title: The history of head transplantation: a review.
abstract: Since the turn of the last century, the prospect of head transplantation has captured the imagination of scientists and the general public. Recently, head transplant has regained attention in popular media, as neurosurgeons have proposed performing this procedure in 2017. Given the potential impact of such a procedure, we were interested in learning the history of the technical hurdles that need to be overcome, and determine if it is even technically possible to perform such a procedure on humans today.
  
  
  
  We conducted a historical review of available literature on the technical challenges and developments of head transplantation. The many social, psychological, ethical, religious, cultural, and legal questions of head transplantation were beyond the scope of this review.
  
  
  
  Our historical review identified the following important technical considerations related to performing a head transplant: maintenance of blood flow to an isolated brain via vessel anastomosis; availability of immunosuppressive agents; spinal anastomosis and fusion following cord transfection; pain control in the recipient. Several animal studies have demonstrated success in maintaining recipient cerebral perfusion and achieving immunosuppression. However, there is currently sparse evidence in favor of successful spinal anastomosis and fusion after transection. While recent publications by an Italian group offer novel approaches to this challenge, research on this topic has been sparse and hinges on procedures performed in animal models in the 1970s. How transferrable these older methods are to the human nervous system is unclear and warrants further exploration.
  
  
  
  Our review identified several important considerations related to performing a viable head transplantation. Besides the technical challenges that remain, there are important ethical issues to consider, such as exploitation of vulnerable patients and informed consent. Thus, besides the remaining technical challenges, these ethical issues will also need to be addressed before moving these studies to the clinic.
authors.affiliation: Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Nayan
authors.initials: N
authors.lastname: Lamba
authors.affiliation: Department of Neurosurgery, Greater Manchester Service Centre, Salford Royal Hospital, Salford, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Holsgrove
authors.affiliation: Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. M.L.D.Broekman-4@umcutrecht.nl.|Department of Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. M.L.D.Broekman-4@umcutrecht.nl.
authors.forename: Marike L
authors.initials: ML
authors.lastname: Broekman
mesh_terms: D000818:Animals; D006257:Head / Q000601:surgery*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects / Q000266:history / Q000379:methods* / Q000639:trends
keywords: Brain transplant; Cephalosomatic anastomosis; Head transplantation; Spinal cord fusion