born with craniopagus parasiticus

The image displayed above is a real photograph of a 10-month-old Egyptian girl named Manar Maged who was born with craniopagus parasiticus, a very rare birth defect that develops when an embryo starts to split into identical twins but does not complete the process. Often the second, undeveloped twin forms as an extra limb or trunk, but in Magar's extremely unusual case it formed as a second head attached to her skull. The twin could blink and smile and respond to stimuli as with her twin but was not capable of independent life as the second head had no body with sufficient organs for life.

On 19 February 2005, Manar underwent a 13-hour operation performed by a 13-member surgical team to remove her conjoined twin.  Doctors waited until Manar Maged was around 10 months old before carrying out the operation of removing the second head from the baby. The operation took 13 hours and 13 doctors to complete and it could take up to 10 days before the baby is released from intensive care. A separate twin sister, Noora, is healthy after initial problems when she was born.

 As of mid-April 2005, Reuters reported that Manar had been transferred out of intensive care and was eating normally:

She has been transferred to ordinary care two weeks ago and she is showing good signs of improvement as she can eat normally without the aid of a tube," said Abla el-Alfy, a consultant in the paediatric intensive care at Benha Children's Hospital, north of Cairo.

She said Manar's mother was allowed to have direct contact with her baby after being separated for almost two months after the operation on Feb. 19.

"Manar is bonding well with her mother," Alfy said.

Doctors have said Manar's case was extremely rare and just surviving the operation was a big achievement.

"I think she will be able to leave hospital as soon as we feel that her mother is capable of taking care of her," said Alfy, adding that Maged's medication was being reduced.

The surgery caused her to bleed extensively because of a major blood vessel that had to be severed from the head.   Complications developed the day after the surgery, including unstable blood pressure, hypothermia, poor liver function and the blood not coagulating.   Her skull had been reconstructed during surgery and her skin had been joined over the bone, thus eliminating the need for further reconstructive surgery.

Manar is only one of about seven children ever born with this condition, the second to have her twin removed surgically, and the only one to survive. 

The operation was the first of its kind in the Middle East.


If the second head displays consciousness and awareness and responds to stimuli as does the first head is there a person there? The second head was living and growing just as the first.  They were growing for ten months.  They could continue to grow. Does removing the second head constitute killing a human being?  If so under what conditions would it be morally justified?

Was one person killed so that another person could live a more "normal " life?  Was one human being killed so that the other would not look "not normal" or "ugly"?


Report by Aviva Gluck (QCC, 2007)

Islaam (Manar's craniopagus parasiticus as it's called) yes she was named but not until burial, was a person, she had a brain and could think, and had she been able to grow up we would have definitely seen that.  However she didn't have a heart or lungs, but did breath on her own, so she actually put added strain on Manar's heart and lungs.  As a result of this Manar ended up in the hospital many times, and doctors knew that if Manar and Islaam stayed attached it would kill Manar.  So the surgery was not preformed because Islaam was seen as a parasite (which is what this is called in layman terms - parasitic twins), or because had they  stayed attached Manar would have had very limited movement in life, rather Islaam was causing severe health problems for Manar. Actually there was only one other documented case of twins like this that survived this surgery - and the twin with the body only survived a few hours past surgery.  So the doctors decided to operate (after consulting with religious leaders).  Manar survived the surgery but died 14 months later, a few days shy of her second birthday.

References gathered by Aviva Gluck (QCC, 2007)

Manar and Islaam Maged: