World's First Facial Transplant Generates Guarded Excitement

Nov. 30, 2005 — -- U.S. doctors said it was exciting to know that a partial face transplant had been completed in France, but cautioned against moving too quickly on offering the controversial and complex surgery.

French doctors said today that they had grafted a nose, lips and chin onto a 38-year-old woman disfigured by a dog bite, according to The Associated Press. The doctors involved in the surgery would not give any other information, but are holding a news conference on Friday to discuss the details.

Partial face transplant surgery involves taking full facial tissue from a living but brain-dead "beating-heart donor" and transplanting it to the patient. This technology has been available for years in the U.S., but development has been slowed by the ethical questions it raises, such as disfiguring the brain-dead donor.

Also, the AP reported that doctors did not try normal reconstructive surgery first on the woman, violating the advice of a French government ethics panel, a surgeon familiar with the case said Thursday.

Doctors have wondered whether transplants should be given to people who aren't at immediate risk of dying from their illness or injury -- as is often the case for patients who undergo hand transplants and pancreatic transplants -- because the drugs needed after surgery, known as immunosupressants, are extremely powerful and can cause numerous and sometimes life-threatening side effects.

"Where do you put a face transplant in that spectrum of things? It clearly falls into the non-lifesaving category, but would a person who doesn't have lips or a nose or any facial features from a burn be better off with a transplant than the way they are?" said Dr. Bruce Cunningham, director of the Division of Plastic and Reconstructive Surgery at the University of Minnesota and president of the American Society of Plastic Surgeons. "A lot of people would say that's a significant improvement."

What needs to be done, Cunningham said, is a series of facial transplants on patients who will be closely followed and cared for by a single, highly reputable medical center. Doing so would allow the center to track the benefits and limitations of such a surgery.

This is most likely to happen at the Cleveland Clinic, which has been trying to organize a facial transplant clinic. The clinic staff released a statement today about the French surgery saying they are committed to offering the procedure one day, but would offer it only for "patients who have exhausted all other means of conventional medical treatment."

John Barker, director of plastic surgery at University of Louisville, which also has been researching the procedure, said in a statement that the treatment could offer disfigured people a "new and potentially better option."

"This is an exciting development, and we will be following the outcome closely for the medical, psychological and ethical information that may be gained," he said.

Currently, a disfigured patient is treated using tissue from the patient's own face, or, if the damage is large and severe, tissue from elsewhere on the body, said Dr. Ian Jackson, director of the Providence Institute for Craniofacial and Reconstructive Surgery in Southfield, Mich.

However, the first option leaves more scarring and the second option often leaves discoloration.

Another option is skin grafting, a technique that simply replaces the skin and not the underlying muscle and connective tissue. But it usually creates a "quilt-like" facial appearance, with patchy areas and skin tightening.

With a donated facial transplant, however, the patient's face would look closer to a normal face, as long as the blood flow remains healthy. What remains to be discovered is whether full facial expression and skin sensation will be re-established. Also, as with most organ transplants, immunosupressant drugs are needed to prevent rejection.

But the medical technicalities aren't the biggest issue. A "beating-heart" donor is needed because muscle tissue can't be transplanted unless taken directly from a patient with bloodflow. But all organs are in short supply, with far more people needing organs than available.

"This is very exciting, but we have a lot to think about before we go full speed ahead with this," Jackson said.