Interview: Robert White, MD PhD
JR: Several of your initial papers at the BRL were about brain isolation and transplantation. I’m wondering why you thought that those surgeries seem not to have gotten as much popular press as the head transplant experiment, because those to me seem in some ways to be just as surprising.
RW: The isolated brain was where the brain was actually removed from the animal. It was first kept alive with a – well, you could call it a clone circulation in a way. That is, it was hooked up to the body of a perfectly normal monkey, sitting in a chair, and the brain was hooked up there, either in a bowl with cerebrospinal fluid, or just sitting out there. That was very exciting. As a matter of fact, Look magazine almost consumed an entire issue with an article on it.
JR: Did you get a lot of responses from that article?
RW: No, we didn’t get an awful lot. We had a full page picture of the isolated brain listening to a little frog-like cricket, when you clicked it, it made noise. The brain can hear that; we had electrodes over the temporal lobe and figured out where the hearing was located, and you could see the changes in the spikes of the EEG.
JR: Wait, how did that work, was the ear still intact?
RW: Yeah, we purposefully left the middle ear intact, and the ear nerve of course, the auditory nerve. We also on occasion have wired the optic nerve, and you can stimulate the optic nerve with an electrode system and then go back to the visual cortex and record it.
JR: So with those experiments, I can’t help wondering, what is that monkey thinking?
RW: Well, that’s a good point. You want to remember, one of the criticisms we got, even though in the early runs these isolated brains – and above all the transplanted brain – had an amazingly good EEG pattern, and some of them were read as fully activated and reflecting consciousness. But you want to remember, unless we had devised a system, there was no sensory input, these brains were not receiving any normal sensory input, because all the nerves were severed. And that’s the reason why we went ahead and I spent all this time drawing up this operation, went ahead to demonstrate what I prefer to call total body transplant, but you can call it transplanting the brain inside the head, because in that case, the cranial nerves are still attached to the preparation. You take two monkeys, A and B. You remove the head of B monkey, and you take A monkey’s head and you move it to B monkey, now you have an A/B monkey. Now when the anesthesia wears off, if you’ve done this operation properly, this head should awake, the brain should now be able to see, hear, taste, smell, and feel stimuli, feel pain. And of course, the first time that ever happened we were dancing on the ceiling and everything else.
JR: So you did that procedure several times through the late 1960s.
RW: Oh yeah, we didn’t do it once, we did it several times.
JR: So I’ve heard a story that when one of the monkeys woke up, it…
RW: Yeah, it almost bit the finger of one of the assistants, that’s right.
JR: Were you surprised that the head transplant worked? Because it seems like your work leading up to that was in some ways more difficult, technically.
RW: Right, the head transplant was in some ways much easier than the isolation, because it is for all practical purposes a neck operation. And under those circumstances, you’re not taking off all the tissues of the head and neck in a very careful way in order to get the brain out. No, there’s really no comparison between either transplanting the brain, or worse, isolating it. That is why these things have never even been duplicated because most of the time the preparation dies. And we had to have at least two, if not three neurosurgeons doing this operation together. That’s why, tragically, no one picked it up. But the head, the head is something that could be done, but unless the tetraplegic organizations and spinal cord injured organizations are in on it, it doesn’t seem to have much future either.
JR: So let me ask about that. One of the questions that I had, was if you found yourself in a situation where your body was failing and a working donor body or artificial perfusion unit was available, would you be willing to abandon your body for a life as a talking head?
RW: The answer for me would be no.
JR: No – ok, so you wouldn’t do it.
RW: No.
JR: And why is that?
RW: Well, first of all, at my age, what do I want to go on as a head on a machine?
JR: Well, I don’t know.
So you think in the future, a human head transplant might actually happen?
RW: Sure, if you think of everything that’s happened in 50 years, where are we going to be in 100 years? I think what you’re going to have first is limb transplants. I examined a guy relatively recently in Stuttgart, Germany who had a double hand transplant, and it was great. In France, they’ve done three face transplants. What’s limiting limb transplants is the nerves. It all comes back to the neural aspect, and what’s happening there is that you can get growth to some degree, but you can’t get complete growth, and that’s the limiting factor to putting a new leg or arm on. But it’s coming.
JR: But there are other problems too. The monkeys in the total body transplant experiment, they only lived a number of days, right?
RW: Oh yeah, the reason we did that. Well first of all, let me tell you – it was bad enough financially to do all the surgery and having all the support and all that sort of stuff. You have no idea the number of people we had to have working with us. But the idea was now, once the head/brain was transplanted or vice versa, you now had to set up an intensive care unit, which needed at least two people to be in constant attendance to this goofy A/B monkey in which you could suction it, clean it out, provide its medication, so on and so forth, and inject local anesthesia around the incision. I mean this was a massive undertaking. Well, the NIH at that time wasn’t interested in having us solve the question [of how to keep the monkey alive indefinitely] – and we couldn’t have because we had such busy practices, I mean this would take 26 hours a day to do it. So therefore, we had been funded just to do this thing that nobody else had done: to make sure that the damn thing could wake up and function. Now if we wanted to get into the world of immunological rejection and all this sort of stuff, tissue rejection, well back in those days that would be a really serious problem. If you think about it this would be a sort of operation that would be similar to a hand transplant – there’s so many tissues involved in the hand: nerves, bone, so on and so forth – well that’s the situation in your neck. So you see that would require a lot of investigation and a lot of help because you’d have to bring a group of people on in relationship to the idea of tissue rejection. And that would require a whole new – almost like oncology – a whole new group of people that would be responsible for handling this sort of thing for us. However, what we did note in those animals that lived several days, was that there was no evidence of rejection of the brain itself. One of the things we discovered in our work is that the brain is actually immunologically privileged – and that’s because of the blood brain barrier…Well how about that.
JR: So were you thinking of those monkey procedures as a “proof of concept”, where what you’re doing is proving that something is possible even if there’s more issues that need to be worked out – before it is performed on a human for example.
RW: Well, first of all, I think that the human surgery – say, for instance you want to do a body transplant for [Christopher] Reeve, for example. A justification – and this was given to me in London when I was speaking there some years ago by one of the doctors in the audience – and he said, as you well know, people that are tetraplegic do not live normal lives and they do not live as long as they would if they hadn’t been injured like this. And I agreed with him, I told him what you’re telling me is what I believe, and that is that the body is nothing more than a power pack for the brain. After all, you now determine when a person is dead when the brain is dead. What you do is go around grabbing all the organs in the body and put them in other people. In fact, I made a mistake once and mentioned to the Pope, Pope John Paul II, and said, “Well, with all these successes in transplantation, I’m wondering if maybe the soul actually resides in the brain.” And I thought this great man was going to fall down, so that was the last time I invaded theology. The whole situation here is that the surgery, because of the size of the vessels, would actually be easier to do, and the management would be easier. Remember that what you’re down to is that you end up a creating a human being – say an A or B human being who is the same as the A/B monkey, and under those circumstances, you’re creating something that’s nothing more than the tetraplegic that you started with. So all the physiology, and all the therapy that’s been worked out on managing completely transected tetraplegics, you’re just creating another tetraplegic. Well, in a sense you’re not, because one of them already existed. The only patient that would be appropriate now would be a tetraplegic who was undergoing total organ failure…his lungs, his kidneys, his liver – all these organs that are very sensitive in these people were failing, so what you do – you simply take a nice kid on a motor cycle who rammed his head into a wall and take the body and transplant it to the head of the quadriplegic.
JR: Ok, well it sounds like that would work.
RW: Well, you know, our friend Christopher Reeve died mainly of the problem that he was just doing too much and he got infections and so forth. You could have put his head on a new body, but he never wanted it.
JR: Did you ever ask him?
RW: No, no, no. Our problem with the spinal societies, some of which I used to run, is the simple fact that they want spinal cord regeneration. And you know, let’s hope and prey that it’s going to be done and can be done. But there may be a lot of mice running around laboratories in Boston, but I don’t see a lot of people running around. So I think it’s going to take many, many more years before they figure out how to do that. It turns out that the millions of fibers that you’ve got in your spinal cord, to my knowledge are not color-coded. So even if you can make them re-grow, how can you get them to grow into the proper ones?
JR: Culturally and bureaucratically, there’d probably be a lot of obstacles to a human head transplant.
RW: Well, you know people have come up to me and said why don’t you do this head transplant business, which would be a hell of a job to get administrative approval for here, but much easier to do it in China [laughs] or to do it in the [former] Soviet Union. Mainly because of the hand transplant success and the facial tissue transplant success, I think this would pass muster very simply, and the surgery would be even easier to do than it would be with animals. I’ve been offered opportunities to do it in Moscow and also in Kiev to do it. In order to even equip the laboratories, to set up a team of Russians, and to train them on all this stuff, the amount of work would be really incredible, but could be done. But the human part of it really isn’t as difficult as the animal part of it that still needs to be done, because we have not done the thing that you asked: how long will these animals live, and therefore how long will the human live following this transplant? So this whole broad area of immunology has to be worked out. The amount of work that you’d have to do in order to keep these people alive for the first few weeks would be monumental, but not impossible, because again, they’re nothing more than somebody that comes in off the roadway that has a fractured neck and is quadriplegic. In the end, it comes down to down to money. The Russians would be delighted to have me do this, the Chinese would be overwhelmed, but where is my eight million dollars, or whatever I need to set this thing up.
JR: Well, I wonder if there’s a rich quadriplegic somewhere…
RW: Well, that’s not impossible, and of course I’d much prefer – and I think it would be appropriate – for it to be done in this country. No, it’ll be done someday, there’s no question about it. You’re too young to realize the hullabaloo that went on in this country following the kidney transplant that was successful, heart transplants that were not successful, my God, then there was artificial hearts, I mean a monumental storm and controversy.