Due to advancements and our constant endeavours in medical science, the idea of organ transplantation is not just a figment of imagination anymore. We have grown relatively accustomed to the method and the concept of organ transplantation. Transplants of solid organs such as kidneys, hearts, and livers, as well as the bone marrow, have become the life-saving procedures of choice for some diseases. The transplantation process gives the receiver a new chance at life. Usually, these transplant in India is roughly estimated to be around 15-20 lakhs.

Although organ transplantation has gained success, transplanting an entire human brain still seems a very far-fetched idea. The cells in our bodies undergo senescence which is defined as the gradual decline of functions. Neurons in our brains are not spared from senescence or the ageing process.

The brain is plastic which means it can learn and unlearn through creating new synapses plus breaking down existing synapses. Having said that, the brain’s gross size doesn’t necessarily increase; it is always learning and changing. Gradually with age, the rate at which new synapses are formed slows down. Also, the quality of the repair function of these synapses falls evidently. Therefore, the ageing of the brain inevitably leads to lower learning ability and memory. 

Is a brain transplant possible? 

To accomplish successful brain transplantation, the surgeons will need to join multiple tissues of the head in the receiver’s body with the muscles, ligaments, skin, bones, blood vessels, and most crucially, the nerves of the spinal cord. Transplanting a brain will involve severing the spinal cord, creating a significant challenge. The key step in making brain transplants possible would be the ability to connect nerve fibres from the transplanted brain to the native spinal cord. It would prove to be an arduous and challenging task. It is one of the main reasons why severe spinal cord injuries are greatly damaging and usually permanent.

Another fitting response that a brain transplant would be possible or not is the body’s immune responses. The immune response is nothing but our body’s way to protect itself against pathogens like bacteria, germs and viruses. All cells in organisms have their own cell membrane. These antigens are specified individually to individuals and if they come in contact with the immune cells of another body, basically the receiver, white blood cells/ leukocytes, the immune cells will recognise the antigens as foreign objects and habitually kill these cells as a result. This will lead to a full-blown immune response, and death might be inevitable due to the rejection of this new organ.

However, in other scenarios, various other organ transplant surgeries are performed on organs such as the heart and liver. Usually, the practitioners will have to perform immune compatibility checks and inject an immune-suppressor to the recipient to prevent organ rejection. There is very scarce knowledge about the antigens on brain cells/neurons, and therefore, it would be rather dangerous to authorise a brain transplant surgery. 

Many other valid concern factors make a brain transplant extremely challenging. For instance, there will be technical difficulties of reconnecting blood vessels within the central nervous system but also between the central nervous system and peripheral nervous system. Cell death will also create challenges during brain transplantation, as neurons are extremely delicate and sensitive to environmental changes. They could die due to insufficient oxygen supply during surgery. When these neurons die, the whole base of brain transplant will be deemed lost and unsuccessful as these dead neurons would also lose their synapses.

Still, some experts believe full head transplants that include the brain could be possible. One such surgeon is Dr Bruce Mathew, and he has suggested moving the entire spinal column along with the brain. This would get rid of the need to attach the brain to the new spine. 

As of today, no brain transplant has been conducted; thus, the cost of brain transplant in India is not known. However, it will cost a fortune since there are a number of processes and skills required. Whether it is a possibility or no, is something that we shall discover as time passes. Ethical concerns also stand in the way of brain transplants becoming a reality. Some believe it could save lives. The surgery could be an alternative for those with healthy brains but terminal illness elsewhere in the body. Others argue they go against human nature. Whether the donor’s transplant and memories will remain in the receiver’s new brain is something that we don’t know yet. There is also a pressing concern over the effect it would have on the mental health of those receiving this surgery, the brain diseases that it may lead to and the neurocritical care thus required. 

Sooner or later, the procedure would be imminent. However, under the prevailing circumstances, the first attempt would be unethical if it ever occurred. For this reason, the discussion over the preparation of proper ethical codes for this specific operation would be remarkably important. It would hold the chance to change the face of modern surgical advancements and bring in the new era, where what started out as fiction could be turned into reality.

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