U.S. Cleared to Choose Face Transplant Patient

Feb. 6, 2006 — -- On this occasion, the French appear to have won the clinical contest -- albeit partially.

In the city of Amiens today, doctors presented 38-year-old Isabelle Dinoire to the media as the world's first beneficiary of a face transplant. It was an historic moment in the history of medical procedures, and the French doctors could not conceal their delight at the achievement.

With fine scar lines from her nose and cheekbones running down to her jaw that had been slightly obscured by makeup, Dinoire spoke movingly of how her face had been disfigured after she had been attacked by a dog. She also expressed her deep gratitude to the family who agreed to donate the face of a deceased loved one so that doctors could transplant the lower half to her face.

It seems churlish not to share in the celebration.

Yet many surgeons, medical ethicists and psychiatrists have cautioned against any rush for more face transplants. And, it seems, with good reason.

Here in the United States, there are medical centers where elite surgeons can now perform precisely the same operation as was done in France. In San Francisco, Houston, Louisville, Ky., and Cleveland, microsurgery specialists have all the skills needed to do so.

But these specialists acknowledge that a face transplant is much more than a surgical procedure.

Each center has been forced to undergo a rigorous ordeal of disclosure and discussion before an independent review board made up of medical experts, hospital administrators, ethicists and members of the public. All members of the board must be satisfied that any kind of experimental procedure is safe, appropriate and offers a life-extending outcome to recipients.

At Ohio's Cleveland Clinic, Dr. Maria Siemionow leads a surgical team that was recently cleared to move forward with selecting a patient who might benefit from a face transplant. But getting approval was an arduous process.

A fundamental question arises: Since facial disfigurement is not a life-threatening condition, is it appropriate to subject a patient to such a profound procedure? In an academic paper published in the Journal of Bioethics, Richard Huxtable and Julie Woodley draw attention to the fact that face transplants take relatively healthy individuals with facial disfigurement and transform them into morbidly ill individuals who must endure a toxic regimen of drugs, including immunosuppressants, for the rest of their lives.

Siemionow accepts that perhaps the greatest challenge comes after surgery.

"You have to take lifelong immunosuppression drugs. There are [possible] side effects -- infections, diabetes, necrosis of the bones, lymphoma. There can be harm to the kidney. And immunosuppression is a toxic regime," she said.

"The patient has to understand both the risks and benefits of taking these drugs. This is a lifelong commitment. Patient compliance is crucial," she added.

Guy Foucher, president of the International Federation of Hand Surgeons, has opposed hand transplants for those same reasons. He has said that a hand transplant would "transform a healthy, one-handed man into a sick man with two hands." He refuses to perform the procedure.

In the United Kingdom, the Royal College of Surgeons has called for a moratorium on face transplants while it grapples with the difficult ethical challenges. Here in the United States, Siemionow is trying to carefully select an appropriate patient. She says there is no timetable and there is no rush.

Meanwhile, all eyes are on Dinoire as she continues with her recovery.