarah Werner and Libby Larson.

If you want to suggest a future we should take on, send us a note on Twitter, Facebook or by email at info@flashforwardpod.com. We love hearing your ideas! And if you think you’ve spotted one of the little references I’ve hidden in the episode, email us there too. If you’re right, I’ll send you something cool. 

And if you want to support the show, there are a few ways you can do that too! Head to www.flashforwardpod.com/support for more about how to give. But if that’s not in the cards for you, you can head to iTunes and leave us a nice review or just tell your friends about us. Those things really do help. 

That’s all for this future, come back next time and we’ll travel to a new one. 

FULL TRANSCRIPT BELOW

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Rose: Hey all, it’s Rose. Before we start today’s episode I want to take a second and acknowledge the current moment and the movement happening in the United States addressing police brutality against Black Americans. One of the most important messages of Flash Forward is that we can, and should, try to imagine better futures. And that also means getting involved and taking actions that move us towards those better futures. And that is what the ongoing protests and actions in the United States are all about — fighting for a better future, specifically for black people in the United States. That fight is incredibly important, and I want to take a minute to encourage listeners, and in particular white listeners, to find ways to get involved. If you don’t know where to start, there’s a post on FlashForwardpod.com with a short list of resources for how to get activated and find your place in this movement. The episode you’re about to hear isn’t about any of this, and I thought about holding off on publishing this week, but instead of doing that I’m committing to donating 100% of the ad sales from this episode to bail funds across the country. So I just wanted to acknowledge and address what’s happening, tell you one of the things I’m doing, and encourage you to figure out how you can help. Okay… on to the episode. 

[music up]

Hello and welcome to Flash Forward! I’m Rose and I’m your host. Flash Forward is a show about the future. Every episode we take on a specific possible… or not so possible future scenario. We always start with a little field trip into the future, to check out what’s going on, and then we teleport back to today to talk to experts about how that world we just heard might really go down. Got it? Great!

This episode we’re starting in the year 2050. 

[music down]

[airlock sounds]

Receptionist: Hello, and welcome to Arcadia, do you have an appointment?

Dr. Kern: Yes, we have a 4:00, under the name Laurent.

Receptionist: Ah, yes, here we are. Excellent. Your technician is going to be Dr. Dowell, I’ll let them know you’re here. Please, take a seat, it shouldn’t be long. 

[waiting room sounds]

[airlock sounds]

Dr. Dowell: Laurent? 

Dr. Kern: That’s us.

Dr. Dowell: Great, please come with me. 

[walking]

Technician: So you must be Marie, is that correct? 

Dr. Kern: My name is Dr. Kern, I’m Marie’s daughter in law. 

Marie: I’m Marie. 

Dr. Dowell: Oh I’m sorry, my mistake. And Marie you’re the one who’s interested in Arcadia’s services, that’s correct?

Marie: Yes, that’s correct.

Dr. Dowell: Excellent. Well as you know, what we offer here at Arcadia is completely unique. There is no other facility equipped to perform these kinds of procedures in the entire world, so you’ve come to the right place. And it’s great that you’ve begun thinking about this early, Marie. Many of our clients aren’t even able to visit the facility in person, they have to do the virtual tour. 

Dr. Kern: I’d like to take a look at your surgical room, at some point. 

Dr. Dowell: Of course, we’ll do a full tour in a moment. Marie, I see here that you haven’t specified which package you’re interested in. We have the Arcadia Live or Arcadia Twilight, do you know yet which you’d like to do?

Marie: No, I’m … undecided. 

Dr. Kern: She’ll do the Twilight one.

Dr. Dowell: Well we actually recommend Arcadia Live to most clients. We expect the success rate to be far higher with that package.

Dr. Kern: You expect it to be, or it is? 

Marie [annoyed]: Brigitte this is my decision, not yours.

Dr. Kern [defiant]: I’m just not going to let you sign up to pay someone to kill you.

Dr. Dowell: Ah, I see, you’re a skeptic Dr. Kern, is that right?

Dr. Kern: Am I skeptical that you can transplant human heads onto preserved bodies? Yes, I am.

Dr. Dowell: Of course, I understand, it’s truly hard to believe. I myself was a skeptic at first.

Dr. Dowell:  Why don’t you come with me, let me introduce you to some of our happy clients?

Dr. Kern: With all due respect, Dr. Dowell, I’m a neurosurgeon…

Dr. Dowell: [interrputing] And so am I. [pause[] This way, let me introduce you to someone.

[walking, airlock noises]

Dr. Dowell: We actually employ a handful of former clients here at Arcadia. Whenever possible, we try to offer them jobs here, so let me see if Thomas is around. Wait here for a moment. 

[opening a door] 

Dr. Dowell [calling into another room]: Is Thomas around? Oh there you are, do you have a moment? Would you mind speaking with a potential client? Thank you! 

Dr. Dowell: Dr. Kern, Marie, this is Thomas. 

Thomas: Nice to meet you both.

[awkward silence]

Marie: Did it hurt? 

Thomas [sweetly]: The procedure? Not at all. Of course, during recovery there are certainly some aches and pains but … I’ll take those over dying of course. 

Dr. Dowell: Thomas was one of our earliest Live clients, actually. 

Dr. Kern: I’m supposed to believe that this head was once on another body. 

Thomas [sweetly]: The fact that you can’t tell means they did a good job right? 

Dr. Kern: Or that this is a scam, and you’re an actor, and the original Thomas is dead. 

Thomas [delighted]: Ah a skeptic! So your theory then, is that Arcadia is able to find actors that looks just like each of their clients, and pay them enough money to abandon their lives and assume new ones? 

Dr. Kern: Well I have no way of knowing that the original Thomas existed. [turning to Dr. Dowell] I’d like to watch a live procedure.

Dr. Dowell: I’m afraid that patient confidentiality precludes that, Dr. Kern. 

Marie [annoyed]: I’d like to see my body options, and given that I’m the client here… not my daughter in law, I think perhaps we can end this conversation and do that? 

Dr. Dowell: Of course, yes, please, my apologies. Come with me, and I can show you what we have in stock right now. Of course, when it’s your time we won’t have these exact options, but you can give us a sense for what you’d like most. 

[walking away]

Thomas: I was a skeptic, too, you know.

Dr. Kern: Not skeptical enough if you went through with it.

Thomas: So you’d rather just die, and forfeit any additional time here?

Dr. Kern: I’d rather not die in pain at the hands of a scam surgeon.

Thomas: Life is pain, Dr. Kern. Anyone who says differently is selling something.

[walks away]

Dr. Kern [to no one]: You’re selling something! 

// 

Rose: Head transplants. Today we are doing head transplants. Well not literally doing them, but talking about them. And this episode is going to get into some sort of intense medical procedure stuff, so if you’re squeamish about hearing about that, maybe skip this one. Because we are going to talk about… cutting off heads. And this is an episode that’s been requested a lot, actually, in part because of the work of one particular person.

Sergio Canvero: I am a functional neurosurgeon. I have been working at head transplants for the past, say, almost 40 years 

Rose: This is Dr. Sergio Canavero, and as you can hear his tape is a little bit hard to understand. I connected with him by Skype; he was in Italy, I’m in California, and the line wasn’t great. But we’ll get through it together. 

Now you might have heard of Dr. Canavero before. He’s a neurosurgeon who has been in the news on and off for years now.

Al Jazeera Host: Now, an Italian Surgeon plans to perform the first human-head transplant in two years time. 

Fox29 Host 1: Could doctors be close to performing a head transplant?

Fox29 Host 2: Excuse me, a head transplant?

NBC Host: Doctors plan on color coding the muscles to make the reattachments easier. 

Chris Hardwick: Hooray, great news for people who had their heads cut off but really are hoping to get back out there in the dating scene. Doctors say they’ve got a head lined up.

Rose: Before we get into any of that, a little bit of behind the scenes here: I went back and forth a lot in working on this episode, trying to figure out the best way to present this idea to you. You should know right off the bat here, that Sergio Canavero is very controversial, and almost all experts don’t trust him. He claims he’s being unfairly criticized because surgeons don’t want to admit that he’s right. So here’s what we’re going to do — I’m going to have Sergio lay out for you his ideas and his plans, and what he claims is currently possible. Then we’re going to unpack those claims and talk about what scientists agree on, and what they don’t agree on. And then we’re going to set aside Sergio and his personality and his claims, and talk about the laws and ethics of this whole premise more generally. Okay? 

Back to Sergio. Basically what he claims is this: he has figured out a way to sever a human head and place it onto a donor body. 

Sergio: I can tell you that we are way beyond monkeys right now, but for the reasons that, perhaps, I’ll be able to explain later on, I can’t give you many more details because we have so much opposition from the liberal front, and from the Vatican, etc etc.

Rose: Now, this is a common refrain from Sergio. He can’t say too much about his work, because he’s being attacked by liberals, and The Vatican, and other scientists. But Sergio claims to have successfully done head transplants on mice, monkeys and dogs using what he calls the GEMINI spinal cord fusion protocol.

Sergio: So, dogs, dogs running. You can see the video on… it’s never been shown on American media, I don’t know why. But Russian, Chinese and European media, you can easily find a video showing the dogs and the monkeys. So, it’s all there.

Rose: Sergio was really adamant that I show you all these videos. And I will post links to them on the website. The dog one that he is talking about is a video of a dog, running in some grass. And we’ll come back to that in a bit. 

But the gist here is that the GEMINI procedure involves using a really, really sharp blade to slice the head off one body, and then attaching that head onto another body such that the two parts communicate with one another, and the resulting organism not only lives, but can function in the world as a whole, single, living creature. 

And again, Sergio claims to have successfully done this on a bunch of animals, and says that he’s ready to do it on humans. In fact, for a while he had a willing donor who was ready to have his head cut off by Sergio, and have that head attached to a donor body. Valery Spiridonov, a Russian computer scientist, had volunteered himself to be the first living recipient of a head transplant.

By the way, just as a side note, it’s weird that they’re called head transplants, right? It should be a body transplant, since… the head is the thing that stays? The donor is the body? I don’t know why they’re called head transplants, but they are, so we’re just going to go with it.

Anyway, Valery Spiridonov volunteered to do this, because, in his words, he wanted to get rid of the limits presented by his original body. Spiridonov uses a wheelchair, and has a terminal muscle wasting disease, and Sergio presented this procedure as a way for folks to swap out bodies that might be causing them pain and suffering, for new ones. Again there’s a lot to critique here, about this, but for now we’re just going to stick with Sergio and his plan, I promise we’re going to get into the ethics of this soon.

I should also note that in 2018, Spiridonov cancelled his appointment to have his head cut off. According to The Daily Sun, which I know is not the most reputable newspaper but it was the only one I could find with an actual explanation, in 2018 Spiridonov and his wife had a baby, and he realized that actually he did not want to test out a basically unproven head chopping off method. 

But no matter, Sergio claims that the first transplant recipient will be a Chinese person anyway, because his main collaborators, and most of his work, in fact, is now happening in China. So if this ever happens, it will probably be in China. 

And Segio isn’t really interested in head transplants for disabled people like Spiridonov anyway. That might be a nice side effect, but for him, it’s not about that.

Sergio: I want to perform a transplant because I want to extend life. I’m a life extender. 

Rose: Sergio believes that if you were to take a person’s head, and place it on a younger body, that younger body would, essentially, make the older head younger. 

Sergio: The blood recirculating through the aging head to bring about a rejuvenation effect. So, you’re giving this a new body and of course, you’re rejuvenating the brain. Because, of course, you don’t want to have an old brain on a young body for the next century.

Rose: So that’s the real goal here, to live forever, constantly swapping your head out with younger bodies as you go. And yes, this does indeed is sort of like the plot of the movie Get Out.

[CLIP FROM GET OUT]

Roman: You were chosen because of the physical advantages you’ve enjoyed your entire life. With your natural gifts and our determination, we could both be part of something greater. Something perfect.

Rose: But I wanted to know more about the actual process here, logistically, how does this work. So let’s walk through Sergio’s dream. 

Sergio: So, let me walk through this. You are now, let’s say — you’re not, but you are — one hundred, and the year is 2050. You’re walking to a special clinic — life extinction clinic — and saying we want to do this ethically. But you get into into this clinic and your body would get cloned. 

Rose: Okay so I show up, and I get myself cloned. Which means I have to do this before I actually want the head transplant, right? Because the clones of me would have to grow up, you don’t really want to put an adult head on a baby. Or even a teenager. Probably, you want to want until they’re at least 18 before you sacrifice them. 

Now, you might be wondering about that sacrificing part, what are the ethics of murdering your own clone to harvest its body? Yes, good question and Sergio has an answer.

Sergio: We are just going to rebuild, reclone your body without your brain. 

Rose: Right, so the clones you have these scientists make are not going to be regular clones. They’re brainless clones… somehow. Let’s keep going. 

Sergio: You have this huge operating room, specially equipped with two surgical teams. Huge surgical teams that just take turns, because in the surgery I can do — we already did it — takes between 24 and 30 hours.

Rose: So you separate the heads from their bodies, and you reattach the head you care about onto the body you want. 

Sergio: And you are brought into an intensive care unit, and kept there, under, for about two weeks, during which time you start electrical stimulation of both the brain, and the spinal cord in order to speed up the process that is already being started by the GEMINI Fusion. And after two weeks, you — the patient — and you start this very intensive rehab program that will lead you to being able to walk again.

Rose: And at the end of this rehab program, in which your head learns how to communicate with this new meatsack that it’s attached to, you can go back to living your life, normally, just with a new body. 

This is the dream. And Sergio claims it’s not even really a dream. He was adamant with me that he could, today, absolutely connect a human head with a donor body, and have that person not only live, but eventually regain pretty much all function.

Sergio: Head transplant is possible now, but we immunosuppress them. In five to 10 years. I expect this to be possible, without immunosuppressant, and that’s going to be huge. And in 30 years to get you a cloned body. 

Rose: And these are the types of claims that get Sergio Canavero in hot water. This claim that not only has he made strides towards a head transplant, but that he can do one, now, today, on humans. That, in five years, he’ll be able to do it without immunosuppresant drugs, and in 30 years, we’ll be swapping our heads onto clones.

Most experts don’t believe any of this. In fact, there are really only two research groups in the world who believe Sergio Canavero, and that’s his own research group, and another group that he’s working with directly. The journal Surgery published the results of the dog study that we mentioned, and here’s a quote from one of the reviewers who recommended that the paper be rejected: “Even if the results of the experiments are “true,” the data presentation is not high quality and it seems way too phenomenologic.” 

And that is emblematic of a lot of Sergio’s work. He wants to focus on this video of a dog running in some grass, but how am I supposed to know that that dog had a head transplant? We’re supposed to just take his word for it, basically, but when you’re making an extraordinary claim like that, some more detailed evidence would be nice! And, crucially, when you actually look at the results of the dog head transplant paper, I’m not sure I would call this a full recovery and success. 

For one, most of dogs in the study couldn’t support their own weight, and developed pressure ulcers. Most of them had persistent urinary incontinence. And all the dogs required abdominal massages twice a day so they could poop. This is the research that Sergio thinks is promising enough to move on to humans, today, right now. And that’s not even getting into the question of whether or not these animal studies can really apply to humans at all. We talked about the applicability of animal studies last year, on the episode This Is Not A Test, but it can sometimes be hard to actually know whether something that works on a mouse or a dog will work on a person. 

In fact, even people who admire Sergio Canavero, who are excited about his work, sometimes find his claims hard to recon with. 

Zaev Suskin: The animal studies have been largely lacking. There’s really no way around that. And not only that, but the animal studies that they have conducted have not been entirely too promising as of yet. So, for him to jump to make these claims that you were just talking about seems a little avant garde. A little ahead, one step too many. 

Rose: This is Dr. Zaev Suskin, a physician from Georgetown Medical School, who wrote a paper a few years ago about the legal and ethical questions around head transplants. And Zaev likes Sergio Canavero; they’ve spoken on the phone before, he finds his work exciting. But he’s also sometimes, maybe a little bit frustrated by some of these big claims Sergio makes, because they’re pretty clearly going too far. 

Zaev: I think he is quoted as saying there’s a 90 plus percent chance of success, which is medically outlandish at this point. While he’s trying to do a lot of good work, there’s a bit of shooting of your own foot that’s going on here when you make these statements. 

Rose: When I asked Sergio why he doesn’t just do a public demonstration on a dog or a monkey, for all the world to see and document step by step, just to put all the questions to bed, he flipped the question back to me.

Rose: Two years ago on an Australian — what it is Australia’s 60 Minutes — I challenged all neurosurgeons around the world, especially in the United States, to prove me wrong; to invite me over wherever they wanted. Animals, or better humans, of their own choice. And I said, let’s do the thing. Let’s apply the general spinal cord fusion protocol. Let’s make these creatures walk again, and disprove me. 

Rose: Of course, nobody took him up on this. Because that’s not really how science works, right? If you’re claiming you can transplant heads, you generally have to provide evidence of that claim, rather than challenging other people to prove you wrong. 

Sergio Canavero has claimed that he’s the most persecuted scientist since Galileo. He believes that the established medical industry is shunning him, not because he’s wrong or exaggerating his findings, but because they don’t want to admit that he beat them to this miracle. That their old methods are incorrect and that this whole time the answer was right under their noses. 

Here’s the part that’s hard to parse, for me, at least. It’s totally possible that Sergio, and his close collaborator, the Chinese surgeon Xiao-Ping Ren, have made contributions to science when it comes to spinal cord injuries and reattachment. But it’s really hard to say, because so much of their work is shrouded in either mystery or hyperbole. 

And while it might seem totally sci-fi to be reattaching heads, Sergio is pulling from a long history of research into this. Scientists have been doing these kinds of experiments for decades, because understanding how to reattach a severed spinal cord would be really, really useful to help people with spinal cord injuries. 

In 1908 a French surgeon named Dr. Alexis Carrel, did a dog head transplant. It wasn’t quite the same as the one Sergio is talking about, Carrel didn’t cut the head off the donor dog’s body. He actually grafted a second head onto a living dog. And, in that experiment, he found that the second head did react to stimuli, at least for a while. The dog didn’t survive very long, but Carrel’s work using really fine needles to stitch things like blood vessels was ground breaking. In 1912, he won the Nobel Prize in Medicine for these techniques. 

In 1954 a Soviet doctor named Vladmir Demikhov did a different dog experiment: he attached the front half of a dog, its head and front two legs, onto another complete dog. Again, no cutting off of the donor dog. Just attaching an extra dog to the first one. These hybrid animals survived for as long as 29 days, and the stuck-on dog again could respond to stimuli and move. But this was the 1950’s, before immunosuppressive drugs existed, so ultimately the animals all died from transplant rejection. 

Ten years later, in the 1960’s a doctor named Robert J. White started working on this question too. White first transplanted just the brains of donor dogs, into the necks of other dogs, just to prove that the brains could, in fact, be kept alive in their non-original bodies. Eventually, he did a series of experiments on monkeys that actually did involve cutting the head off both monkeys, and trying to attach it to different new bodies. In these cases, the resulting, hybrid, monkeys were sometimes able to track things with their eyes, and even swallow, but none of them survived longer than three days, even with the help of immunosuppressive drugs. And White’s experiments were roundly criticized as unethical, abusive, and generally just… creepy. White is no longer alive, but a few years ago, Motherboard did a short documentary about him, here he is talking about his work.

Robert White: While there was criticism, people, very good scientific people, that don’t agree with the direction I’ve gone, To me, speaking of our work in general, that really transgresses many important intellectual fields. Not just transplant biology, but philosophy, theology. That, if what we were doing was successful, would be crossing new divisions that had never been crossed before. 

Rose: Because of the blowback White got from animal rights activists — and honestly I think that blowback was pretty justified in this case, these experiments were pretty brutal — researchers didn’t touch head transplant studies on animals for a while. Then, in 2014, the Chinese surgeon Xiao-Ping Ren, came up with a method that altered exactly how and where you make your cuts on the donor and recipient heads. Many experts think that this was a legitimate discovery, an actual additional step forward. 

And then, this is where things start to get muddy. When Ren and Canavero started working together, things quickly went from “we have made advances in elements of this technique in mice” to “we’re going to do a head transplant on people in a few years.” And that…. that’s a huge jump. 

This is all to say that there is research, real research, on head transplants out there. There have been breakthroughs in this field, even recently. But what, exactly, Sergio and his collaborators have added to this existing body of work is hard to really figure out. And it’s not just me

Zaev: And that’s fair. And I’ll be honest with you, even those of us who read medical papers and neurosurgical papers on a daily basis, have had a tough time discerning that line within Doctor Canavero’s work. 

Rose: It doesn’t help, of course, that Sergio Canavero likes to make claims that fall pretty far outside his area of expertise, about things like philosophy, psychology, the microbiome. Take the whole, headless clones thing. He just kind of glossed over that when he was giving me the rundown. 

Rose [on the phone]: Just to go back to the cloning question, has anyone ever cloned something without a head before?

Sergio: Well, actually, if you just take a page from nature, there are, you probably know, that there’s some fetuses born without a brain. So, being able to grow a clone without a head. Well, it’s not absolute… it’s not that difficult because you have to just to, sort of, walk the cloning through certain steps that will be made possible through gene editing, and things like that. 

Zaev: Yeah, you know, I think that there’s a lot of problems with that. I’m actually quite surprised that Dr. Canavaro envisioned that as his ideal, kind of, triumph of this procedure. I’m actually quite surprised at that. 

But there’s a couple things here. One is, I’ll say medically, I just can’t see how that would be possible. Obviously, the brain does a lot more than consciousness; than cognitive tasks like counting or speech or things like that. The brain is essential to all functions of the body, from the autonomic function of the heart, to how your gastrointestinal system construes its bacteria, and processes what you eat, to telling the body when to pee. I really can’t envision how a corpus, how a body can develop without a brain. 

I think, again, this is another example of taking the ball 90 yards, and then just throwing it on the ground, when there’s nobody blocking you. Because all of his work… like I’ve said, I’m a big admirer. I think what he’s trying to do with the procedure, as of now, for those who are truly ill, is great. But this is, this is somewhere else. 

Rose: And this is just one example, a classic Canavero, where he is so quick to find solutions to problems you might raise that he’s willing to gloss over pretty big scientific questions. Of course we can fix that. Oh no problem. Absolutely possible. He’s honestly the most hopeful person I’ve interviewed in a long time. Almost to the point of absurdity. 

It’s not just the clones, either. He does the same thing with questions like: psychologically, how is someone going to cope with this procedure, with looking down and having a totally different body? Some psychologists have argued that this could be almost impossible for a person to process, and could lead them to terrible mental health outcomes.

No problem, says Sergio, all we have to do is put you in a virtual reality simulator before the transplant and get you used to your new body. Next question! 

And he doesn’t just do this in interviews. He does it in his papers too.

Paul Wolpe. When he makes any kind of a controversial claim, he cites himself. And then when you go look at the original source, it doesn’t in any way prove the claim that he has cited himself to make. And when he occasionally cites other people, to try to prove a claim he’s making, if you go back to that source, you see it doesn’t support the claim he’s making either.

Rose: This is Dr. Paul Root Wolpe, the director of the Center for Ethics at Emory University. And Paul doesn’t know this, but he’s kind of the reason for this episode. 

Here’s the thing, listeners have asked for this topic a lot. Because Sergio is in the news a lot, constantly claiming that this is right around the corner. But I’ve put off doing this episode for years, because I wasn’t sure if talking about it was the right thing to do. Why give someone who’s probably selling nonsense a platform? What good does it do to cover what most other scientists consider basically a hoax? But I was reading through the back issues of The American Journal of Bioethics (AJOB) Neuroscience, which is a thing that I do, and I noticed that they had done an entire special issue on head transplants. Paul is the editor in chief of that journal, and it was his decision to do this issue, and here’s why he decided to commit an entire issue to this topic that some people have argued isn’t even worth considering. 

Paul: There were two reasons why I decided to do it. The first was because Dr. Canavaro had a colleague — Dr. Ren — in China. They had reportedly, or at least they reported, they had permission in China to do this. They had set up a service there to, in fact, engage in this. They had given a time; they said when they were going to do this. And, for a while at least, although that fell apart, they had a volunteer patient to do this.

So, it was plausible that they might actually attempt this. So, I felt, as a medical ethicist, it was important to get into the conversation. Why this was profoundly unethical to try. 

Rose: Basically, as soon as someone’s actual life was potentially on the line, Paul felt like ethicists had a duty to seriously weigh in. 

Paul: And the second reason is because the question itself, outside of Canavero, looking into the future, is an interesting ethical question. So it’s worth discussing what a head transplant might mean, should we ever get to the point where it’s technologically feasible and ethically attemptable.

Rose: And those are the questions we’re going to tackle, when we come back. 

[AD]

Rose: Okay, so a few things to say before we fully set aside Sergio Canavero. If you’ve listened to this show for a while, you might notice that there’s kind of a philosophical overlap between this episode and the episode we did last year called Switcheroo. If you heard that episode, you’re familiar with some of the things I’m about to say, but I wanted to just be really explicit. The way that Sergio talks about who might benefit from this technology is often pretty callous and problematic, particularly when he starts to talk about disability, and gender identity. Some advocates have claimed that this could be a solution for disabled people, who, in this version of the world, must of course hate their bodies and want to replace them. We’ve talked about this idea in a lot of different episodes, probably most notably in the CRISPR episode called Snip, Snip, Snip. Some disabled people might genuinely be interested in the idea of a body transplant, head transplant, whatever. Others might not, because, in fact, their bodies are just fine the way they are, it’s our society and culture that gets in their way by not accommodating them.

Sergio has also claimed that this could be a great “cure” (air quotes there, Sergio’s words, not mine) for trans people. Again, we talked about this in the Switcheroo episode, but today, most trans people reject the narrative that they were “born in the wrong body.” And honestly, it doesn’t seem to me that Sergio has actually talked to very many trans people about this — the way he refers to gender and trans people in his writing uh, leaves a lot to be desired, let’s say. So if you do go read his work on this, which I will link to in the blog post for this episode, just be aware that you might encounter that language and way of thinking. 

Okay so, for the rest of this episode, I want to kind of leave Sergio Canavero behind. His claims are hard to evaluate and controversial and they sort of muddy the waters of this conversation. He’s such a big personality here, and he’s making these predictions, and it makes it hard to talk about the underlying questions of ethics around head transplants more broadly. But let’s try to do that. 

In the Switcheroo episode we talked about body swapping, but we kind of glossed over the mechanics of how that would actually work. In that episode, we just sort of said, oh, there’s a machine, it’s basically magic, let’s talk about what that might mean. 

And on that episode we talk a lot about this question of where you are. What makes you, you? Is it your brain? Is it your body? Is it something else? Is it all of the above? And the answer to this question really matters when we start talking about literally cutting off your head. 

Paul: We in the West are what I call Cerebro centric. We think that everything that makes me me; everything that makes me Paul, my memories, my personality, my thoughts, my way of being, are all lodged physically between my ears. 

Rose: This way of thinking is really the only way that a head transplant makes any sense, right? But there’s plenty of reason to doubt this idea. The idea that the only thing that actually matters is the spicy meatball between your ears. 

Paul:  And I want to give two examples. One you referred to briefly earlier, and that is the microbiome. The microbiome is the sum total of all bacteria that live, primarily, in our guts. And it turns out that they have a profound impact over us, over mood, and now looks like depression and other things can be affected by changing, or altering, or replacing the microbiome. 

Rose: Scientists don’t really know all that much about exactly how, and to what extent, the microbiome impacts our personality. There’s a lot of research into this, and it’s fascinating, and often overhyped, and also beyond the scope of this episode. But,if you want to hear more about the microbiome, you can listen to the episode Micro But Mighty, and read the book I Contain Multitudes, by Ed Yong. Side note, I think that, at this point, I’ve now hit some kind of record for how many past episodes of this show that I have referenced in one current episode…. so hooray for me, gold star.

Anyway, it’s not just the microbiome that likely shapes who we are. There’s also something called the enteric nervous system. Okay, listen, I had honestly never heard of this, and it absolutely blew my mind. The Enteric Nervous System is the largest nervous system cluster in the body outside the brain. It’s so big that experts often actually call it a “second brain” and it governs our gastrointestinal tract. 

Paul: For example, a lot of people have heard of serotonin. Serotonin is a neurotransmitter.. What people don’t know is that ninety five percent of the serotonin in your body is in your gut. 

Rose: And it’s not just serotonin, the Enteric Nervous System makes over 30 different neurotransmitters. It’s like you have a second spicy meatball controlling your body, and we have no idea what might happen if you separated your head meatball from your gut meatball. 

Paul: And this idea that if you took my head, and put it on Rose’s body, that that resulting hybrid would be Paul and not Rose is a theory. 

Rose: On the Switcheroo episode we talked about how organ recipients often feel as though they got something, somehow, from their donors. But when you’re talking about a whole body, you probably will genuinely feel the impacts of that body on your sense of self. There’s really no analogue here, there’s no other transplant like this. The closest we might have is a face transplant, where, when you look in the mirror you see someone else, but even that isn’t really the same thing.

Paul: It is not remotely like a face transplant, or hand transplant, in that it is a profound mixing of two people in a brand new way. And we don’t know what the nature of the outcome will be. 

Rose: And beyond the individual impact on a singular person, the recipient, and their experience of themselves, and the world, there’s some other questions that ethicists raise when it comes to head transplants.

Paul: If we had plenty of extra bodies, and plenty of extra organs, it wouldn’t be as much of an issue. But from one dead body, we can get lungs, heart, liver, kidneys, and they can go and save multiple lives. 

Rose: There’s a shortage of perfect organs in this world, and we can’t yet grow new ones, which is something we covered on the Easy Bake Organs episode — boom, another past episode reference! 

A lot of ethicists think that saving one person with a body transplant isn’t ethical when you could, instead, save many by dividing these organs up and divvying them out to those in need.

Now, Paul doesn’t actually think that head transplants are inherently, always, in every case unethical. Some ethicists do think that. You can read the various arguments in that special issue of the journal I mentioned, it’s open access so anybody can read it and I’ll link to it in the blog post for this episode. That issue also does include two different pieces from Sergio Canavero, and his collaborator Xiao-Ping Ren, so if you want to read their paper, and their response to these critiques, you can do that. 

But there’s one question about this that we haven’t gotten to. 

Paul: You can’t kill someone for their body, for someone else’s head. That’s called murder. 

Rose: And when we come back, we’re going to get into those legal questions. But first, a quick break.

[AD]

Rose: Okay, so let’s just say this is possible. Sergio Canavero proves all the haters wrong, and he does this, he cuts the head off of one body, and attaches it to another body. Has anybody, in this situation, committed murder? 

There are a couple of really interesting and weird legal questions here. And before we can answer them, we have to define which version of this procedure that we’re actually talking about. 

So, let’s start with what Sergio claims is possible today — you have a donor body, and a recipient head, and you do this procedure. In that case, the donor is already dead, so there’s no question of murder there. But, there is a question of murder when it comes to the recipient. 

Paul: Imagine that you’re the surgeon. You cut the head off and you’re preparing it for transplant, and it dies. In what sense have you not committed murder? You just severed someone’s head, which, you know, under almost any definition is an act of killing. And, after severing that head, the head has ceased to live, as has the body. So, no matter what your intentions were, that person is dead. And, no matter what their intentions were, you cannot give another person permission to kill you. 

Rose: And, even if the procedure goes well, the recipient head actually does have to technically die as part of this whole process. 

Zaev: You’re going to have to, for a time, stop brain function. There’s no way around that, even if you’re perfusing it.

Rose: That’s Dr. Zaev Suskin again.

Zaev: The recipient does have to undergo death, by definition. Procedurally, one part of the procedure… in a 200 step procedure, for example, one step is going to be to stop the life of the recipient here. 

Rose: If things go well, then you bring them back to life and it’s all fine. But you do kind of kill them, briefly, for a moment. 

[Movie clip]

Miracle Max: It just so happens that you’re friend here is only mostly dead.There’s a big difference between mostly dead and all dead. Please open his mouth. 

Rose: Some legal scholars, like Dr. Nita Farahany, have argued that if Sergio did this procedure in the US it would be, at best, active euthanasia and, at worst, reckless homicide. And some of this comes down to another question: informed consent. In medicine, it’s really important that people understand and consent to procedures. And this is where Segio’s boasting becomes problematic again — he claims he will have a 90% success rate. Even his admirers say that’s ridiculous. So, if you’re a patient who goes in to talk to him, and you’re promised something that isn’t backed up by science, you’re not really giving informed consent, because the information you’re being provided is incorrect. 

Zaev: If we’re going to go through informed consent, and we are going to undertake this procedure, it needs to be done meaningfully, and it needs to be done honestly.

Rose: Then there’s the question of the whole cloned body thing. Can your brainless clone even consent to being killed for its body?

Zaev: I think it would be entirely clear that a brainless body could not consent. To anything. 

Rose: In medicine, there are really intense debates and struggles over someone’s capacity to consent. 

Zaev: You know, when you get patients who come in with Alzheimer’s, patients who come in with these other illnesses that slowly, or suddenly, affect cognitive functions, or just one part of function, we have to start to question whether they have the capacity to consent to even the most minimal treatments. Now, take it then to this: which you’re talking about somebody who has no brain, whatsoever, consenting to give over the entirety of their body. And that is… there’s no sense in which that could be consented to. 

Rose: But if the clone wasn’t brainless, you’re then absolutely talking about murder. And even Sergio admits that.

Sergio: Otherwise it will be a murder, will be just manslaughter, so to speak. You can’t just make a clone of yourself, and then kill the clone to give you a new body. 

Rose: So, to do this legally, ethically, you really do have to stick with donor bodies, people who have died and marked the little box for whole body donation on their drivers license, or something. 

Speaking of drivers licenses, let’s talk about identity for a second, shall we? We covered the philosophical elements of how a new body might change your identity last year on that Switcheroo episode, but what about legally? How do we, legally, define a person?

Zaev: So physically, DNA — which most people are, at this point, familiar with — is used to define one’s identity, legally. This is how, in today’s day and age, criminal evidence, paternity testing, things like this, are used in order to establish the identity of a person. 

Rose: But if you have this new body, your DNA is mostly going to be that of the donor, right? So are you now… them? That doesn’t really seem right, does it? Plus, if you get a new body you shouldn’t necessarily get to escape whatever your head did in the past? 

Zaev: If Person A is two hundred thousand dollars in gambling debt, and they get a new body… things like that. They should still be in two hundred thousand dollars worth of gambling debt, or they should still have responsibilities towards their children.

Rose: Again, this assumes that the head is where our entire entity lies, that the body is simply a machine for our brain to command around. And again, we don’t know that. 

Zaev: To be very clear here, you know, everyone has a right to self-determination. And if the patient wakes up, and they feel like someone else, or they feel like something else, that is within their right. But legally speaking, I think that it is clear within the U.S. legal system, we should simply make it so that they are legally identified as the person they were before. And when I’m saying person here, of course I’m talking about the recipient. 

Rose: Meaning that if the resulting person, who comes out of a head transplant, doesn’t really act or feel like either the head or the body, but instead some middle person, they will still legally be defined as the head person. 

And one of the weird things about this whole thing, is that for a lot of these questions about identity, and who the person is, there’s really only one way to find out. 

Zaev: You can’t ask an animal if they are the same person they were before the procedure. And these are kinds of questions that really the procedure can only be tested in humans. 

Rose: And that brings us back to Sergio. He claims he’s ready to do this on humans, that he’s got everything figured out. Other people aren’t so sure. Paul doesn’t think Sergio Canavero is actually ever going to try this on people. Zaev thinks he might. And it’s worth noting that by moving his experiments to China, Sergio might be able to get around some of the usual ethical standards and rules around what’s allowed. 

And if he does do this, there will be some big questions about what happens next, and how successful the procedure was. It’s likely that the first transplants, if they’re successful at all, will not result in a person who can go on and live their lives normally for another 30 years, or something.

Zaev: Even if the person where to only live for a couple months, but then could no longer live — because the kind of immunosuppressants that are required for this procedure aren’t sufficient — but even if they were only to live for a couple of months, we could learn an immense amount about identity, about brain function, about continuous perfusion of the brain. There’s a whole lot of medical, biological, ramifications that could indeed be considered successful here. 

Rose: And, if Sergio never tries this, then he’ll just fade into the distance as another guy claiming he can do something extraordinary without sufficient proof to back it up. But there will always be someone interested in this question.

After Sergio, there will be another scientist, and then another. And maybe, eventually, we will get closer to this kind of procedure. And even though he’s not exactly a fan of Sergio, Paul is kind of glad that the neurosurgeon has opened up this door. 

Paul: I actually think the ethical questions around head transplants — Who is it? Who are they legally? Who are they morally? To what degree would it help us understand the relationship between the brain and the other and the microbiome and the entire nervous system? — they’re really interesting questions, around head transplants. And what Canavaro has given us is an opportunity to talk about them. 

[music up]

Rose: Flash Forward is produced by me, Rose Eveleth. The intro music is by Asura and the outtro music is by Hussalonia. The episode art is by Matt Lubchansky. The voices from today’s future were provided by Liz Neeley, Eler de Grey, Brent Rose, Sarah Werner and Libby Larson, who is a Patron! Did you know that if you become a $10 patron you get a chance to be a voice in future skits? Now you know! You can find out more about perks and rewards for supporting the show at patreon.com/flashforwardpod. 

If you want to suggest a future we should take on, send us a note on Twitter, Facebook or by email at info@flashforwardpod.com. We love hearing your ideas! And if you think you’ve spotted one of the little references I’ve hidden in the episode, email us there too. If you’re right, I’ll send you something cool. 

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That’s all for this future. Come back next time, and we’ll travel to a new one.