Theseus Ship and Organ Transplants

Theseus' Ship is an ancient Greek paradox. It is a paradox about the nature of being. The core question of this paradox is what creates 'something'? Is a thing's existence the result of the existence of its individual particles, or is a thing's existence the result of its essence (something non-physical, eg the perception of its being.) But I think I am getting ahead of myself. Let me first clarify what the paradox actually states. 

Imagine you are a royal ship maker and the king wants you to preserve a ship. So you do. But over the years, some of its parts need replacement so you replace those parts. This cycle continues until one day you realize you have replaced every part of the ship. The question now comes that is it still the same ship that you wanted to preserve, even though now it has none of its original parts. 

Is something a 'thing' because of the presence of its individual parts, or because of something non-physical? [I want you to answer this question right now in your mind and see if you can still stick to your answer till the end of this blog]

The first human organ transplant, stitching one person's internal organ to another's, happened on 23rd December 1954. The organ that was transplanted was a kidney. A singular kidney. Now, for a few moments, I want you to forget that you live in 2022, where it is almost routine to hear about organ transplants, and instead I want you to go back to 1954. You live an average life, a common man/woman and you have never heard of organ transplants. You have never imagined that your body can be cut open and then one of your vital organs can be swapped for someone else's. You believe your body is yours and your organs, the building blocks of your own body, are yours, so how can you be replaced by someone else's? You are 'you' because of the things, the organs, that make you up are your own, right? Imagine you live in 1954 and never heard of organ transplants. At best, if you were a little well-educated or perhaps if belonged to the medical community in 1954, you would have known about skin grafting. That was the limit of 'organ' transplants in 1954.

Philosophers, be it western or eastern, had always debated over what constitutes your self to be. What is a 'human being'? Is it a mind with a body? Or a body with a mind? Eastern religions and philosophies broadly believe the 'you' to be something called the 'soul'. 'You are a soul that changes bodies like one changes clothes', says Krishna of Hinduism. Similarly, Siddartha or Goutama Buddha of Buddhism says in his Jataka katha that he was born 99 times as different animals and only in the 100th birth did he get the birth of a human. However, the Western religions and philosophies defined 'you' as a dualistic being, you are as much of your body as much as you are your soul. 'You' is not your soul alone. 'You' are not a soul going through cycles of birth and re-birth in Christianity or Hellenistic religion. 'You' are your body and your soul, that will be judged only in the afterlife and instead of rebirth 'you' go either to heaven or hell. (A nugget piece of knowledge. In Christianity, tattooing is considered a sin, because you are polluting 'your' body. 'You' is as much about the body as it is about the soul in Christianity.)

You know what? Let me reframe the original question. Imagine you find a very beautiful ship and decide to look after it. But after a few years, you find some parts of the ship have been damaged. So you think let me replace just those parts, and you do so. After some years, the same problem appears and you apply the same solution yet again. This thing repeats until one day you are left with a ship that has none of the original parts that you wanted to look after. Is it still the same ship?

But wait, all these heaven and hell and all these are philosophical talks, things to ponder slowly over time. These are spiritual talks. What if you are a person of science? Perhaps you are a doctor. You haven't studied these loose definitions of 'being' and 'soul'. You have studied real hard science. You have studied thick books about blood vessels, bones, lymphatic and immune systems. You have a real job out there in the real world and you save real lives. But as much it is the part of a doctor's career to heal the living, it is also to declare the living as dead. Only a doctor writes a death certificate, not a monk or guru. So, when do declare someone dead? When the organs fail? Or when the soul leaves the body? 

Back to 1954. You still haven't heard of organ transplants, but might have heard of skin grafting; but even in that area, you have heard of often recipients' immune system not accepting the donor's skin, or even in some cases, the body does not even recognize it's own skin if taken from a different area. The body literally is detecting that something is wrong, something else is being grafted on me, this is not right, and so it rebels, or at least the immune system does. Your own body starts fighting 'you'. Knowing all these, will you, as a common man/woman in 1954 agree when a team of doctors proposes they want to try a kidney, a vital organ, transplant for the first time. What will your definition of 'self' be, if the operation succeeds? 

These are the exact questions that plagued the team of doctors in 1954 as they were about to do something for the first time in medical history. Sure, science previously had been stretched to its absolute limit and beyond, but this operation and its success were not only about science, it was about ethics and religion/philosophy too. In medical history, this was equal to Galileo stating the Earth does NOT revolve around the Sun, thus falsifying the Christian belief that Man is at the center of God's creation and the universe. If this operation was to be successful, it would imply 'you' are not your body. This would imply that 'you' can still exist without 'your' organs. 

Hey, wait again, have we strayed far from the original question again? Let me reframe it again. Imagine you have a ship-shaped Lego toy. You love it very much and it is very pretty. But one day, your brother breaks it apart and some of the pieces go under the bed. Unable to reach those pieces, you decide to take some other Lego pieces and rebuild it. Your brother does the same thing again and you again had to rebuild it using some more different pieces. This process continues for some time until you realize you no longer have your original favorite toy, it still is a Lego ship, but no longer with its original pieces. Do you still have the same toy?

During the fall months of 1953, Richard Herrick of Boston, USA was diagnosed with a failing kidney. By August 1954, he was barely able to walk. His distraught brother, Ronald Herrick, met with Richard's private physician, David Miller. Ronald persisted if there was any way, he could help his dying brother, he would do it. Was there nothing he could do? "Doctor, I'd give him one of my own kidneys if it would help" he said. Doctor Miller started explaining to him that a transplant like that won't work because Richard's body would reject his brother's kidney, but then he stopped mid-sentence. Richard and Ronald, he suddenly remembered, were identical twins, thus having similar immune systems, which makes it probable that Richard would survive the operation. What happened after that is recorded in glorious pages of medical history. The operation was a success and paved a new wave of medical revolution. What we now take as granted, or something as a normal operation, i.e., organ transplant, was once not only a medical problem but also a religious one.

Speaking of religious and medical problems, remember the other question I posed earlier? When do you declare someone dead as a doctor? As a man of hard science, when do you issue a death certificate? When the heart stops beating? Or when the brain stops running? Well, now in 2022 you all know the answer. Brain death is the sure sign of death and not organ failure. But once, this too was a problem; because fundamentally, up to 1968, even the scientific community hadn't settled on what the definition of a 'being' was. Was it a body with a mind (brain activity)? Or a mind with a body? And unless you define what a 'being' is, you cannot define what the absence of the being means, i.e., what death means. And this question was becoming more and more important to answer with new medical/ethical cases started emerging such as organ transplants, coma patients, psychologically ill patients, etc. So, in 1968, 14 years after the first organ transplant, a team of Harvard medical researchers settled this issue in a paper that they published titled "A Definition of Irreversible Coma". The conclusion of the paper was, 'brain death is the only sure of death of a person. This paper fixed, medically at least, the 'being' of a human being to its brain, its consciousness, and not its mechanical parts such as the beating heart or functioning lungs. After the publication of this paper, it was now medically ethical to take out the still-beating heart of a brain-dead patient and transplant it onto someone who is in need of it. Today, this might not seem like an important publication, but this, medically at least re-defined what death was, and therefore also defined what 'being' human was. 

But exactly how important was this defining of death? And how important was the organ transplant? Did they even change anything other than a few technicalities and scientific achievements? 

For a long time, crippled, or as now, with more acceptance of the condition we like to call it, the physically disabled or differently-abled were seen as sub-human. Physical perfection was once as important a factor in defining a perfect 'being' as was mental perfection. Historically, even colonizers justified slavery and racism due to them being of 'superior physical build'. But, now with the scientific re-centering of the 'being' to be at the brain, suddenly there was more acceptance of the differently-abled. There was more acceptance of life support devices like pace-maker when they came out, as it was now no longer seen as something making you a sub-human. Countless families agreed to organ transplants and had their patients live some more years in joy as it became no longer taboo to have organs donated or transplanted. 

The 'you' was no longer defined by what individual parts created you, the 'you' was now defined by your intelligence and brain activity.

Let me simplify the original question one last time. You don't have to imagine a ship. Not even a toy ship this time. Imagine a simple pocket knife, One with just two parts, a handle and a blade. After some years of use, you realize you need to replace the handle and you do so. But after some time you realize you also need to replace the rusty blade, so you do that as well. So now that you have replaced both the handle and the blade, do you still have the same knife?

And now that I have changed every word of the original question, do I still have the same paradox?

And do you still stick to your original answer to the question I asked in the beginning? Is something a 'thing' because of the presence of its individual parts, or because of something non-physical? No matter if you stick to your original answer or not, I hope now you have at least more clarity in your answer.

What are you, if your organs are transplanted? Do you become less of you? Or you are you as long as your head, your consciousness, your soul is intact. I hope throughout this blog, you also have found an answer to the much more difficult question (that many people avoid saying it's too philosophical or too boring) - are you a mind with a body or a body with a mind?

Personal Notes/PostScript 

Being a Bengali, Durga Pujo has been an obvious religious influence on me. But only recently had I thought deeply about this Ship of Theseus problem and able to link it with my own religious thoughts. Every year we bring in a new idol of the goddess Durga, made out of new clay, an entirely new material than the previous year because the same soil is obviously not used each year, but we still worship it with the same ritual and same devotion of heart year after year. The Goddess is the same to me each year, even if its constituting particles are different.

If you have still stuck around till the very end of this, I want to wholeheartedly thank you. Nothing brings me more joy than sharing my passion of writing with equally passionate readers. I would like to however mention that inspiration for such multi-dimensional projects involving different subjects like this one does not come from one singular source that I can study and copy down. Thus it takes me months, like this took me close to 3 months, to completely write, edit and structure a blog. You might have noticed that I changed the question of the ship of Theseus slowly through the blog until the new question had everything except its wordings different from the original question; just like the original Theseus Ship paradox. And also because I talked about organ transplants, I purposefully edited in a way to cut and merge two different sections, like medical history and topics of theology, into one coherent narrative, just like one person might be perfectly fine even with someone else's organ fit into them. Nothing brings me more joy than completing projects like this, so I would love to know what you think about this. Did you like it? :D 

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