Experimental head transplant surgery sparks international ethics debate

Claims made by Italian neurosurgeon Sergio Canavero and Chinese surgeon Ren Xiaoping of the successful transplantation of a human cadaver head onto another human cadaver body at Harbin Medical University Hospital in China using the controversial HEAVEN (head anastomosis venture) procedure was followed by renewed debate among medical ethicists.

The opinions of Karen Rommelfanger, Director of the Neuroethics Program at the Emory Center for Ethics, and Paul Boshears, East Asian scholar at Kennesaw State University were highlighted in a Newsweek article that asked, “Why China? Why now?”

Why was Canavero received at Harbin Medical University after being forced out of Italy on ethical grounds? The authors posit, “At a minimum, this procedure reveals that Chinese authorities believe there is no cost too high for raising China’s profile on the world stage.”

Rommelfanger and Boshears ask two ethical questions apparently unique to China. Is Canavero’s team using bodies or heads from individuals who have not consented to participate? Since China lacks a legally accepted medical standard for declaring brain death, are the bodies or heads coming from individuals not considered legally dead by Western standards?

Rommelfanger, also senior editor of the American Journal of Bioethics Neuroscience, pointed out that, given China’s lack of transparency and history of using executed prisoners for transplants, these questions require urgent answers: “What’s very important—that no one has spoken about—is where the bodies are coming from, and who consents.” She added that this project is nothing but a public relations opportunity for China to showcase its “no-holds-barred” research.

It has been nearly twelve years since investigations first revealed that China has developed a thriving transplant industry by killing prisoners of conscience for profit. Prisoners targeted for organ harvesting have been adherents of the spiritual discipline, Falun Gong, as well as Tibetans, House Christians and Uyghurs. The value of China’s transplant industry, which attracts patients in need of organs from around the globe, is estimated at over $1 billion a year.

In response to international attention, state-run media depicts Chinese officials as equally outraged. Huang Jiefu, director of China’s Organ Donation and Transplantation Committee, declared the head transplant a “publicity stunt” claiming, “China absolutely does not allow this type of clinical trial to occur in the country.” Dismissing the possibility of clinical trials involving a human head transplant, he adding that such an experiment severely violates China’s ethical rules.

Canavero’s partner Ren Xiaoping, surgeon and professor at Harbin Medical University responded to critics saying, “It is inappropriate to call it a head transplant because it was only an experiment” and produced documentation of approval from the Human Research Ethics Board at Harbin Medical University and consent to use the bodies from families of the deceased.

Canavero came to Harbin because “China is investing in science and technology in order to make this a Chinese century…. China is doing something that people believe is impossible” and the surgery followed “a very detailed, carefully planned design that we made two years ago.” He belittled concerns of Western ethicists and medical professionals saying, “Bioethics as such is not a scientific discipline. It springs forth from other forms of ethical debates that permeated Western history, in particular in Judeo-Christian religions.”

In contrast to Canavero’s opinion, an entire edition  of the American Journal of Bioethics-Neuroscience (AJOB-Neuroscience) was devoted to discussions by all concerned of the problematic issues raised by head transplantation surgery. The AJOB-Neuroscience news blog, The Neuroethics Blog published a summary of the issue.

Emory University’s News Center also reported on the debate. Paul Root Wolpe, Professor of Bioethics and Director of the Emory Center for Ethics said, “[Canavero and Ren’s] lack of convincing evidential support and ethical sensitivity for such an ethically fraught and unprecedented surgical undertaking, all point to a kind of social and scientific tone-deafness that might have been avoided with a more scientifically and ethically rigorous, transparent, and collegial approach to the endeavor.”

A blog post from the international Journal of Medical Ethics related, “The medical community has resoundingly asserted that the procedure is extraordinarily unethical, given the current state of our medical technology and the unforeseen effects such a procedure might have on the patient, assuming the patient survived at all. Canavero… has not provided enough evidence to satisfy the rigors of academic research, raising serious doubt about his results.”

The author named several ethics documents that forbid dangerous therapies and experiments as well as many traditional formulations of medical ethics, such as the Hippocratic oath, that urge clinicians to only offer therapies where benefits exceed possible harms. He added, “Unfortunately, none of these documents are legally binding… If a researcher can simply travel to another country to perform techniques widely condemned by leading experts in their field, we need to seriously question whether or not our societies take respecting human value seriously.”

The strong evidence that China has engaged in forced organ donation from prisoners demonstrates how widely divergent its values are from internationally accepted medical and research ethics. As no legal method exists to stop such abuses, a strong international mechanism with which to prevent unethical medical practice and research is urgently required.