TVP WEEKLY: How does a representative of science find herself in today's post-pandemic world, where science is constantly questioned? Conspiracy theories, self-appointed authorities - we have a crisis of confidence, probably the biggest in the history of medicine ?

BRANDY SCHILLACE: I am a science person, but also a historian—as a historian, nothing really surprises me. After all, the entire history of this science is actually a history of distrust of its discoveries, but also of the spread of half-truths. What happened during the pandemic COVID -19 is only a continuation of this, reinforced by the enormous political and social polarization of today.

Today, however, we are not going to talk about epidemics, but about transplants. I would never have thought that besides the Cold War space race, there was another rivalry between the U.S. and the USSR, and that was in the field of medicine …

Many people don't know that during the Cold War we hadn't only an outer space race, but also an inner space race. There were races about how medicine would work, how science would change the way we dealt with things, and also about transplantation. In my last book I describe the fierce competition in the field of medicine and transplantation and the importance of the first experiments in the Soviet Union. Remember that the greatest advances in medicine, the eradication of many diseases, and the spread of vaccination occurred after the Second World War. It was also the time of the first successful transplants, the first of which - a kidney transplant - took place in the USA in 1954. The first donor and the first recipient were identical twins, so the risk of rejection was limited. One brother donated a kidney to the other, but the operation performed by Dr. Joseph Murray involved enormous risks. Had this transplantation failed, it would have meant questioning the entire branch of medicine, even put an end to transplantation, or at best having to take a few steps back.

Why did the Russians create a two-headed dog in the 1950s? If it hadn't been captured on film, it would sound like ridiculous fakenews....

The quick, if flippant, answer: because they could. During the Cold War, the U.S. and USSR vied for supremacy of their ideology. And given the space race, the arms race, and the medical transplant race, it was thought that if your science won, then your ideology won. To win in science, to be the “first,” meant to prove that one's country was the best, that it was right, and that it would have a great future. As a result, all sorts of strange experiments were conducted to show the rest of the world who was the boss. The films about the two-headed dog were released in the West as scare tactics, as propaganda. The Russians claimed they had solved the problems of transplantation. Of course, they hadn’t; the transplants always failed because of immunological rejection — but the scientists in Russia, including Demikhov, who performed the operations on the two-headed dog, believed in grafting. They assumed that eventually, even without anti-rejection drugs, the new organs or limbs would ‘take.’ It didn’t work, but the U.S. didn’t know that. So the race continued.

And after a while, the Russians had imitators in the U.S. who wanted to catch up with them.

The protagonist of my book "Mr. Humble and Dr. Butcher" is the American transplantologist Dr. Robert White. He was an outstanding scientist who, as early as the 1960s and 1970s, set himself the goal of not only transplanting organs, but performing a "whole body transplant" of the human body. Although this still sounds like science fiction today, it is not necessarily that unrealistic. White wanted to help paralyzed patients who were functional only from the neck or chest up. He endeavored to provide them with a new body by means of a donor body. In doing so, he did not introduce the concept of a "head transplant" because, as a deeply religious Catholic, he recognized that the head is the carrier of the human being, the self and the soul. White knew that paralyzed people have shorter lives and eventually suffer from organ failure, and he wanted to help them live longer. He argued that his experiments could lead to people like paralyzed Stephen Hawking having a better quality of life. Therefore, he asked rhetorically, why do we deny such patients this right?

Towards the end of his scientific career, he even had a volunteer for his experiment.

He was approached by Craig Vitovitz, who was completely paralyzed. The operation never took place, there was no legal approval, and besides, the patient's organs began to die. But there's no guarantee that the surgery would work — or that getting a new body would actually improve or prolong life. White’s first experiments in the 1970s were successful — he transplanted the head of one monkey onto the body of another, and it lived. But only for 9 days. Could a human head survive indefinitely on the body of another human? Would it be rejected? Would the new hormones and processes in that body change the transplanted brain? We just don’t have the answers.

Dr. White, however, like the Russians, became famous for his controversial animal experiments. They were quite cruel, triggered a wave of protests, and the scientist was dubbed "Dr. Butcher"

Elon Musk is also presently being attacked for violating animal ethics rules with his neuralink experiments (more than 1,500 animals are said to have already been used for laboratory experiments in research on this technology, on whose brains implantable brain-machine interfaces were tested - editor's note)

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  White’s experiments may be difficult to understand by today’s standards, but he never violated the rules of professional conduct. But that does not mean there were no problems. Dr. White had a tendency to tangle with people with whom he disagreed. He felt that animal rights activists were threatening the future of patients, and he told them so. Loudly. And often. Similarly, groups in support of animal rights launched various offensives against Dr. White — including chasing his car in monkey costumes and even throwing a severed plastic head at him during a dinner party. I attempted to give a balanced view; Dr. White did save many lives (especially children’s lives) with his operations, which he first perfected on animals. But he also experimented on primates in ways we would consider inappropriate today. In the 1970s, monkeys were kept in small, isolated cages with no mental stimulation or exercise. Today, laws in the U.S. require that animals be kept in a more natural environment where they can engage in sufficient activity. We have these disputes between science and medicine to thank for that. But no matter how you look at it, it remains true that White cut off the heads of monkeys, isolated their brains, and kept the heads and brains alive without their bodies. Several hundred monkeys (I believe over 300). It is not surprising that PETA (People for the Ethical Treatment of Animals, an international non-profit organization that advocates for animal rights - editor's note) referred to him as Dr. Butcher.

Dr. White, like the aforementioned author of the first transplant, Joseph Murray, were Irish Americans and deeply religious Catholics. How did their worldview relate to their attempt to play the role of a demiurge, or rather... Dr. Frankenstein?

For Dr. White, there was no division between religion and science. He believed that his abilities as a surgeon and scientist came from God; he even went so far as to say that he was God’s own hands. There is, of course, a bit of hubris and ego in there, obviously. But because White was out to save lives, and because he believed the soul lived inside the brain, all his work (for him) was about saving “souls” We see the discrepancy (and I think it’s very obvious — that’s why the English title sounds a bit like Jekyll and Hyde). But Dr. White himself never saw this discrepancy.

What were his relations with the Vatican and his contribution to Roman Catholic medical ethics?

White played an important role in developing a new view of the Catholic Church on the issue of transplantation. He considered himself a personal friend of Pope Paul VI and the Holy Father John Paul II. The Polish Pope met with him in audiences and also invited White to become a member of the Pontifical Academy of Sciences to advise him personally on bioethics. It was White who advised the Church to recognize brain death as actual death (instead of the earlier definition based on respiratory arrest). He was also involved in the development of the Uniform Determination of Death Act, which was passed in the United States in 1981 to standardize the criteria for brain death. White proudly stated that he had developed a "definition of death"

Do we still have doubts about the definition of death? Are there clear criteria that determine when a body is ready for donation?

We have lots of concerns about the definition of death. As I write in my book, we have legal definitions of death but no unified medical definition of death. There are criteria such as coma, absence of brainstem reflexes, and apnea (inability to breathe on one's own, etc.), but these can still be subjective; someone has to interpret them. Therefore, there are different degrees— - depending on which country you live in, the parameters may be slightly different. At the same time, it must be stated that “you" as an individual have died when brainstem reflexes are no longer present. You will not come back, you will not wake up, the brain cells that are responsible for thinking and all the other things that make us who we are have died.

What controversies are emerging in today's debate about the ethics of transplantation?

Transplantation has been accompanied by controversy from the beginning. Take the infamous case of Bruce Tucker in the 1960s. Tucker was a black man, and his organs were taken in less than 24 hours (the usual time for trying to contact family) to save a white patient. The case went down in history and contributed to the laws we have today about when you can take an organ and what protocols must be followed. The fear that minorities would be sacrificed or that doctors would not try as hard to save a person if they wanted the organs was very real. Brain death is real, and the person is not coming back, but since we don’t have perfect means to measure and prove it, the debate remains. There are still ethical debates about what exactly can be done with a brain-dead body, but in general it is possible to harvest the organs and save other lives if it is an organ donor. Of course, it comes down to consent — and wishes. There is currently a great deal of controversy about whether brain-dead bodies can be used as incubators for embryos, and although there are many practical reasons why this would not work, the ethical condition remains paramount.

And what is the future of transplantation, what will be the next milestone?

I think the future lies in growing organs using STEM cells and also in the new possibilities of brain implant technology as explored by Brain Gate and the Functional Electrical Stimulation partners (Brown University, MIT, CWRU, the list goes on and on), as well as new ways of controlling prostheses through implants and stimulation. Another transplant on the horizon: uterine transplants.

What about xenotransplantation? The implantation of an organ from one animal species into another — it took a major step forward when a 57-year-old man with end-stage heart disease was transplanted with a genetically modified pig heart for the first time.

Pigs have been widely used for xeno transplant, especially heart valves. Much good has come of this, but an animal — no matter how close to a human — is still not the same as a human. Immunological rejection remains the greatest threat. But there's also the possibility of endogenous viruses infecting recipients (things that normally only affect animals but could now affect humans). In addition, there are ethical concerns about the distribution of animal organs. Who gets one? I wrote an article for WIRED magazine about a case in which a man was offered only pig organs because his physical condition was not considered the best — meaning you end up with a hierarchy of patients who are not considered “good” enough for a human heart and receive pig hearts instead. You can imagine that there will be issues of racial and economic inequalities in this, especially in countries like the U.S. where medical services are highly commercialized.

Will the story of these most advanced transplants have an epilogue? Perhaps it will be written by the famous Dr. Sergio Canavero, who has been announcing for years that he will transplant a human brain. The Italian neurosurgeon from the University of Turin declared a few years ago that he had transplanted the head of a dead man, and now announces that he will do so in a living patient.

Funny you should ask that; I just recently received an email from Dr. Canavero. He thinks he is on the verge of a breakthrough. But I don’t find that the details bear that out. By and large, body transplantation — even if it is technically possible — is not ethically defensible. The truth is that you could do such a transplant, but the person would have to take enormous doses of anti-rejection drugs, would remain paralysed and, if he or she survived the surgery, would not live long. At the same time, one would take a body donor and give all the organs to only one person. How can one justify such a thing when the waiting lists for organ transplants are already so long? Who decides, and what criteria are used to approve a body transplant? Even when White thought about it, the cost was in the millions; given inflation, only very wealthy people would even have a chance. I could say more: organ transplants have saved lives. We have learned a lot from experiments with heads and brains — perfusion procedures, brain metabolism, surgical techniques, and more. But putting a head into a new body would not only save or prolong one life, but potentially end several others (those on the transplant list). The epilogue, then, is: knowing you can do something has never been a substitute for understanding whether or not you should.

– interviewed Cezary Korycki

TVP WEEKLY. Editorial team and jornalists

Dr. Brandy Schillace is a medical historian and critically acclaimed author on the subject, including her most recent work translated into Polish, "Mr. Humble and Dr. Butcher: A Monkey's Head, the Pope's Neuroscientist, and the Quest to Transplant the Soul" („Doktor White i jego głowy, czyli śmiałe eksperymenty w transplantologii”). She worked in an English department, a historical department and for a journal of medical anthropology. For five years she was a research assistant in a medical museum. She is host of the Peculiar Book Club, a livestream community for authors and their readers, winner of the 2018 Arthur P. Sloan Science Foundation Award, and editor-in-chief of BMJ’s Medical Humanities Journal.