Face transplant: Yes, it's possible - but is it right?
By Peter Gorner
CHICAGO TRIBUNE
Ethicists may find the idea unacceptable, but at least two U.S. medical centers are in the final phases of planning for a controversial new procedure: a face transplant.
Surgeons say they are ready to remove the face of a cadaver and stitch it onto an adult who has been severely disfigured by trauma, burns or tumors. The goal is helping people who often say they are shunned by society.
Doctors now try to reconstruct faces by transplanting tissue from other sites on the body in multiple operations - sometimes 120 or more separate surgeries - and by implanting prosthetic devices.
A face transplant would permit surgeons to mold an actual face and underlying tissue, which proponents say is closer to what nature intended. They want patients to regain the ability to eat, drink and communicate with others through the vast array of facial expressions that few people think about unless they are lost.
Critics note that face transplants won't save or prolong lives but will require recipients to take powerful and perhaps dangerous immunosuppressive drugs for the rest of their lives. Such drugs normally are given to organ-transplant recipients who otherwise would die.
And if the surgery goes wrong - if the body rejects the face, for example - the consequences could be dire.
"The risks to the patient are staggering. This is a terrible idea that should not be tried," said Arthur Caplan, chairman of bioethics at the University of Pennsylvania.
"It's time"
Transplant surgeons say the operation would allow the patient's face to move instead of being like an insensitive mask, which is often the case after skin grafts.
The new face would probably resemble a cross between the donor and recipient, depending on the amount of facial muscles used in the operation. A person's facial identity is mostly determined by the underlying skull, which would not be transplanted.
The surgeons say they can perform the surgery and are tired of being stymied by the squeamish.
"It's time to do face transplant. Technically, it could have been 10 years ago," said Dr. John H. Barker, director of plastic surgery research at the University of Louisville, which performed the nation's first hand transplant in 1999.
He is seeking permission from his institution to perform 10 face transplants, all on severely burned patients.
Ethicists say the risks are just too great. Given the potential problems - the possibility of tissue rejection, side effects of anti-rejection drugs, unforeseen psychological difficulties - a high price could be paid for the hope of looking normal.
"It's not certain that the transplant will provide a functioning or even partial-functioning face," Caplan said. "The drugs required are powerful, noxious and potentially life-threatening."
No one knows for sure how the body's immune system will react to a new face. If acute rejection occurs shortly after surgery, "the subject may die with the entire graft sloughing off his or her face," Caplan said.
"This surgery is not for vanity"
Transplant surgeons say such comments are made by individuals with no experience in this field. Their first "rescue strategy" would be to transplant another face; otherwise, they would revert to normal reconstruction procedures.
"It's essential that people understand this surgery is not for vanity. The people seeking facial transplants are isolated and desperate," said Dr. Maria Siemionow, director of plastic surgery research and training for the Cleveland Clinic Foundation.
In October, her institution became the first in the nation to give permission for face transplants and allowed her to start screening patients.
Some critics point out that a face transplant is not necessary to preserve life. But that objection has not prevented other types of transplants from being performed in various countries, including hand transplants, abdominal-wall transplants, a larynx transplant that enabled the recipient to speak and the first total tongue transplant.
