Ellen Ter Gast Ethics, Reflections

Just Like in the Movies: The Science and Fiction of Organ Transplantation

A transplant surgeon once asked me why people have so many doubts about becoming an organ donor. Why do they think organs transplantation is dangerous or immoral? I believe the main reason is that what they see on television and read on the Internet raises so many philosophical questions. For example, when I think of organ transplantation the first image that come into my mind it that of COMA. I saw this movie in the late 1970s as a young girl. It was the first thriller I saw, very exciting. The movie tells the story of healthy people who get into a COMA after undergoing a relatively simple surgical procedure. These COMA patients are moved to a special clinic where they are to receive proper medical care. But as the heroin of the story discovers, the Jefferson Institute is not a hospital, it is a repository of fresh, healthy human bodies whose organs are collected and traded on the black market.

The story, written in 1977 by Robin Cook, is a reflection of the developments in medical science at the time. A number of successful first organ transplants were performed in the late 1960s. One breakthrough followed another. The first successful heart transplant was performed in 1967 by the charismatic South African heart surgeon Christiaan Barnard. His patient, Louis Washansky, lived another 18 days after the procedure. He died of pneumonia. This medical breakthrough fueled fiction and wild fantasies.

“One need not be a science fiction writer to envision the possibility of future murder rings supplying healthy organs for black-market surgeons whose patients are unwilling to wait until natural sources have supplied the heart or liver or pancreas they need. More prosaically, shall people near death be allowed to sell their heart or liver to the highest bidder or shall the future use of such vital “spare parts” be decided by some agency set up by society ” wrote a New York Times commentator about Barnard’s revolutionary transplant.

In the years that followed, the techniques improved and with the discovery of cyclosporine in the early 1970s, organ transplantation became a more and more a common medical procedure. It radically changed the way we perceive the human body, and therefore human beings.

Transplant medicine, forced us to replace a holistic image of the body with a mechanistic image. The body changed from a unique entity into a  body made up of interchangeable parts. The body became a machine and organs become a commodity.

The fact that we can so easily replace body parts also raises a another philosophical question. How is the body related to the ‘I’, or the soul? Can you just take part of a body and transplant it to another body without affecting the identity of the recipient of the organ?

This question is older than transplant surgery. Take for example the silent movie Les Mains du Orlac from 1924. This movie narrates the story of a successful pianist who loses both his hands in an accident. His girlfriend cannot accept the loss and urges the doctor for a transplant. Coincidentally, a violent criminal was executed the same day so his hands are used. You can guess it, those hands lead a life of their own. These were the hands of a murderer. Orlac cannot control the hands (with which he cannot play the piano) and starts killing.

A more comical and absurd variation on this story is the halloween episode of The Simpsons Halloween Special IX, Hell Toupee. The story is similar to Mains du Orlac: serial killer Snake is executed and Homer Simpson gets a hair transplant that same day. He looks good, only the nerves from hair transplant grow under his skull to his brain and take control of Homer who suddenly behaves like a serial killer.

Here you can see how he wants to kill his own son with a sledge hammer. It is bizarre. It is funny. What do these fantasies, these horror stories tell us about how people feel about and think of organ transplantation?

Bruce Hood, professor of cognitive neuroscience at the University of Bristol, studied the effects of information about the donor’s moral character on the potential heart recipient. It made a huge difference. Most of the respondents did not want the heart of a rapist or serial killer. I fully understand this. It’s just not a nice idea that walk around with the heart of a rapist beating in your chest. According to Hood, we feel that way because we deep down believe that after a transplant we become a little bit like the other person.

 “Essentially they believe they will take somehow on those characteristics of the donor.”

I give you another example. Not fiction but a true story: Gary Gilmore. Gilmore was a serious criminal, convicted for multiple rape and even murder. He was sentenced to life for his actions. He did not like that. That is why he asked the American state to be executed. He wished to die in front of a firing squad. But he had one more wish. He also wanted to donate his organs. This happened in 1977. Someone got a kidney (the other was damaged by a bullet). Two others got his corneas. Strange thought? That’s also what Timothy Smith songwriter, singer of the punk band the Adverts, thought. He wrote a song about is:

I’m lying in a hospital,
I’m pinned against the bed.
A stethoscope upon my heart,
A hand against my head.
They’re peeling off the bandages.
I’m wincing in the light.
The nurse is looking anxious,
And she’s quivering in fright

I’m looking through Gary Gilmore’s eyes.

The doctors are avoiding me.
My vision is confused.
I listen to my earphones,
And I catch the evening news.
A murderer’s been killed,
And he donates his sight to science.
I’m locked into a private ward.
I realise that I must be

Looking through Gary Gilmore’s eyes.

Looking through Gary Gilmore’s eyes.

I smash the light in anger.
Push my bed against the door.
I close my lids across my eyes,
And wish to see no more.
The eye receives the messages,
And sends them to the brain.
No guarantee the stimuli must be perceived the same

When looking through Gary Gilmore’s eyes.

Gary don’t need his eyes to see.
Gary and his eyes have parted company.

These kinds of reflections go beyond biology. It’s about the relationship between body and personality. Body and identity. Organ transplant enables people to fuse. That simply must have an effect on the recipient. At least, that what some people, with no medical expertise think. There are plenty of high-profile cases of people claiming to have changed character after a transplant. Their  stories are weird and amazing and very entertaining!

Take for example, the remarkable story of Sonny Graham. Too good to be true one might say.  He married the 20 years younger widow of his heart donor. (When he got the heart he was married to another woman with children!) Several years after the wedding, he commits suicide with a firearm. Just like his heart donor did.

Would you like to hear more stories like this? Then watch Mindshock transplanting memories, a channel 4 documentary. The main message of this documentary is that the heart is also a carrier of memories. You hear two scientists, who come up with very plausible explanations.

The Daily Mail is always a source of good stories. The one about a woman who started reading Dostoevsky after her kidney transplant is my favourite. Other stories are about fast food, green peppers, sports. Alle these articles tell more or less the same story: it is difficult for the recipient of a donor organ to let go of the thought of the other. The other person whose heart is pumping your blood through your body.

That is exactly what the 21 grams is about.

The movie begins with the following image: Sean Penn lying in an hospital bed, holding a heart in glass jar in his hand. His own heart. Someone else’s beats in his chest. Even if you do not have a medical background, you can see clearly his heart was in dire need of replacement. It does not look healthy.

Anyway, with that new heart his life becomes an emotional roller coaster. He argues with his wife (he finds out she once had an abortion) and becomes obsessed with that new heart. He must and know who was the previous owner of his new heart. He hires a private investigator to find out who that person was. He learns that the heart belonged to happily married man with children. Killed in a car accident.

As soon as he discovers this, he starts chasing the widow. She is a nice woman, beautiful woman. He makes contact with her. The rest is easy to guess. I find the most dramatic scene when she lies with her head on his chest and listens to the beats of her deceased husband’s heart. The film does not have a happy ending. But I can recommend it. It is very relatable.

This I cannot say about Heart of a stranger ‘based on a true story’. This story is about a female piano player, who receives a heart from a young brash drunkard. After her operation she turns into a ruthless woman. With a lust for beer. The story on which the film is based is that of Claire Sylvia, allegedly her first words after the successful heart transplant were: “I am dying for a beer.”

She had never drunk beer in her life.

Ellen Ter Gast Ethics

The Anatomical Preparations of Frederik Ruysch: Art, Freak Show or Science?

The anatomical preparations by Frederik Ruysch (1638-1731) are part of the anatomical collection of the Academic Medical Centre in Leiden. They are centuries old. The material, body parts of deceased people, was prepared by Ruysch in the early 18th century. He often used the bodies of criminals, but also very young and stillborn children. Ruysch added all kinds of elements to the preparations, lace collars, bonnets, or even glass eyes. He turned them into true still lives. It is still a beautiful collection. The fact that these preparations, almost 400 years later, still look so good is due to the special embalming technique that Ruysch developed. As a result, his preparations have retained their natural color. The Russian Tsar Peter the Great was so impressed by Ruysch’s work that he bought almost the entire collection and had it shipped to Saint Petersburg. Through intervention of professor Albinus, a student of Ruysch, some of Ruysch’s preparations ended up in Leiden. Doctors and medical students can see them, but the general public cannot. When the Boerhaave Museum decided to exhibit them in 2015, this gave rise to ethical questions.

I was asked, what I, being a bioethicist, think of the public display of the preparations of anatomist Frederik Ruysch from the early 18th century.

The great thing about such an old preparation is that it is many things at the same time. First of all, it is a curiosity from the eighteenth century. Dressing up baby corpses and turning them into still lifes is not something we do nowadays. But it is also a story about the different moral values ​​of that time. For example, with today’s ethical standards, we would never be allowed to use the bodies of criminals or still born for art works. In the past, there was no such thing as a right to the integrity of the body. Deceased criminals could end up as a preparation without any problem. They lost the right of ownership of their body. We now have different ideas about these practices. Someone has to give permission for his body to be used after his death. This is what we refer to as informed consent in medical ethics.

Perhaps, the anatomical preparations played a role in the education of  doctors in earlier centuries, but this no longer the case. These preparations are of no educational value to today’s medical students. Nowadays, students learn a lot more about the human body by dissecting the bodies themselves. So that is not an argument for showing those preparations to young doctors, but not to the general public. You have to be consistent. Either you say, those (remnants of) people retroactively deserve the right to their physical integrity and therefore a grave. Or you say, we wouldn’t do that anymore, but these preparations are already here and they are too good to throw away.

In that case, I would choose to show those preparations to the public, especially to show their unique beauty. It’s real craftsmanship. I really like them a lot. They tell a story. I think those preparations deserve the label ‘art’. I know that I am moving on slippery ice now, because it is also about the definition of art. I will not go into that further now. I would be delighted if these preparations, which for years were only visible for a select group of medical professionals, now become part of the collection of a science museum and can be admired publicly. Though, I do have some issues with the plasticized corpses in Bodyworlds. These are recently acquired bodies. Where do these bodies come from? Did those people give their consent while they were alive? What did they get in return?