Face Transplant Patient Recovering Well, Surgeon Says

April 13, 2009— -- The surgeon who led the country's second-ever face transplant operation said that he and his team are "cautiously optimistic" over the recovery of the patient who underwent surgery Thursday.

On ABC's "Good Morning America," Dr. Bohdan Pomahac of Brigham and Women's Hospital in Boston said the patient, who has thus far chosen to keep his identity a secret, is recovering as expected following the 17-hour surgery to replace the front part of his face with that of a dead donor.

"So far he is doing very, very well," Pomahac said.

The surgery, which took place Thursday at Brigham and Women's Hospital in Boston, is the second face transplant operation performed in the United States and the seventh in the world.

There are hints that Brigham and Women's Hospital may have bent its previous rules on who could be considered a viable patient for the procedure -- but doctors and ethicists say the move was likely justified.

The patient was a man who required facial reconstruction after injuries he suffered in a severe traumatic accident, a Brigham and Women's Hospital spokesman said.

At a Friday press conference, Pomahac acknowledged that the patient had not undergone immunosuppressant therapy before the operation became necessary -- a deviation from the hospital's previously stated policy on facial transplantation.

As late as last year, the hospital had publicly stated that it would not perform this kind of transplant due to ethics guidelines that they created when face transplants first became a viable option. Citing the fact that immunosuppressants generally become a lifelong requirement -- with a host of possible side effects -- the hospital's old rules, now changed, would only allow a patient to receive a face transplant procedure if he or she was already using them after a procedure such as a heart or kidney transplant.

Immunosuppressant therapy -- a course of medication designed to ratchet down a patient's immune response -- is normally necessary in such operations to prevent the patient's body from rejecting the organs or tissues of the donor. Such therapy is crucial to the patient's survival, but it also comes with serious side effects, including an increased risk of infections.

At the press conference, Pomahac said that the hospital has obtained approval from an institutional review board -- a committee that reviews the ethics of medical procedures -- for performing the operation on patients not on immunosuppressants. He said that the hospital made the decision to liberalize the rule in order to help more patients in need.

"We felt it was a natural progression of the program to extend [the operation] to the patient who is not on immunosuppressants."

Still, immunosuppressant therapy is a significant commitment. Dr. Joseph McCarthy, director of the Institute of Reconstructive Plastic Surgery at New York University's Langone Medical Center, said that the side effects of immunosuppression may be an even weightier consideration than the surgery itself.

"You are really committing the patient to a lifetime of treatment to prevent rejection," he said. "You have to be absolutely convinced that no existing traditional surgery or techniques would give these patients the quality of life they need, and therefore you can justify starting a course of immunosuppressant medications."

Pomahac said that the patient is now on immunosuppressants, and likely will be for the forseeable future.

"The patient is now expected to take immunosuppressant medication for the rest of his life," he said. "There is nothing on the horizon, no major medical breakthrough that would suggest otherwise."

But he noted that the doses would likely be reduced as time progresses, which would likely come hand-in-hand with a reduction in side effects.