The reaction of ethical rejection

Is body transplantation acceptable?

Valery Spiridonov, RIA Novosti

In early 2015, Italian neurosurgeon Sergio Canavero made a sensational statement about his intention to perform a head transplant and launched a project called HEAVEN. According to Canavero, such an operation should primarily help people with cancer and muscle degeneration.

In addition to obvious technological and scientific problems, this operation has a number of ethical issues that generate contradictions in the scientific world and misunderstanding in society. Let's talk about the first ones first.

Immune rejection reaction and complications of immunosuppressive therapy

One of the main obstacles to head transplantation is the high probability of its immune rejection by the donor body.

To prevent this from happening, the patient will have to take large doses of immunosuppressants, which are highly toxic and which can provoke the development of cancer.

In addition, scientists have found that most patients who have undergone any kind of transplantation often pick up opportunistic infections, such as the re-awakening of cytomegalovirus, clostridium and herpes. Such operations are often associated with metabolic complications – hyperglycemia, hyperlipidemia and impaired renal function.

Therefore, the question arises: how justified is a head transplant operation in this case, provoking the inevitable development of complications, possibly incompatible with life?

Sergio Canavero believes that modern immunosuppressants at the initial stage of recovery after surgery contribute to the regeneration of the central nervous system and do not cause cancer complications after prolonged use. Different types of transplanted tissues have their own degree of rejection, and the most "xenophobic" at the same time is human skin. The head is only 8% of the body weight. Here it should be taken into account that in the case of head transplantation, the donor's body will reject it, and not vice versa.

The answer to this question can be found in the success of transplants of one of the parts of the head – her face. By 2015, doctors managed to carry out about 30 such operations, as well as transplanting over 100 hands and parts of hands.

The experience of these operations shows that transplanted body parts take root in the long term in 94% of cases and that they are rejected exclusively with incorrect immunosuppressive therapy.

According to the experts of the HEAVEN project, the developed method of combining immunosuppressants and their various methods of administration will allow achieving a "reboot" of the immune system with a further reduction in drug doses over several years.

Therefore, scientists believe that ideally, after a head transplant, a person does not need to receive drugs that prevent rejection for life, and, consequently, complications from their long-term use will not threaten the health and life of the patient.

Soul transplantation and personality changes? Psychological problems of transplantology

There are beliefs that the transplantation of the human body will inevitably cause changes in the personality of the recipient.

According to this concept, the human body contains particles of the soul, and after transplantation, the recipient will begin to show character traits and behavioral characteristics of the donor.

Supporters of this idea are particularly afraid of what may happen in cases where the bodies of executed criminals are used as donor material. In addition, it is morally difficult for a renewed person to realize and accept someone else's body, especially the body of a person with a criminal past.

Here they say that in the practice of transplantology there are cases when people could not come to terms with the presence of a foreign organ of an already deceased person and ended their lives by suicide.

From the point of view of science, such problems exist only at the level of the human psyche. For example, in the case of limb transplantation, accepting an alien hand as one's own requires a long psychological preparation. Therefore, transplant recipients should be carefully selected through clinical and psychiatric screening.

A person will not be able to control the body after surgery?

Most opponents of the operation agree that the existing transplantation technologies are not able to restore mobility and control over the body to a person, and the maximum that a person can feel in case of successful transplantation is his face.

Is the operation humane, which will make the subsequent life of a person unbearable?

According to Canavero, the solution to these problems lies in influencing the areas of the patient's brain responsible for self-perception. As he notes, modern cognitive research shows that a person's self–consciousness is just an illusion that can be changed at will.

Moreover, the existing technologies of immersive virtual reality (IVR – artificial reality, which is created in the human mind under the influence of technical systems) can make a person feel artificial or fictional limbs and teach him to control them.

For example, recently scientists were able to attach a rubber hand to the body of a volunteer with the complete illusion of feeling it as a part of the body.

The same applies to a head transplant, where the whole body is transplanted. In accordance with Canavero's plans, a few months before the actual operation, the IVR technology will be additionally used so that the recipient can get used to the new body. For maximum effect, hypnosis will also be involved in the process.

Religious controversies in matters of transplantation

In Italy itself, posthumous transplantation causes an ambiguous reaction, and the Catholic Church strongly condemns the practice of transplantation of human bodies after death. The Russian Orthodox Church, on the contrary, approves of sacrificing oneself or a part of one's body to another person as a manifestation of Christian love, which is even spelled out in the "Fundamentals of the Social Concept of the ROC."

Director of the Academician V.I. Shumakov National Research Center for Transplantation and Artificial Organs, Chief transplantologist of the Ministry of Health of the Russian Federation Sergey Gauthier comments on the general negative attitude of society to organ donation: "Compatriots simply do not want to understand that by refusing, they deprive several fellow citizens of hope for life. In a Christian way, and simply – is it human? I don't think. Unfortunately, neither the state nor the church, with the exception of some of its representatives, have until recently been engaged in explaining the ethical meaning of donation. But you have to start doing this almost from kindergarten, as in European countries."

Antiethical animal studies

Every year millions of animals are killed in the course of research, most of which have no prospects of application and are aimed only at publications in scientific publications.

At the same time, some of these studies have made a huge contribution to the development of medicine and have also opened up new opportunities in transplantology, including the work of Robert J. White and Vladimir Demikhov. Such exceptions include experiments with mice by South Korean scientists on gluing the spinal cord using bio–glue - polyethylene glycol (PEG).

It is with the help of PEG bioclay during the head transplant operation that it is planned to connect up to 30% of the nerve cells responsible for transmitting nerve impulses from the brain to the spinal cord.

Polyethylene glycol also has broad prospects for use by people who have suffered from an accident or have suffered industrial injuries.

Reproductive issues of donation ethics

It's hard to imagine what the relatives of the body donor will have to go through. How to accept that your loved one, whose brain has already died, will become just a serving part of someone else's head?

And if the new body is fully functional, the issue of planning future offspring is no less complicated. Such an operation should probably be accompanied by freezing of the recipient's germ cells and, possibly, even sterilization of the donor body in order to avoid unwanted heredity.

Sergio Canavero has a different point of view: "For me, this is not an option, and I will not support the "sterilization" of the donor's body. HEAVEN is a revitalization project that allows life to spread. But at the same time, HEAVEN is not a cure for infertility!"

Legislative regulation, facets of justice and the black market of transplantology

Performing head transplant operations raises a number of regulatory and legislative issues:

• How is it possible to regulate the queue for receiving a donor body and by what criteria?
• How to determine where the priority is in the transplantation of the whole body or individual organs to save the lives of several people?

Wang Yifang, a medical ethics expert from Peking University, believes that "using the body of a donor whose healthy organs could help several people just for the sake of one person is probably unfair."

In the Russian practice of transplantology, the receipt of donor organs is regulated according to the following criteria: compatibility of the donor organ and the potential recipient according to medical indicators, the vital importance of transplantation, as well as the duration of being on the waiting list. These criteria are taken into account consistently, based on the principle of fairness in the distribution of donor organs of medical bioethics.

In our case, it is likely that the criterion of the possible number of saved patients will be taken into account. Then the possibility of a head transplant probably won't get proper development without government support.

It turns out that head transplantation will be available only to the most affluent citizens, and not to those who really need it. Therefore, there are reasonable concerns about the emergence of a black market for the sale of people for body donation.

According to Sergey Gauthier, commercialization in this area should by no means be allowed – neither legally (as it is now), nor even at the level of discussions.

At the international level, the foundations for the observance of legality and justice in countries developing organ transplantation are defined in the Istanbul Declaration on Transplant Tourism and Organ Trade, adopted in 2008 without the participation of Russia.

Despite the fact that Russia was not officially invited to this meeting, the Russian professional community voluntarily follows the designated provisions. In Russia, the main mechanism regulating donation procedures is the federal law "On Donation of Human Organs and their Transplantation", which entered into force on January 1, 2016.

Portal "Eternal youth" http://vechnayamolodost.ru  22.08.2016