Iran J Public Health, Vol. 47, No.9, Sep 2018, pp.1231-1233 Editorial

Ethical, Social & Psychological Challenges of Head Transplantation in Human

*Dariush D. FARHUD 1,2 (Editor-in-Chief)

1. School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2. Dept. of Basic Sciences/Ethics, Iranian Academy of Medical Sciences, Tehran, Iran

*Correspondence to: Email: [email protected]

(Received 12 Jul 2017; accepted 20 Jul 2017)

Many people remember the story of Frankenstein This kind of was performed successfully by Mary Shelley published in 1818. It was a story on mice, dogs and monkeys (1) (Fig. 1). Sergio of an ambitious young scientist, linking the pieces Canavaro had claimed that he would go to trans- of dead bodies and actions related to them creat- plant the first head of human in 2017. He was ed an uncontrollable creature that overcame his supposed to transplant the head of a Russian creator. Readers found the story only as a myth subject with neuromuscular disease to the body and imagination of the writer. In twenty-first cen- of an individual with cerebral death (2). tury, with the development of medical technolo- Although successful progress of such is gies, the world of science will may witness the considered wonderful advance in medical scienc- realization of the dream. es and would change the life of human being, it Today, the transplant surgeries have common follows the important challenges in public health features (autograft, allograft, isograft, and xeno- such as psychological and ethical challenges. ). Head transplant is an advance surgery that Therefore, it is necessary to predict and control transplants the head of one organism to another. these challenges, primarily.

Fig. 1: Head transplant surgery on Mouse (3)

1231 Available at: http://ijph.tums.ac.ir Farhud: Ethical, Social & Psychological Challenges of Head …

The most important challenge in public health is Totally, it can be said that any change in body related to individual identity. Identity is a social identity is the greatest challenge for individual and psychological factor and it includes all atti- with head transplant. According to the viewpoint tudes, characteristics and feeling of a person that of some experts, head transplant with potential differentiates him/her from others and it com- effects on identity leads to the psychological dis- prises the “self” (4). Self-imagination is the im- orders like mood disorder, psychosis, suicide (8). portant factor that comprises identity. Various This perspective results from observation of pa- evidences advocate the close relationship be- tients with surgeries like hand, foot, heart, liver tween formation of identity and body image and transplant. Sex change operations in transsexual it is stated that body identity has a clear role in persons they present depression and other psy- emergence of cognition and personality (5). Self- chological disorders most commonly. imagination has a significant impact on self- There are also some ethical challenges in head esteem and life satisfaction (6). transplant surgeries that must be considered. Since the head is a symbol of individual identity, From the last decades, ethics was considered in in head transplant surgeries, the body is seen as a theories, hypothesis, social and religious discus- donor organ and the head as a recipient. Hence, sions and today is focused on four dealing with new organ may lead to significant fundamental principles: Autonomy, beneficence, challenges (7), that it changes cognition, skills, non-maleficence and justice (9, 10). In head character, behavior and personality. Inevitably, transplant, all of the principles will be considered. they may be confused about their identity. The first question is that: Is the beneficence of Since the cognition and personality depends on surgery is more than its maleficence? Is the au- the sensory/motor experiences that develop dur- tonomy of patients respected? And so on (Fig. 2). ing the growth period, the subjects with head Generally, the most important ethical challenges transplant may be faced with the new organ in head transplant are as followed: strangely (7). As the new organ provides new ca- - Respecting the fundamental principles of ethics (au- pabilities, the recipient may experience consider- tonomy, beneficence, non-maleficence and justice) able problems. There are various uncertainties. - Ensuring the brain death of the donor body For instance: the habit of walking, movement of - Considering the biological differences of receiver hands, gestures and lateralization. How do these and donor functions? How the new organ reacts to tics and - Transplantation must be based on the success of obsessions? Moreover, to which family does the operation, not the power and wealth of the donor new combination belong? and recipient.

Fig. 2: Prioritize the head transplant (11)

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- Considering the feelings of the donator’s fami- 2. Osborne H (2016). Sergio Canavero: Human ly, since, they will be faced with serious chal- head transplant on track for 2017 after spinal lenges about the living body. cord experiment on dog. Available at: www.ibtimes.co.uk. Accessed: 24 Dec 2016. - Preventing the possible abuse of these trans- 3. Ren XP, Ye YJ, Li PW, Shen ZL, Han KC, Song plants by the powerful and profiteers. Y (2015). Head transplantation in mouse Conclusion model. CNS Neurosci Ther, 21: 615- 618. 4. Leary MR, Tangney JP (2012). Self and identity. The medical world by being on the verge of realiz- New York: The Guilford Press. P. 73-74. ing a longtime dream adventure (head transplanta- 5. Kamps CL, Berman SL (2011). Body image & tion surgeries), should be ready for possible side identity formation: the role of identity distress. Revista Latiniamericana de Pdicologia, 43(2): 267- effects. The most common challenges are psycho- 277. logical, social and ethical challenges. In domain of 6. Dittmar H, Llyod B, Dogan S, Hallywell E, Ja- mental health, the increase of psychological disor- cobs N, Cramer H (2000). The body beauti- ders that result from individual identity confusion ful. Sex Roles, 42: 887-915. is to be considered. In domain of ethics, head 7. Pascalev A, Pascalev M, Giordano J (2016). transplant leads to different issues and hence, fun- Head transplants, personal identity and neu- damental principles of medical ethics are chal- roethics. , 9(1): 15-22. lenged. Therefore, the preparation of ethical codes 8. Cuoco JA, Davy JR (2016). Operation Franken- for these advances is absolutely necessary. stein: Ethical reflections of human head trans- plantation. Insights in Neurosurgery, 1(2): 9-11. Conflict of Interests 9. Farhud DD, Malmir M (2015).Viewpoints of Medical Ethics Department of Iranian Acad- None declared emy of Medical Science. Journal of Ethics in Sci-

ence & Technology, 10(4): 1-6 (In Persian). References 10. Farhud DD, Malmir M, Khanahmadi M (2015). Ethics and priority processing in community 1. Lamba N, Holsgrove D, Broekman M (2016). genetic. Iranian Journal of Medical Ethics and His- The history of head transplantation. Acta Neu- tory of Medicine, 8(5): 1-9 (In Persian). rochir, 158(12): 2239-2247. 11. Available from: www.themarysue.com.

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