Friday, March 18, 2016

Chinese Surgeon Prepares for World’s First HEAD TRANSPLANT

                                            Boris Karloff in the 1931 film Frankenstein

'Was Dr Frankenstein a good man or a bad man?' asks Ren Xiaoping, while rejecting comparison with the fictional character, as he and his team of young researchers move closer to performing the first human head transplant,

                          Dr Ren Xiaoping at his laboratory in Harbin

As he drives me to his laboratory in Harbin, northeast China, the surgeon who made headlines around the world by conducting a successful head transplant on a monkey - and who is preparing to do the same operation on a human patient as early as next year - asks a rather startling question: "Was Dr Frankenstein a good man or a bad man?"

Dr Ren Xiaoping has heard a great deal about British novelist Mary Shelley's gothic horror creation since he returned to Heilongjiang province in 2012 from the United States, where he was educated, to work as an orthopaedic surgeon at a hospital and at a government-funded laboratory. Even Chinese state media have compared the 55-year-old to Shelley's character Dr Victor Frankenstein. 

Since his return to China, Ren has built up a team of young doctors who are preparing for the first human head transplant by experimenting on rats, mice, pigs, monkeys and human corpses as part of a handsomely resourced project that reflects the country's determination to become a world leader in science.

Shortly after taking office, President Xi Jinping implored top scientists to strive for "innovation, innovation, innovation" to help fulfil what he calls the "Chinese dream". Today, Ren's team at Harbin Medical University are on the cusp of realising their macabre yet remarkable part of that dream.

In the summer of 2015, they successfully carried out a head transplant on a monkey, which lived for 20 hours (albeit without any attempt to reconnect its spinal cord) before being euthanised. Since then, Italian neurosurgeon Sergio Canavero, who worked with Ren on the operation in Harbin, has identified a paralysed Russian patient willing to undergo a head transplant to save his life.

If the science is ready - and that is a massive "if" - Ren is expected to take charge of the operation on Valery Spiridonov, a 31-year-old with severe muscular atrophy who faces an early death as his bodily organs stop functioning.

"A human head transplant will be a new frontier in science," says Ren, in an interview in his hospital office before we visit his laboratory, where the transplant is expected to take place. "Some people say it is the last frontier in medicine. It is a very sensitive and very controversial subject but if we can translate it to clinical practice, we can save a lot of lives."

First, though, the science must be perfected - and, equally importantly, Ren believes, people need to be persuaded of the vast medical possibilities of the procedure. Head transplantation needs to shed its Frankenstein image, in other words.

Ren heard the name Frankenstein only when he was a graduate doctor in the US, where he was part of the team that carried out the country's first hand transplant, 20 years ago. Since then, he has read a summary of Shelley's story and has given a presentation on its similarities to a Chinese myth about a man given a new head with catastrophic personal consequences. But he waves away the comparisons made between him and the monster's creator.

"I am just doing my work as a scientist," he says. "People can say 'You are Frankenstein.' I don't care. I care about my job. I care about my science.

"We are getting closer and closer to our goal of a human head transplant. I don't have a timetable. It is very complex work. We can't say it will happen tomorrow - but I am not ruling out next year."
Ren declines to reveal how many human corpses or monkeys his team has practised transplants on, but does say his work has the potential to save the lives of people paralysed from the neck down as well as cancer patients and people with multiple organ failure.

It is crucial, he argues, that people overcome their innate abhorrence of the idea of head transplants, and points out that society first reacted with horror to the concept of heart transplants and, more recently, hand and face transplants.

"Many people say a head transplant is not ethical," he says. "But what is the essence of a person? A person is the brain, not the body. The body is just an organ."

Ren treats patients two days a week at his bustling orthopaedic clinic in Harbin Medical University Hospital, but almost every other waking moment appears to be spent at his laboratory on the campus, on the outskirts of the city.

What is the essence of a person? A person is the brain, not the body. The body is just an organ

In the main laboratory, a colleague operates on a mouse. The animal's back has been cut open and its spinal cord exposed in preparation for an attempt to sever and reconnect it, using a newly imported diamond-tipped scalpel for a cleaner incision.

The walls are lined with boards charting landmarks in head transplant research, including pictures of a grisly operation at the university in the 1950s, when a second head was grafted on to the neck of a dog. On the wall overlooking the operating tables are photos of Ren operating on a monkey under the approving gaze of a visiting provincial leader.

A native of Harbin and a graduate of its medical university, Ren spent 15 years studying and working in the US. He left his wife and two daughters behind and gave up a position at the University of Cincinnati to pursue his transplant dream.

Getting funding for the controversial research would have been difficult if not impossible in the US, says Ren, who draws attention to the huge geographical shift in medical exploration during his professional lifetime.

"Twenty years ago, when I went to the US, it was so exciting," he says. "Now it is like that here in China. China has developed so fast."

The central government provided an initial grant of about 10 million yuan (HK$12 million) to set up the laboratory and is giving ongoing annual grants to Ren and his team of more than 20 specialists. They have conducted operations on some 1,000 mice - sometimes grafting a black mouse's head on a white rodent's body. So far, none has survived for more than a day.

His still-growing team has graduated to pigs and monkeys and experiments on human corpses.

"Small animals are far away from humans," Ren explains. "Monkeys are closer to humans in anatomy and physiology but are very expensive. We cannot use them frequently."

A transplant on a monkey takes 20 hours, Ren says. He expects a human head transplant to take 30 to 40 hours. Experiments on human corpses have helped develop the techniques.

"It helps us learn how to do dissection and connection," he says.

Daunting challenges remain, Ren admits, not least the amount of time in which a brain can be kept alive.

"A finger preserved in a freezer can be successfully transplanted after three days. A kidney, or a heart, can survive for several hours. But with a brain you have only four minutes."

Three key surgical issues have yet to be fully solved: how to cut the spinal cord cleanly enough for it to be reconnected with nerves intact, how to maintain blood pressure to keep the brain alive after decapitation, and how to avoid organ rejection after the transplant.

"If these issues were solved, you could come to me and ask, 'When will you do the first human head transplant?' and I would reply, 'OK, tomorrow,'" Ren says.

Despite his evident curiosity about the Frankenstein legend (I tell him I think Shelley presented the scientist as an essentially good man), Ren insists it is not for him to address the ethical issues surrounding his work.

"I cannot solve all the issues," he says. "The questions of psychiatry are for another field."

He also dismisses concerns from animal welfare groups.

If we don't win public support, the process might take another 10 or 100 years, even if the technique is read.

"China has several centres to provide monkeys [for experiments]. If we really need a monkey for an important part of the project, we use a monkey. It is the same with universities everywhere."

Animals are being experimented upon by his team "almost every day", Ren says, but they receive the same levels of anaesthetic as a human would during an operation and do not suffer.

A series of academic papers detailing the procedures and findings of the monkey head transplant are due to be published in the coming weeks. Ren declines to talk about the findings until they are released. But he makes it clear that he believes the work they have done has brought him and his colleagues, both in China and overseas, to the brink of a huge breakthrough.

"This year is a very important year," Ren says. "I have worked in this field for almost 20 years since the first hand operation [in the US]. I think we are almost there. We just need to organise ourselves and get support and cooperation to make this first operation successful.

"People have to change their thinking. We need support from society. People need education to make this move forward. If we don't win public support, the process might take another 10 or 100 years, even if the technique is ready."

Red Door News Hong Kong


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