For Face Transplant Patients, Selection Criteria Could Stiffen in Future

So while there are standard exclusion criteria for some forms of organ transplant -- for example, a patient in need of a liver may be denied a spot on the UNOS waiting list if he cannot abstain from alcohol for six months before surgery -- there are currently no such restrictions for face transplant candidates.

This makes is difficult to determine whether Maki, who has a past history of drug abuse, would normally fit the bill of an ideal organ recipient. By the same token, the world's first face transplant patient, Frenchwoman Isabelle Dinoire, in a much-publicized story, continued her smoking habit as her grafted tissue healed.

Face Transplants Only Option for Some Patients

Rather, facial transplant patients are largely selected by a process of elimination -- those patients for whom other surgeries have not worked.

"In my mind, facial transplants have to occur when traditional methods fail," said lead surgeon Dr. Bohdan Pomahac of Brigham and Women's Hospital in Boston at the Thursday press conference.

The extent of Maki's injuries, Pomahac said, certainly fulfilled this criterion. Pomahac was the burn surgeon on duty when Maki arrived in the Brigham and Women's Hospital emergency department after the accident that destroyed his face.

"He burned off his face, including nose, upper lip, roof of the mouth, et cetera," Pomahac said.

Indeed, Maki's injuries were so profound that 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.

As late as last year, Brigham and Women's had publicly stated that it would not perform this kind of transplant because of ethics guidelines that it created when face transplants first became a viable option. Citing the rigors and side effects of immunosuppressant therapy to prevent organ rejection, the hospital's old rules, now changed, would only allow a patient to receive a face transplant procedure if he or she already was using these drugs after a procedure such as a heart or kidney transplant.

However, doctors and ethicists have subsequently agreed the move was likely justified.

"It is hard for us to imagine how difficult it was for Jim. He feared going outside," Pomahac said. "I feel that we are here on a mission, using cutting-edge technology to restore patients' lives."

Future May Hold Stricter Face Transplant Guidelines

While finding a family who is willing to donate the face of their deceased loved on is still a challenging prerequisite for face transplant surgery, the number of patients involved in these surgeries is still small enough that large-scale selection criteria probably do not come into play.

Face Transplant Criteria Could Become More Stringent

While face transplant recipient candidates remain scarce, as of Thursday afternoon there were 102,137 Americans on the UNOS organ transplant waiting list. The number of available organs is far fewer, and many patients die before an organ becomes available.

"Solid organs for transplantation are extraordinarily scarce resources," said Rosamond Rhodes, director of Bioethics Education at the Mount Sinai School of Medicine in New York City.

"When one person is allocated an organ, someone else may die for lack of an organ. Consequently, it is critical to allocate the short supply justly," she said. "Because face transplantation is so new, the just allocation issue is not yet critical."

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