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By Pramod K Nayar

Girish Karnad, one of our most significant playwrights, pondered on the intricacies of transposed heads in Hayavadana. From a different context, Thomas Mann’s ‘The Transposed Heads’ (1940), set in India, was a precursor text. Mann and Karnad’s exploration of identity and belonging are not simply myth reworked, at least not since 1970 when Robert White transplanted the head of a rhesus monkey onto the body of another. The monkey on which the head transplant was first done survived for 36 hours, with full consciousness being acquired in 3-4 hours.

White wrote later, referring in passing to the Frankenstein tale: ‘What has been accomplished in the animal model — prolonged hypothermic preservation and cephalic transplantation, is fully accomplishable in the human sphere’. Then Sergia Canavero of the Turin Advanced Neuromodulation Group in Italy set up HEAVEN, the ‘head anastomosis venture’ Project to research head transplantation (also called whole-body transplantation), one of the most daring ventures in the field.

Heaven’s Processes

The opening paragraph explains the hypothermia protocol:

“The only way to perform a cephalic exchange in man is to cool the body-recipient (R)’s head to such a low temperature to allow the surgeons to disconnect and reconnect it to the donor (D)’s body, whose head has been removed in the same operating theater … Once R’s head has been detached, it must be joined to D’s body, that is, it must be reconnected to the circulatory flow of D, within the hour. Mammals can be sustained without blood flow for 1 hour at most when cooled to the accepted safe lower limit of 12-15°C: At a temperature of 15°C, the cerebral metabolic rate in man is 10% of normal. Recovery following circulatory arrest for as long as 1 hour has been reported at <20°C temperatures since the 1950s. Profound hypothermia curtails the onset of global ischemia and give time to the surgeons to reconnect the bodies.”

Then there are detailed accounts of the tracheotomy, the incisions, the polymers used for connecting the spinal cord. There are also readable accounts of the conditions of and within the brain that the surgeons engage with: “White matter is particularly resistant to many of the factors associated with secondary injury processes in the central nervous system (CNS) such as oxygen and glucose deprivation and this is a safeguard to local manipulation.”

Towards the end of the write-up, Canavero writes: “Several conditions would qualify for HEAVEN surgery… tetraplegics, who show a tendency to multi-organ failure… possible cure for intractable cancer without brain metastases … the first patient should be someone, probably young, suffering from a condition leaving the brain and mind intact while devastating the body, for instance, but by no means exclusively, progressive muscular dystrophies or even several genetic and metabolic disorders of youth. These are a source of huge suffering, with no cure at hand.”

In 2021, the HEAVEN team reported a head transplant on a corpse. HEAVEN raises fascinating questions in terms of the social and the ethical. And there are no answers, yet.

New Identity?

The philosopher Catharine Malabou in The New Wounded argued that, in the case of severe brain impairment through Alzheimer’s or injury, the result is a whole new person: “a person with Alzheimer’s disease, for example, is not—or not only—someone who has “changed” or been “modified,” but rather a subject who has become someone else.” Such a person has a ‘new identity with loss as its premise’.

Personhood, the sense of the self, the continuity of memories that constitute an individual are vested in the head – a position known as cerebrocentrism. Head/whole-body transplantation is then perceivable as a means of the continuity of personhood across bodies because the transplanted head carries the self.

The complication arises when we ask: would psychological and mnemonic continuity be assured with the head transplantation, and are these sufficient to speak of a continuation of a person’s identity? The question points to the uncertainty here: is personal memory the source of identity?

Following from the above is another: is it possible to believe that the post-transplant individual will retain the identity of the head donor over time, or would the old body assert itself over the head? In such a case, as Jason Eberl, Director of the Albert Gnaegi Center for Health Care Ethics, Saint Louis University, asks: in a head transplant, do we lose a head or gain a body?

Transplanted Identities?

However, can one claim that a person’s identity is all in the head, or would this be rather reductive? If we say a person is all brain/mind, it implies a rather atomised view of the individual. In contrast, in several Asian cultures, personal identity is rooted in the social and networks such as the family. Then, the head donor’s identity is separated from the body which is also a key element of a person’s identity.  What would be the nature of familial and social relationships in the case of a ‘person’ whose entire body (including the head) was at one time embedded in one setting but now has a new head and body in the same setting? Would the relationships then get reconfigured because of the new head and despite the old body? Following from this, would the new head-old body person be one person or two?

Dementia and geriatric medicine specialists like Steven Sabat and Julian Hughes have argued that the lack of continuity of the psychological self, and even the loss of memory, do not always signify a total loss of identity.

Julian Hughes et al write: “The person’s identity … is more than simply the connections between their memories. People engage with each other, in everyday life and in care settings, in a bodily way and part of what they are, their quiddity, is their physical instantiation … our bodily interactions … in the world—make up our quiddity.” The implication is that memories alone do not signify the entirety of a person. Neither does the body alone.

The head/whole-body transplantation has had bioethicists and philosophers working overtime (in their individual and collective heads!) to examine the ethical and social issues but also foundational questions such as the above. It is evident that the rate of progress of technology makes philosophy’s tasks difficult as it strives to keep up. But it is also true that unless these philosophical issues of identity and personhood — some of which have legal implications — are discussed and ideally resolved, the technologies will remain a subject of suspicion and controversy.

The gateway to HEAVEN, shall we say, is open, and the route is via bioethics.

(The author is Professor, Department of English, University of Hyderabad)

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Author: Howard Caldwell