The Tartan

Everything had prepared Dr. Robert J. White for this surgery. As a child, his academic proclivity caught the attention of one of the brothers at his elementary school, who recommended he attend an elite preparatory military academy at St. Paul. But White would have to turn down the scholarship due to his parents’ adherence to giving all of their children equal opportunities. Instead, he was enrolled at DeLaSalle High School in Minneapolis where he elicited praise from his biology laboratory teacher who noticed the precision with which he removed the cranium of a frog. The teacher went so far as to remark that White should become a brain surgeon, a statement that seems prophetic in retrospect. In 1944, he was drafted into the U.S. Army, and when they viewed his academic record, they enlisted him as a lab technician. As a private, he began taking medical courses while running experiments and blood tests.

Fully funding his undergraduate education with scholarships and the GI Bill, White attended the College of St. Thomas to pursue an undergraduate degree. Convinced by a professor that his last year of studies would be better served at medical school, White ended his undergraduate career after three years ​​— earning an honorary Doctor of Science degree instead of a Bachelor of Science — and enrolled at the nearest medical school, the University of Minnesota, on a full scholarship. After a year at medical school, a professor noticed White’s acuity for neuroscience and urged him to attend Harvard Medical School, which he would transfer to, again on a full scholarship.

White completed his general surgical and neurosurgical training at Peter Bent Brigham Hospital and Children’s Hospital in Boston, the same hospital in which the first successful kidney transplant had been performed by Drs. Joseph Murray and David Hume in 1954. It was there that Dr. Donald Matson noticed White’s prodigious aptitude for neurosurgery and encouraged him to pursue the field as a career, and so he did, going on to pursue a neurosurgical fellowship at the Mayo Clinic.

Eventually, White became the Chief of Neurosurgery at the Metrohealth Hospital in Cleveland, Ohio, where he would go on to perform many of his experimental surgeries.

During White’s time, many physicians worked on the total isolation of individual organs, which taught them that organs can continue being viable under certain conditions despite being removed from the body. White was interested in doing the same to the brain. In the early 1960s, he kept the brain viable under deep hypothermic conditions, which allowed him to extend the time that a brain could survive without blood flow. This discovery came after the brain of a dog was removed, and connected to the blood vessels in the neck of another dog, which was then encased in a fabricated skin sac. Thus, a dog with two heads was born.

This experiment would allow White to pioneer a new surgical technique in which the amount of time surgeons have to operate on a human brain is extended from three to five minutes to one to two hours by lowering the temperature of the brain.

He employed this technique when he removed a life-threatening tumor from the brain of a patient in 1964. White cooled the brain into “suspended animation” at 11 degrees Celsius. With this technique, they were able to operate for over an hour without causing damage to the brain and central nervous system.

Then, on March 14, 1970, in a brain research lab at the Cleveland Metropolitan Hospital, White performed the first cephalic transplant on two rhesus monkeys. For the sake of simplicity, let’s call these two monkeys A and B. First, the two monkeys were anesthetized. They isolated the head of monkey B by severing the spinal cord. Monkey B would be sacrificed so that monkey A could live. All the vasculature of monkey B would be ligated while the carotid arteries and jugular veins would be directly sutured to those of monkey A, whose spinal cord had also been severed. Meanwhile, temporary blood vessels in the form of plastic coils were installed into the head of monkey A, tethering the head to the body.

One by one, a blood vessel from the head of monkey A was detached from the body and connected to those of monkey B, gradually removing the head of monkey B altogether. Once all blood vessels from the head of monkey A were connected to the body of monkey B, the surgeons waited for monkey A to awaken and to see if their work had come to fruition.

Monkey A did awaken, alive and in distress. The monkey was able to smell, hear, and see, but couldn’t breathe on its own due to the severing of the spinal cord and needed continuous mechanical respiratory support. And although the monkey couldn’t move its new body, it did endeavor to bite the finger of one of White’s colleagues. But it would only go on to live another eight days before the body rejected the head. This would mark the beginning of many more head transplants to come. White, a devout Catholic, would refer to these surgeries as total body transplants as he believed the brain was the home of the spirit.

Such a surgery would guarantee quadriplegia to anyone who underwent it as no doctor then or now could ever reconnect a severed spine. However, White believed this surgery could help patients with spinal cord injuries or progressive mobility diseases like amyotrophic lateral sclerosis (ALS). Of course, the goal of such surgery for these patients wouldn’t be for them to regain full body control, but rather to provide them with a new set of healthy organs. You see, patients suffering from progressive mobility diseases aren’t just stripped of normal bodily movement, they often face multi-organ failure and paralysis. It was White’s hope that with a full body transplant, a patient facing such issues could receive a new set of organs all at once, thereby prolonging their life.

Most of these surgeries were performed when bioethics was only just emerging, but even during White’s time, many protested against his work, calling his experimental surgeries cruel and unethical. Animal rights activists would refer to him as Dr. Butcher and call his home phone number. Even White called his work “Frankensteinian.” But despite facing direct threats to himself and his family, he never let it stop him from pushing the boundaries of neurosurgery and medicine and doing the work he believed would allow him to improve the lives of paraplegic patients. White argued that many of the medical advances we enjoy today are the result of decades of animal experimentation.

In 1968, the Harvard Medical School Ad Hoc Committee published its report on the definition of death based on neurological criteria. This new definition immediately faced backlash due to the fact that the withdrawal of care for brain-dead patients and the retrieval of organs for transplantation was now permissible. White advocated for the validity of death by neurological criteria, arguing that when the brain is dead, the person is dead.

A seasoned neurosurgeon, White’s work delved into cerebral hypothermia, isolation of the mammalian brain, and cephalic transplantation. His work revolutionized the medical field’s understanding of the human brain and propagated the field of medical ethics.