Head Transplants

Brain injured

Perhaps you saw this on the news. I think I caught a glimpse of it somewhere but when it came up on my Twitter feed from Journal of Medical Ethics, I went and did a little digging. 

Fortunately New Scientist Magazine had carried an article on it. Sergio Canavero, Surgeon at the Turin Advanced Neuromodulation Group in Italy, first proposed the idea in 2013 and he now says it is completely possible by 2017. 

Canavero plans to announce the project at the annual conference of the American Academy of Neurological and Orthopaedic Surgeons (AANOS) in Annapolis, Maryland, in June 2015. 

I don’t even know what to say to this latest “Scientific research???  

Furthermore, Dr. Canavero is calling his new surgical strategy the HEAVEN procedure, which preserves brain function through hypothermia during the transplantation procedure, which is performed at cervical level C5/6. 

Basically doing a head transplant requires cooling the recipient’s head and the donor body to extend the time their cells can survive without oxygen. The tissue around the neck is dissected and the major blood vessels are linked using tiny tubes, before the spinal cords of each person are cut. 

Details will be presented at the conference in June however you IF you ARE interested in this you can read some of the details here.

Ethics

Transplanting living human heads onto new bodies raises extraordinary ethical questions. But so did a non-beating heart donor a few years ago. Canavero intends to use brain-dead organ donors to test the fusing of the spinal cord with Polyethylene glycol. 

Polyethylene glycol (PEG) is a polyether compound with many applications from industrial manufacturing to medicine.

Dr. Scripkoa neurologist and bioethicist with an interest in headache, traumatic brain injuries and concussions at Salinas Valley Hospital in California said that “many of the ethical implications related to the surgery depend on how you define human life. “I believe that what is specifically human is held within the higher cortex. If you modify that, then you are not the same human and you should question whether it is ethical. In this case, you’re not altering the cortex.” However, she adds that many cultures would not approve of the surgery because of their belief in a human soul that is not confined to the brain.”

So it all boils down to yes maybe it CAN be done, But SHOULD it be done? 

  • When does human life begin? 
  • Who should determine’s when someone is dead? 

You know my belief, life begins at conception and ends when true death occurs? It is not our choice but God’s. He is the author and finisher of life. The beginning and the end. True death occurs WHEN the soul leaves the body. 

Your eyes saw my unformed body; ALL the days ordained for me were written in your book before one of them came to be. Psalm 139:16

Vital organs need to be fresh and undamaged for transplantation. Vital organs (from the Latin vita, meaning life) include the heart, liver, lungs, kidneys and pancreas. In order to be suitable for transplant, they need to be removed from the donor before respiration and circulation cease.

We know that brain death is not true death. We know that without blood and oxygen the brain it starts to die within a few minutes. So I think we can conclude that in a head transplant the brain would need to alive with blood and oxygen flowing into both the donor and the recipient. As Dr. Canavero said doing a head transplant would require cooling the bodies of both donor and recipient to slow down cell death. 

My question is WHY is this cooling NOT being done in hospitals to prohibit the brain swelling after a traumatic brain injury? 

I posted on guidelines for treating trauma here and asked why hospitals aren’t doing it as a standard protocol? 

As I quoted from the Nova interview between Dr. Jamshid Ghajar: 

It’s a lot easier just to put the patient on the ventilator and then turn up the rate and then give them some drugs and come back next week and see how they’re doing. They’re lying there in a coma. They’re not screaming out for help. They’re not saying, “I’m in pain.” And so it would be quite easy to say, “Well, they have half a foot in the grave, why do anything else?” 

“That’s the real issue. I think if these patients were awake and saying, “Listen do something for me,” we’d be doing a lot more for them. But because they’re in a coma and they cannot speak for themselves, we’re treating them the way they are now.”

I find in unconscionable that we are on the verge of head transplants as a scientific reality and doctors can’t immediately use hypothermia to cool down the body and the brain of an injured person upon first entering the hospital. 

Dr. Jamshid Ghajar continued, “here are a lot of young people, children, especially, who are dying unnecessarily. These kids could live and have a very good quality of life, and they’re dying.

Flickr Photo Credit 

Happy Birthday Jamie,

Jamie Birthday Card

To say we miss you seems so trivial… I keep waiting for this “new normal” to happen that everyone says will happen. I’m not sure I really believe in that concept because our family is just NOT the same without you and dad and “Lily”.

I’m not sure I really believe in that concept because our family is just NOT the same without you and dad and “Lily”.

I think that is one of the hardest things for all of us, Christa, Matt, Andrew and Allyssa, is that the whole family being changed in such a short time has thrown us all off-balance.

It just doesn’t “feel” right, like being in a new family.

How is that normal?

All of us have grown closer if that was possible.

Life Lessons

 


I have learned that everyone who is living will experience loss and suffering and only then do people understand grief. Recently, I was visiting someone in the hospital and got to chatting with a family who was standing outside. They were going to see their 80-year old mother who had just lost her son. She was the sister and it was her brother who had died. The mother just could not handle the grief so they had to admit her.

I understood, but many people would have not understood how a 80-year old mother could be in such crippling grief over the loss of her 62-year-old son.

The first year you went to heaven I was completely numb and in shock.  When the numbness and shock wore off, I walked around dead or on auto-pilot. I did what I had to do, sold homes and read so many books on Heaven I could write one myself.

The second year I focused on writing your story to be able to help other families going through a traumatic situation. The book is finished and I am just waiting for a physician to finish editing the medical part. Working on the book and doing all the research allowed me to focus beyond my pain.

We are now in the third year and again I am going through ANOTHER transformation. In the book, You Can Heal Your Heart, by Louise Hay she says and I have found it to be profoundly true is that:

“Grief is the window that provides the opportunity to examine your primal thinking about relationships.”

When death invades a home, in the beginning friends, family, acquaintances rally around, bring food, text to check on you, call and do all the wonderful things to help you get through your loss. Then it stops, perhaps they think we are “over it” and we are “back to normal”.

Truthfully, what else could they do?

People have their own lives to live, with all of their own challenges.  But we are still HERE facing the days and nights without you and dad and bear. Life for someone grieving can be a very dark, and lonely place. There have been so many times where I had to beg God to give me the love and forgiveness He has for them and to heal my heart from the disappointments.

The joy I get is when I am helping and advocating for others in worse situations than me. Children who have been ripped out of the arms of their loving parents due to the crisis in medical kidnapping; parents whose children are suffering from cancer.  So heartbreaking and I can “feel” the pain and grief they are walking through.

So yes I am being shaken up on what is important in life and what does God want me to do to finish my race.

Celebrating Jamie Caulk

Jamie caulk on set at Lee University So here we are on your 31st birthday and even though you are not physically present you are still inspiring and motivating me to live life with a sensitivity to others. You were amazing at this and gifted in understanding when people were in pain.

One of the sweetest most inspiring letters we got about you was from this girl:

I guess five years ago or so I was at Starbucks completely utterly totally overwhelmed. I had been assaulted and had just found out that I was pregnant.

I had no clue what I was going to do. I went to Starbucks. And your brother was in line and he pulled me aside and asked if he could pray for me. He prayed for the life that was to be.

He prayed that I would have peace and that God’s grace and love would surround me. He looked at me and said “Be brave. God never gives us something we can’t handle. We serve a faithful and mighty God.”

I cried and cried to this complete stranger and poured my heart out of all the questions I had wondering where God was and how my plans had failed. And he looked at me without judgment and said “God’s plans are so much bigger than ours. You have to trust him. Your faith will get you through this!! Sometimes God has to take us through pain to get us back where we need to be. To make us remember that we are not in control and that He has this bigger and better plan than we could ever imagine.”

I cannot tell you what those words did for me. I now have a little girl and I cannot imagine my life without her. Never did I imagine my life like this but never would I change it.

I never got to thank your brother. He was a complete stranger to me and as far as I was concerned he was God’s messenger to me that day.

So even though I cannot thank him here on this earth I will get to thank him in eternity. And I wanted You to know how thankful I am for his life here on earth!!

 Jamie Caulk See you soon

Jesus says, in John 16:33 to “Be of good cheer”.  The new house is nearly ready for you. Moving day is coming. The dark winter is about to be magically transformed into spring. One day soon you will be home—for the first time.

Meanwhile, we on this dying Earth can relax and rejoice for our loved ones who are in the presence of Christ. As the apostle Paul tells us, though we naturally grieve at losing loved ones, we are not “to grieve like the rest of men, who have no hope” (1 Thessalonians 4:13). Our parting is not the end of our relationship, only an interruption. We have not “lost” them, because we know where they are. They are experiencing the joy of Christ’s presence in a place so wonderful that Christ called it Paradise. (excerpt from Randy Alcorn’s , book Heaven)

When I think of you which is every day, multiple times. I don’t look at the sky and clouds. I look around at our lake house, our home in Saline, the earth I am now living on and the places I visit.  I KNOW that one day we will all be together on the New Earth without the curse of sin and death and without the suffering and corruption of our political systems.

I take the advice you gave the young lady as my own from you, “God’s plans are so much bigger than ours. You have to trust him. Your faith will get you through this!!

Mostly I long for never having to say, good-bye again.

Happy Birthday “Jamo-Pup”, I love you to the moon and back,

Mom

Guidelines for treating brain trauma

Dr. Jamshid Ghajar, is a well-known neurosurgeon, president of the Brain Trauma Foundation, chief of Neurosurgery at New York’s Jamaica Hospital-Cornell trauma center and a practicing neurosurgeon at New York Hospital. In 1996, he saved the life of a woman who was savagely beaten in Manhattan’s Central Park using innovative neurosurgical procedures.

Interview on Treating Brain Trauma

I was interested in this interview because IF you or a loved one were ever in an accident and need medical attention you would have some understanding of what to ask about the hospital’s protocol.

This interview is from Nova and unfortunately I can’t get the audio to play on my Mac.

Nova: What’s a typical kind of place if you had a severe head injury and you ended up—what would they do?

I would say a sort of typical not very active trauma center would—you’d be put on a respirator. You would be given—you’d be hyperventilated, which means that they’d put you on the respirator and breathe you very rapidly. You would not have your brain pressure monitored. You may be given steroids, which have been shown to have no effect on head injury in terms of outcome. And you’d be given some drugs that cause you to lose a lot of fluids. And eventually you would lose so much fluids that your blood pressure would drop and you would die. More than half the people coming in that situation would die, and the rest of them would end up with significant disability.

Human Brain Synaptic GaspDr. Jamshid Ghajar did a survey with the Brain Trauma Foundation of 260 trauma centers throughout the United States that took care of severe head injury. And he asked them very basic questions like:

How many head injury patients do you see a month?

Do you monitor the pressure in the brain?

Do you treat brain swelling and so on?

And we found indeed there was a great deal of variability. And some of the treatments that were being used were—frankly, there was no scientific evidence supporting them, and in some cases could be deleterious.

So based on this and from my colleagues and my personal experience in talking around the country, we decided to develop guidelines.

What are the key parts of the guidelines?

Probably the key part is monitoring the brain pressure—the key part in treating patients with severe-head injury and trying to prevent the second injury—the first injury is the accident. You’re trying to prevent the second big injury. You’ve got a small piece of brain that’s been bruised and now this is being propagating. It’s going throughout the whole brain. You’re trying to prevent that from occurring. And the way to do that is diagnosis, which is monitoring the brain pressure, putting a tube in the brain and monitoring the pressure. Once you do that you get a number. Once you get that number you know how swollen the brain is, and then you do other things to try to prevent the brain from swelling even more.

How do you prevent the brain from swelling anymore? 

You have this fluid that the brain makes every single day, and it floats in it – the spinal fluid. The thing is to put this tube into the middle of the brain where the spinal fluid is made so that you can measure the pressure in the brain and if the pressure gets too high, you can just drain some of this fluid and relieve the swelling. We always put the tube into the front part of the brain.

One of the main problems is not having an adequate blood pressure in the brain.

Now, what does that mean? It means the brain is swollen.

It’s very high pressure, and you’ve got to get blood and oxygen into it. And if the blood pressure drops, you’re not going to get your oxygen and blood into the brain. The brain’s going to suffer even more injury.

It sounds like treating the brain injury is more work? 

There is more work on the part of the medical personnel.

There is more work.

It’s a lot easier just to put the patient on the ventilator and then turn up the rate and then give them some drugs and come back next week and see how they’re doing. They’re lying there in a coma. They’re not screaming out for help. They’re not saying, “I’m in pain.” And so it would be quite easy to say, “Well, they have half a foot in the grave, why do anything else?”

“That’s the real issue.

I think if these patients were awake and saying, “Listen do something for me,” we’d be doing a lot more for them.

But because they’re in a coma and they cannot speak for themselves, we’re treating them the way they are now.”

Resistance from Doctor’s.

Dr. Jamshid Ghajar was asked if he got any resistance when sharing the guidelines. His answer:

“I think when I talk privately to doctors, they say, “Yeah, I know about the evidence, but I still do what I do.” And there’s no rationale for it. And, you know, scientific data can be disputed. You can be controversial. In fact, the way we did the guidelines to show some evidence is stronger than others. But currently this is the best evidence we have.

Now, you can say, “I don’t believe the evidence. I believe the way I practice.” Well, that’s just not good science. And I don’t think the public wants to be exposed to this kind of variability.”

He continued, “here are a lot of young people, children, especially, who are dying unnecessarily. These kids could live and have a very good quality of life, and they’re dying.

I see it, the way they’re being treated. Kids more than adults are not having their brain pressure monitored and are being severely hyperventilated, having their blood pressure drop and so on. Kids can make a very good recovery, even better than adults. And what’s driving me is that there are deaths occurring every ten minutes as we’re talking. That a potentially salvageable patient that can go on and have a very good quality of life. We’re not talking about an 80-year-old or a 90-year-old with a stroke. We’re talking about a 15-year-old, a 14-year-old. Somebody who’s got the rest of their lives in front of them.”

Scientific Research Studies

Concussion Guidelines

Marked improvement in trauma centers when guidelines are followed. PDF

The entire interview with Dr. Jamshid Ghajar on Nova can be read here.

Ok, so what can we learn from this interview?

  1. There are guidelines and in many cases they are not being used.
  2. Many patients could have a good quality of life if they were treated.
  3. It is important to talk to your local hospital and find out what protocols they are using in the event you or a loved one has a brain injury caused by trauma.
  4. The fluid can be drained off the brain.
  5. That treating brain injuries is more work for the medical personnel.
  6. That fewer people would be pronounced “brain dead” if they were treated and not allowed to just lay there pumped full of drugs.
  7. That the secondary injury is “brain death” not the accident itself.

Flickr photo credit 

At least this is what I learned from the interview with Dr. Jamshid Ghajar, what did you learn?

The retreating boundaries of organ harvesting.

There is an article on Slate which questions when death is and WHO determines it. The author ends with this statement, “Modern medicine has brought us tremendous power. With that power comes responsibility. Boundaries such as death, heart stoppage, and ownership of organs have guided our moral thinking because they seem fixed in nature. Now we’ve unmoored them.

one domino at a time fallsThe author then goes on to state he is a registered donor because he believes in the gift of life, and that the job of providing organs falls to each of us. So does the job of deciding when and how we can rightly take them.

I would love to see that discussion.

Full disclosure as most of those who read my blog know…I believe life and death are NOT human decisions but one that only God can make. He gives life and He takes life away.

Dr. Robert Truog has been saying for years that taking organs from living people is causing death in the process. He has even gone to far as to call it a medical, legal fiction. (it is)

Dr. Truog believes that ethically it is OK to take organs from severely injured people as long as they have given informed consent via a life directive or a surrogate to be terminated (killed) in this way.

Informed Consent?

How is “informed consent” given by any person who signs up to be a donor? You can sign up online, on Facebook or at the Secretary of State or Department of Motor Vehicles. Are you given a pamphlet that talks about ANY of this? Have you been informed?

Since its inception, organ transplantation has been guided by the overarching ethical requirement known as the dead donor rule, which simply states that patients must be declared dead before the removal of any vital organs for transplantation. Before the development of modern critical care, the diagnosis of death was relatively straightforward: patients were dead when they were cold, blue, and stiff. 

The dead donor rule was accepted as a justification for pronouncing a person dead before harvesting organs.

If a family is told their child or loved one is brain dead, 99% of the time they do not question what is said or really even understand it. Nothing matters until it happens to you and then your eyes are open to the legal medical fiction.

In one sense, I agree with Dr. Troug I just don’t agree with his ultimate conclusion that it is OK to kill for organs IF you give permission.

Yes, the boundaries are retreating in organ donation

When Harvard first published their criteria in 1968, EEG’s were a part of the evaluation, then in 1971 the Minnesota criteria along and they decided patients didn’t need EEG’s because too many families got upset when they saw brain waves. Then the “Pittsburgh protocol” came along and they began to take organs not from “just” the “brain-dead” patient but from patients after cardiac death. Now in Denver they are waiting 75 sec for a babies heart to stop and then proceeding with organ harvesting.

Dr. Sam Parna’s book Erasing Death goes into the entire issue of the science of resuscitation.

As the author of the Slate article, Will Saletan states,

“Pick up the New England Journal of Medicine, and you’ll see the far edge of this tortured world. In the journal, doctors at the Denver Children’s Hospital describe how they removed hearts from infants 75 seconds  after their hearts stopped. The infants were declared dead of heart failure even as their hearts, in new bodies, resume ticking. The federal government funded the procedure; other hospitals are looking to adopt it.”

Be informed, discuss this with your families and friends. Know what you believe and why you believe it.

Brain injured patient’s need treatment quickly

Sanjay Varade, Neuro physician, just reported in Times of Indiamost brain injury patients get paralytic strokes as they are not brought for treatment on time.

Jamie CaulkWhen Jamie was injured in the auto accident the social worker told me on my way in route to Nashville that they got to him “in time.” Meaning his accident was close to Vanderbilt.

The accident happened at 3:30 A.M.Jamie was talking and responding. In fact he was talking until he crashed when they were getting ready to do a “procedure.” From the medical records they were inserting a chest tube.

This was at 9:00 A.M.

Five hours later.

The medical records state that he was agitated and complaining of a headache. They gave him fentanyl to keep him calm. We have talked many times in our family about Jamie being agitated. He was an athlete, he had no feeling in his legs. I would have been agitated too. I have read that in assessing a patient in trauma that it is important to find the reason for their agitation.

Did they ask him? Well, we will never know, right?

According to doctors, severe headache, sudden confusion in the head, blurring of vision in one or both the eyes, tingling sensation in the hands and legs, dizziness and inability to balance are the symptoms of brain haemorrhage or damage.

“If any injury to the brain is treated on time, then physical incapacity and death can be prevented.

Most patients suffer debilitating injuries or die due to late treatment.

According to the World Health Organisation, death due to injury to the brain is the third most common cause of death in the world. Around 36.2% of people under 40 years of age across the world suffer from brain injuries. But if the patient is treated within three to four hours, the chances of paralysis or death reduce,” claimed neurophysicians Sanjay Varade and Suhas Patil during the program.

Do you have any idea how hard it is to read this?

I was 7 hours away on my way down to Nashville when I got the call. I am not saying at that point they weren’t trying to help him. I will say after he went into the coma they gave “no hope” and were ONLY trying to get us to donate his organs.

Dr. Paul Byrne has told me over and over to “make sure the doctors are told to do EVERYTHING to protect and preserve their life.”

As many as 25 percent of all patients are harmed by medical mistakes. What’s even less known to the public is that over the past ten years, error rates have not come down, despite numerous efforts to make medical care safer. Makary, Martin (2012-09-18). Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care (Kindle Locations 61-63). Bloomsbury Publishing. Kindle Edition.