Surgeon turns her back on Castro's `brain trade'

Cuba's transplant industy: World-renowned neuro-surgeon in revolt over her country's use of foetal tissue to earn hard currency

Cuba's most prominent brain surgeon, Dr Hilda Molina, has quit her clinic, the Communist Party and her parliamentary seat over the transplants of brain tissue from newly-aborted foetuses to dollar-paying foreigners with Parkinson's disease. She is now trying to leave the island, but has been refused exit permission and has been harassed and followed by security agents.

Dr Molina, 52, who is known worldwide as a pioneer in experimental transplants of foetal brain tissue, made her decision for two reasons. Like many Cubans encouraged by Fidel Castro to renounce theirCatholicism after his 1959 revolution, she has returned to her faith and believes abortion, not to mention foetal tampering, is unethical.

Second, the Cuban government and Communist Party, desperate for hard currency, wanted to turn the transplants into a "massive" dollar-earning industry for foreigners prepared to pay $15,000 to $20,000 for a foetal transplant, she said.

Foetuses up to 12 weeks old were used for Parkinson's victims because foetal brain cells continue to regenerate when transplanted, while those from adults or cadavers do not.

The women who had the state-paid abortions were not informed as to what would happen to their foetuses, Dr Molina told the Independent by telephone from her Havana home. The money-making aspect also raised the spectre of abortions being encouraged specifically to provide fresh brain tissue, she noted.

A Cuban-American doctor in Miami, Pedro Jose Greer, yesterday said that several young Cuban women had told him of abortions carried out on them without their knowledge when they lived in Cuba. "One 17-year-old was told after waking up that she had not only received an abortion but had had an intrauterine device (IUD) inserted. The doctor told her it was `for the betterment of society, to keep the population down'," said Dr Greer, assistant dean at the University of Miami School of Medicine.

Dr Greer said there was nothing to link the cases he mentioned directly with the foetal brain transplants carried out in Cuba. "But these raise the question: where are the foetuses going to be obtained?" he said. "Are we reverting back to Nazi Germany when human beings become less important than the scientific ends?"

Transplants of foetal brain cells have been going on for several years, notably in the United States, Sweden, Japan and even Britain, but only on an experimental research basis under strict controls monitored by hospital ethical committees. In Britain, the operations ceased after the country's most prominent researcher in the field, Professor Edward Hitchcock of the University of Birmingham, died in December 1993. Dr Molina knew Professor Hitchcock and exchanged research findings with him.

The transplant involves removing a tiny amount of brain tissue from a newly-aborted foetus and implanting it through a needle, using the so- called stereotactical method, into the basal ganglia part of the brain, which controls body movement. The new tissue is supposed to secrete the chemical dopamine. In Parkinson's victims, the cells that make dopamine appear to have died.

As a young medical student, Dr Molina rejected her chances of a lucrative career abroad and followed the precepts of Castro's revolution, becoming a Communist Party militant and dedicating herself to the idea of free health care for her fellow countrymen. The health system was one of President Castro's great successes, putting Cuba in the vanguard in several biomedical fields.

Pioneering neuro-transplants for paraplegics, quadraplegics and various brain disease victims, Dr Molina carried out Cuba's first transplant of foetal brain tissue for a Parkinson's victim in 1987. In 1989, she organised the founding of Havana's state-backed Inter- national Centre of Neurological Restoration (CIRN) and in 1993 was "elected" to Cuba's party-controlled National Assembly. The Communist Party had put her on the candidates' list for District 5 of Camaguey province as recognition for her achievements.

Between 1989 and last year, when she resigned from the clinic and all her party-related posts, she or her 32-year-old brain surgeon son Dr Roberto Quinones, now in exile in Argentina, carried out around 50 foetal brain transplants on Parkinson's victims.

Most were Cubans, but last year, as Mr Castro pushed the hard currency- earning "health tourism" policy, Public Health ministry, tourism and party officials insisted Dr Molina set aside 90 of her 180 beds for dollar- paying foreigners.

"We had carried out the operations under a strict internationally-agreed protocol, on carefully chosen cases, with tight controls and long-term monitoring of patients before and after," said Dr Molina. "Then officials of the Ministry of Public Health, of the [Communist] party and of Cubanacan [the Cuban tourist organisation, which has a special "health tourism" department] began putting pressure on me. They wanted me to perform more transplants, to turn it into a massive practice.

"I told them I had dedicated my life to the revolution, to helping my fellow Cubans for free, not to earning money from foreigners.

"From a scientific point of view, it was legal but it was still experimental. It could only be done with careful monitoring of patients. I heard Cubanacan officials were charging patients between $15,000 and $20,000."

Dr Molina was earning 550 pesos a month when she resigned. That's around $16 a month at black market rates, or pounds 120 a year.

Although she resigned late last year, Dr Molina decided to tell the Independent her story this week because of the harassment she has suffered, and the fact that the authorities have refused her request to visit Roberto, her only son, and her newly-born grandson in Buenos Aires. She admits that she can no longer tolerate the regime she served for three and a half decades and wants to emigrate, along with her ailing 76-year-old mother.

At Havana's Jose Marti international airport in May, when Roberto was leaving for a neurosurgery conference in Japan with his Argentine-born wife, he and Dr Molina, there to see them off, were harassed. He decided not to return and settled in Buenos Aires.

"After I resigned from everything, my mail began arriving opened. Invitations to medical congresses abroad never showed up," Dr Molina said. "They began watching me, sometimes following me home from church."

At the Midlands Centre for Neurosurgery and Neurology at the University of Birmingham, Dr Paul Byrne, who worked with Professor Hitchcock on foetal transplant research, said transplants had stopped after his death. "The question remains: does it work or not?" said Dr Byrne. "It's important to stress that it's still experimental. It's highly debated.

"Professor Hitchcock would go to the abortion clinics in Birmingham and dissect foetuses himself. I am a Catholic. I didn't like it. He obviously felt it was justified. But it raises the question: are you encouraging abortion?"

Dr Byrne said that some Parkinson's patients have improved considerably after undergoing foetal tissue transplants. "One patient who could hardly move is now playing tennis," he said. But he stressed that it was still not clear whether the foetal tissue had caused the improvement.