For Face Transplant Patients, Selection Criteria Could Stiffen in Future

It's a procedure so rare that only a handful of surgeons worldwide have any experience with it. Patients are rarer still.

But as the number of successful face transplant surgeries inches ever higher, medical ethicists already are discussing how to make decisions on if and when patients should be eligible for the costly and complex procedure that some say represents the ultimate gift from a deceased donor's family.

The issue of face transplantation garnered renewed interest on Thursday, when James Maki, 59, the country's second-ever face transplant recipient, appeared before reporters and cameras gathered at Brigham and Women's Hospital in Boston.

VIDEO: James maki receives a partial face transplant.
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In 2005, Maki lost much of his face to burns when he fell on the electrified third rail of a Boston subway track. While the surgeries prior to the face transplant restored some function, he still was missing a nose and otherwise grossly disfigured.

Maki's first order of business in his first public appearance following the operation was to thank the widow of Joseph Helfgot, the deceased donor of his new face. Helfgot died last month after a heart transplant procedure.

"I want to say thank you to Susan and her husband Joseph for the gift they have given me. I will be forever grateful," Maki said. "I also want to thank the doctors and nurses who have given me a new chance to live my life. ... I now see this chance as a way to start fresh."

A month after the surgery, Maki's face still has not healed completely. Deep purple furrows run from the top of his newly replaced nose to the base of his reconstructed cheeks. He still has some trouble speaking, and he has yet to gain feeling in much of the new face. Still, he noted that he was pleased with the result of the surgery.

"My nose looks the same as my old nose," he told reporters.

The press conference took place shortly after Maki had met Susan Whitman-Helfgot for the very first time.

"Joseph's life ended too soon, but it is my great joy to meet Jim," Whitman-Helfgot said. "It is a miracle and a blessing."

When Is Face Transplant the Proper Choice?

But even now, as the world's total number of face transplant recipients stands at six, it is clear that there are differences when it comes to determining whether a patient is a viable candidate for a new face, as opposed to a liver, heart or other organ.

The United Network of Organ Sharing (UNOS) has no hard-and-fast rules when it comes to the lifestyle behaviors of those on the organ transplant waiting list, noted UNOS spokeswoman Mandy Claggett. However, the hospitals that put these patients on the waiting list often will create strict criteria on alcohol use, substance abuse or any factors that would suggest the patient would have difficulty adhering to the stringent regimen of anti-rejection drugs they would have to take for the rest of their lives.

"Most programs do exclude patients who are non-compliant or not adherent with medical therapy, and most exclude patients who continue to engage in the same behaviors that resulted in end-organ damage -- intravenous drug abuse, continued alcoholism, et cetera," said Dr. David Cronin, director of liver transplantation at Froedtert Memorial Lutheran Hospital in Milwaukee. "On the issue of face transplantation, I suspect that many of the candidates incurred their 'end-organ failure' from an accident or war-related injury."

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