by Mary Roach
The killer, Andrew Lyons, shot a man in the head in September 1973 and left him brain-dead. When Lyons’s attorneys found out that the victim’s family had donated his heart for transplantation, they tried to use this in Lyons’s defense: If the heart was still beating at the time of surgery, they maintained, then how could it be that Lyons had killed him the day before? They tried to convince the jury that, technically speaking, Andrew Lyons hadn’t murdered the man, the organ recovery surgeon had. According to Stanford University heart transplant pioneer Norman Shumway, who testified in the case, the judge would have none of it. He informed the jury that the accepted criteria for death were those set forth by the Harvard committee, and that that should inform their decision. (Photographs of the victim’s brains “oozing from his skull,” to quote the San Francisco Chronicle, probably didn’t help Lyons’s case.) In the end, Lyons was convicted of murder. Based on the outcome of the case, California passed legislation making brain death the legal definition of death. Other states quickly followed suit.
Andrew Lyons’s defense attorney wasn’t the first person to cry murder when a transplant surgeon removed a heart from a brain-dead patient. In the earliest days of heart transplants, Shumway, the first U.S. surgeon to carry out the procedure, was continually harangued by the coroner in Santa Clara County, where he practiced. The coroner didn’t accept the brain-death concept of death and threatened that if Shumway went ahead with his plans to remove a beating heart from a brain-dead person and use it to save another person’s life, he would initiate murder charges. Though the coroner had no legal ground to stand on and Shumway went ahead anyway, the press gave it a vigorous chew. New York heart transplant surgeon Mehmet Oz recalls the Brooklyn district attorney around that time making the same threat. “He said he’d indict and arrest any heart transplant surgeon who went into his borough and harvested an organ.”
The worry, explained Oz, was that someday someone who wasn’t actually brain-dead was going to have his heart cut out. There exist certain rare medical conditions that can look, to the untrained or negligent eye, a lot like brain death, and the legal types didn’t trust the medical types to get it right. To a very, very small degree, they had reason to worry. Take, for example, the condition known as “locked-in state.” In one form of the disease, the nerves, from eyeballs to toes, suddenly and rather swiftly drop out of commission, with the result that the body is completely paralyzed, while the mind remains normal. The patient can hear what’s being said but has no way of communicating that he’s still in there, and that no, it’s definitely not okay to give his organs away for transplant. In severe cases, even the muscles that contract to change the size of the pupils no longer function. This is bad news, for a common test of brain death is to shine a light in the patient’s eyes to check for the reflexive contraction of the pupils. Typically, victims of locked-in state recover fully, provided no one has mistakenly wheeled them off to the OR to take out their heart.
Like the specter of live burial that plagued the French and German citizenry in the 1800s, the fear of live organ harvesting is almost completely without foundation. A simple EEG will prevent misdiagnosis of the locked-in state and conditions like it.
On a rational level, most people are comfortable with the concept of brain death and organ donation. But on an emotional level, they may have a harder time accepting it, particularly when they are being asked to accept it by a transplant counselor who would like them to okay the removal of a family member’s beating heart. Fifty-four percent of families asked refuse consent. “They can’t deal with the fear, however irrational, that the true end of their loved one will come when the heart is removed,” says Oz. That they, in effect, will have killed him.
Even heart transplant surgeons sometimes have trouble accepting the notion that the heart is nothing more than a pump. When I asked Oz where he thought the soul resided, he said. “I’ll confide in you that I don’t think it’s all in the brain. I have to believe that in many ways the core of our existence is in our heart.” Does that mean he thinks the brain-dead patient isn’t dead? “There’s no question that the heart without a brain is of no value. But life and death is not a binary system.” It’s a continuum. It makes sense, for many reasons, to draw the legal line at brain death, but that doesn’t mean it’s really a line. “In between life and death is a state of near-death, or pseudo-life. And most people don’t want what’s in between.”
If the heart of a brain-dead heart donor does contain something loftier than tissue and blood, some vestige of the spirit, then one could imagine that this vestige might travel along with the heart and set up housekeeping in the person who receives it. Oz once got a letter from a transplant patient who, shortly after receiving his new heart, began to experience what he could only imagine was some sort of contact with the consciousness of its previous owner. The patient, Michael “Med-O” Whitson, gave permission to quote the letter:
I write all this with respect for the possibility that rather than some kind of contact with the consciousness of my donor’s heart, these are merely hallucinations from the medications or my own projections. I know this is a very slippery slope….
What came to me in the first contact…was the horror of dying. The utter suddenness, shock, and surprise of it all…. The feeling of being ripped off and the dread of dying before your time…. This and two other incidents are by far the most terrifying experiences I have ever had….
What came to me on the second occasion was my donor’s experience of having his heart being cut out of his chest and transplanted. There was a profound sense of violation by a mysterious, omnipotent outside force….
…The third episode was quite different than the previous two. This time the consciousness of my donor’s heart was in the present tense…. He was struggling to figure out where he was, even what he was…. It was as if none of your senses worked…. An extremely frightening awareness of total dislocation…. As if you are reaching with your hands to grasp something…but every time you reach forward your fingers end up only clutching thin air.
Of course, one man named Med-O does not a scientific inquiry make. A step in that direction is a study carried out in 1991 by a team of Viennese surgeons and psychiatrists. They interviewed forty-seven heart transplant patients about whether they had noticed any changes in their personality that they thought were due to the influence of the new heart and its former owner. Forty-four of the forty-seven said no, although the authors, in the Viennese psychoanalytic tradition, took pains to point out that many of these people responded to the question with hostility or jokes, which, in Freudian theory, would indicate some level of denial about the issue.
The experiences of the three patients who answered yes were decidedly more prosaic than were Whitson’s. The first was a forty-five-year-old man who had received the heart of a seventeen-year-old boy and told the researchers. “I love to put on earphones and play loud music, something I never did before. A different car, a good stereo—those are my dreams now.” The other two were less specific. One said simply that the person who had owned his heart had been a calm person and that these feelings of calm had been “passed on” to him; another felt that he was living two people’s lives, replying to questions with “we” instead of “I,” but offered no details about the newly acquired personality or what sort of music he enjoyed.
For juicy details, we must turn to Paul Pearsall, the author of a book called The Heart’s Code (and another called Super Marital Sex and one called Superimmunity). Pearsall interviewed 140 heart transplant patients and presented quotes from five of them as evidence for the heart’s “cellular memory” and its influence on recipients of donated hearts. There was the woman who got the heart of a gay robber who was shot in the back, and suddenly began dressing in a more feminine manner and getting “shooting pains” in her back. There was another rendition of the middle-aged man with a teenage male heart who now feels compelled to “crank up the stereo and play loud rock-and-roll music”—which I had q
uickly come to see as the urban myth of heart transplantation. My out-and-out favorite was the woman who got a prostitute’s heart and suddenly began renting X-rated videos, demanding sex with her husband every night, and performing strip teases for him. Of course, if the woman knew that her new heart had come from a prostitute, this might have caused the changes in her behavior. Pearsall doesn’t mention whether the woman knew of her donor’s occupation (or, for that matter, whether he’d sent her a copy of Super Marital Sex before the interview).
Pearsall is not a doctor, or not, at least, one of the medical variety. He is a doctor of the variety that gets a Ph.D. and attaches it to his name on self-help book covers. I found his testimonials iffy as evidence of any sort of “cellular” memory, based as they are on crude and sometimes absurd stereotypes: that women become prostitutes because they want to have sex all day long, that gay men—gay robbers, no less—like to dress in feminine clothing. But bear in mind that I am, to quote item 13 of Pearsall’s Heart Energy Amplitude Test. “cynical and distrusting of others’ motives.”
Mehmet Oz, the transplant surgeon I spoke with, also got curious about the phenomenon of heart transplant patients’ claiming to experience memories belonging to their donors. “There was this one fellow,” he told me. “who said, ‘I know who gave me this heart.’ He gave me a detailed description of a young black woman who died in a car accident. ‘I see myself in the mirror with blood on my face and I taste French fries in my mouth. I see that I’m black and I was in this accident.’ It spooked me,” says Oz, “and so I went back and checked. The donor was an elderly white male.” Did he have other patients who claimed to experience their donor’s memories or to know something specific about their donor’s life? He did. “They’re all wrong.”
After I spoke to Oz, I tracked down three more articles on the psychological consequences of having someone else’s heart stitched into your chest. Fully half of all transplant patients, I found out, develop postoperative psychological problems of some sort. Rausch and Kneen described a man utterly terrified by the prospect of the transplant surgery, fearing that in giving up his heart he would lose his soul. Another paper presented the case of a patient who became convinced that he had been given a hen’s heart. No mention was made of why he might have come to believe this or whether he had been exposed to the writings of Robert Whytt, which actually might have provided some solace, pointing out, as they do, that a chicken heart can be made to beat on for several hours in the event of decapitation—always a plus.
The worry that one will take on traits of the heart donor is quite common, particularly when patients have received, or think that they have, a heart from a donor of a different gender or sexual orientation. According to a paper by James Tabler and Robert Frierson, recipients often wonder whether the donor “was promiscuous or oversexed, homosexual or bisexual, excessively masculine or feminine or afflicted with some sort of sexual dysfunction.” They spoke to a man who fantasized that his donor had had a sexual “reputation” and said he had no choice but to live up to it. Rausch and Kneen describe a forty-two-year-old firefighter who worried that his new heart, which had belonged to a woman, would make him less masculine and that his firehouse buddies would no longer accept him. (A male heart, Oz says, is in fact slightly different from a female heart. A heart surgeon can tell one from the other by looking at the ECG, because the intervals are slightly different. When you put a female heart into a man, it will continue to beat like a female heart. And vice versa.)
From reading a paper by Kraft, it would seem that when men believe their new hearts came from another man, they often believe this man to have been a stud and that some measure of this studliness has somehow been imparted to them. Nurses on transplant wards often remark that male transplant patients show a renewed interest in sex. One reported that a patient asked her to wear “something other than that shapeless scrub so he could see her breasts.” A post-op who had been impotent for seven years before the operation was found holding his penis and demonstrating an erection. Another nurse spoke of a man who left the fly of his pajamas unfastened to show her his penis. Conclude Tabler and Frierson, “This irrational but common belief that the recipient will somehow develop characteristics of the donor is generally transitory but may alter sexual patterns….” Let us hope that the man with the chicken heart was blessed with a patient and open-minded spouse.
The harvesting of H is winding down. The last organs to be taken, the kidneys, are being brought up and separated from the depths of her open torso. Her thorax and abdomen are filled with crushed ice, turned red from blood. “Cherry Sno-Kone,” I write in my notepad. It’s been almost four hours now, and H has begun to look more like a conventional cadaver, her skin dried and dulled at the edges of the incision.
The kidneys are placed in a blue plastic bowl with ice and perfusion fluid. A relief surgeon arrives for the final step of the recovery, cutting off pieces of veins and arteries to be included, like spare sweater buttons, along with the organs, in case the ones attached to them are too short to work with. A half hour later, the relief surgeon steps aside and the resident comes over to sew H up.
As he talks to Dr. Posselt about the stitching, the resident strokes the bank of fat along H’s incision with his gloved hand, then pats it twice, as though comforting her. When he turns back to his work, I ask him if it feels different to be working on a dead patient.
“Oh, yes,” he answers. “I mean, I would never use this kind of stitch.” He has begun stitching more widely spaced, comparatively crude loops, rather than the tight, hidden stitches used on the living.
I rephrase the question: Does it feel odd to perform surgery on someone who isn’t alive?
His answer is surprising. “The patient was alive.” I suppose surgeons are used to thinking about patients—particularly ones they’ve never met—as no more than what they see of them: open plots of organs. And as far as that goes, I guess you could say H was alive. Because of the cloths covering all but her opened torso, the young man never saw her face, didn’t know if she was male or female.
While the resident sews, a nurse picks stray danglies of skin and fat off the operating table with a pair of tongs and drops them inside the body cavity, as though H were a handy wastebasket. The nurse explains that this is done intentionally: “Anything not donated stays with her.” The jigsaw puzzle put back in its box.
The incision is complete, and a nurse washes H off and covers her with a blanket for the trip to the morgue. Out of habit or respect, he chooses a fresh one. The transplant coordinator, Von, and the nurse lift H onto a gurney. Von wheels H into an elevator and down a hallway to the morgue. The workers are behind a set of swinging doors, in a back room. “Can we leave this here?” Von shouts. H has become a “this.” We are instructed to wheel the gurney into the cooler, where it joins five others. H appears no different from the corpses already here.*
But H is different. She has made three sick people well. She has brought them extra time on earth. To be able, as a dead person, to make a gift of this magnitude is phenomenal. Most people don’t manage this sort of thing while they’re alive. Cadavers like H are the dead’s heroes.
It is astounding to me, and achingly sad, that with eighty thousand people on the waiting list for donated hearts and livers and kidneys, with sixteen a day dying there on that list, that more than half of the people in the position H’s family was in will say no, will choose to burn those organs or let them rot. We abide the surgeon’s scalpel to save our own lives, our loved ones’ lives, but not to save a stranger’s life. H has no heart, but heartless is the last thing you’d call her.
9
JUST A HEAD
Decapitation, reanimation, and the human head transplant
If you really wanted to know for sure that the human soul resides in the brain, you could cut off a man’s head and ask it. You would have to ask quickly, for the human brain cut off from its blood supply will slide into unconsciousness after ten or twelve seconds. You
would, further, have to instruct the man to answer with blinks, for, having been divorced from his lungs, he can pull no air through his larynx and thus can no longer speak. But it could be done. And if the man seemed more or less the same individual he was before you cut off his head, perhaps a little less calm, then you would know that indeed the self is there in the brain.
In Paris, in 1795, an experiment very much like this was nearly undertaken. Four years before, the guillotine had replaced the noose as the executioner’s official tool. The device was named after Dr. Joseph Ignace Guillotin, though he did not invent it. He merely lobbied for its use, on the grounds that the decapitating machine, as he preferred to call it, was an instantaneous, and thus more humane, way to kill.
And then he read this:
Do you know that it is not at all certain when a head is severed from the body by the guillotine that the feelings, personality and ego are instantaneously abolished…? Don’t you know that the seat of the feelings and appreciation is in the brain, that this seat of consciousness can continue to operate even when the circulation of the blood is cut off from the brain…? Thus, for as long as the brain retains its vital force the victim is aware of his existence. Remember that Haller insists that a head, having been removed from the shoulders of a man, grimaced horribly when a surgeon who was present stuck a finger into the rachidian canal…. Furthermore, credible witnesses have assured me that they have seen the teeth grind after the head has been separated from the trunk. And I am convinced that if the air could still circulate through the organs of the voice…these heads would speak….
…The guillotine is a terrible torture! We must return to hanging.
It was a letter, published in the November 9, 1795, Paris Moniteur (and reprinted in André Soubiran’s biography of Guillotin), written by the well-respected German anatomist S. T. Sömmering. Guillotin was horrified, the Paris medical community atwitter. Jean-Joseph Sue, the librarian at the Paris School of Medicine, came out in agreement with Sömmering, declaring his belief that the heads could see hear, smell, see, and think. He tried to convince his colleagues to undertake an experiment whereby “before the butchery of the victim,” a few of the unfortunate’s friends would arrange a code of eyelid or jaw movements which the head could use after the execution to indicate whether it was “fully conscious of [its] agony.” Sue’s colleagues in the medical community dismissed his idea as ghastly and absurd, and the experiment was not carried out. Nonetheless, the notion of the living head had made its way into the public consciousness and even popular literature. Below is a conversation between a pair of fictional executioners, in Alexandre Dumas’s Mille et Un Phantomes: