The risks of craniopagus twin separation surgery are great. In the 64 documented attempts since 1928, 32 twins died and 17 were neurologically impaired. In 2003, Iranian twins Laleh and Ladan Bijani died from surgical complications. They were successful lawyers before the procedure.
After thoroughly weighing the risks and benefits, the Italian twins' parents and the medical team decided to move forward with the procedure. The larger twin, who would be left without kidneys, would go on dialysis until she was strong enough for a transplant. And the risk of brain damage in the smaller twin would be minimized by doing the procedure in stages. The benefits of separation for both twins, both medical and otherwise, outweighed the risks.
But during the procedure, the surgeons noticed the layer of tissue covering the twins' brains was dangerously tight -- a twist that tipped the risk-benefit scale. The surgery was aborted, and both twins recovered.
"This is a compelling case; it's very dramatic," said Becker. "But I think it can be generalized, because everything we do potentially has effects on other people."
Becker said the nuances of the twins' case make it a good discussion point for ethics: The twins themselves could not consent; the medical and social risks and benefits for both babies were at times conflicting; the cost was exorbitant; and the outcome was uncertain.
"You can always cherry pick a success story of people who have stayed together or a success story of people who were separated, but that's not necessarily predictive of any one family," she said. "That's why having these discussions is so important."