Coool...We may be doing face transplants in the near future

[BBFRN, BSN, PhD]

Sign me up...lol

http://www.courier-journal.com/localnews/2004/09/17ky/A1-face0917-8700.html

Doctors prepared to do face transplant

Team includes UofL researchers

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By Laura Ungar

[email protected]

The Courier-Journal

Even as ethicists and others raise concerns, a team of doctors from Louisville and the Netherlands says it is ready to perform a face transplant.

"There arrives a point in time when the procedure should simply be done. We submit that that time is now," the researchers wrote in an article scheduled for publication today in The American Journal of Bioethics.

The article, by the team from the University of Louisville and the University of Utrecht in the Netherlands, explores the ethical and psychological issues, and physical risks, involved in a transplant that would attach the face of a dead donor to someone with a severely disfigured face, such as the victim of a serious burn or accident.

Although researchers will not say when such a transplant would be done, they are taking steps toward the first operation, which would be considered clinical research.

In addition to seeking comments from peers, they have submitted an application to an institutional review board in the Netherlands and are almost ready to submit one to an independent board in the United States. The Louisville doctors said they would not perform the transplant without approval from one of the boards, which are designed to protect medical research subjects' rights.

The team has also evaluated several potential candidates for the transplant-in both the United States and the Netherlands-but has not yet found an "optimal" candidate, said Dr. John H. Barker, one of the article's authors and a member of the UofL/Utrecht team. They are not actively screening potential patients, he said, but do consider those who call.

"The people we're considering are people who have no other options," said Barker, director of plastic surgery research at UofL.

Not everyone believes the world is ready for such a transplant, however.

Members of another local team, a partnership of UofL, Jewish Hospital and Kleinert, Kutz Hand Care Center, do not think a transplant should be performed yet. Dr. Gordon Tobin, a member of that team, said ethical and other issues have not been fully explored, and there needs to be a more thorough understanding of the procedure by the public.

Nichola Rumsey of the University of the West of England, an expert in psychosocial issues in medicine, expressed similar sentiments in one of 14 essays written in reaction to the UofL/Utrecht article and published in the bioethics journal.

"Previous research and current understanding indicate that the psychological risks are more complex and extensive than the Louisville team suggest," she wrote. "I have no wish to minimize the distress experienced by many people with severe disfigurements, but to my mind, the current risk/benefit ratio ... is dubious at best."

But Osborne P. Wiggins, chairman of the UofL philosophy department and one of the authors of today's article, said researchers have gotten as far as they can without actually performing the procedure.

"Do we let the uncertainties and unknowns stop us and decide not to do it at all? Or do we go ahead and perform the procedure and learn the answers? We're willing to take the second option," Wiggins said.

Problems and benefits

Face transplants differ from other transplants because the face is an integral part of someone's identity, said the researchers, who helped write the article. "What is at stake," the researchers wrote, "is a person's self-image, social acceptability and a sense of normalcy as he or she subjectively experiences them."

The procedure involves removing a donor's skin and other tissue, putting it over the recipient's bone and cartilage and reconnecting it.

Researchers outlined some potential problems, such as misuse of the procedure. Aging rich people, for example, might seek a transplant for cosmetic improvements and criminals might want to conceal their identity, researchers said.

People getting such transplants would also face the same risks as other transplant recipients, such as the increased incidence of infection and cancer associated with immunosuppressive drugs.

Given such issues, Tobin said, doctors need to move forward carefully and methodically.

But the benefits are many, researchers said in the bioethics article. For example, transplants could restore facial expressions and sensory functions and improve people's psychological outlook. Besides Louisville, such transplants are being considered by teams in Cleveland, England and France.

"In a large number of cases facial disfigurement leads to depression, social isolation and even the risk of suicide," the UofL researchers wrote. "Restoring the abilities to make facial expressions, enjoy an aesthetically acceptable appearance and interact comfortably with others lends significant weight to the benefit side of the risk/benefit equation."

Experts disagree

But the other side of the equation weighs heavy too, some experts said.

Rumsey, the English researcher, wrote that potential recipients might have to wait a long time for suitable donors and might be tempted to put their lives on hold in the interim. They might also have to endure lots of media coverage, she said. Socially, she wrote, such a procedure might convey the notion that people can't live well with disfiguring conditions.

Carson Strong, of the University of Tennessee College of Medicine, wrote that two prominent professional committees-the Royal College of Surgeons of England and the French National Ethics Advisory Committee-have said that a face transplant should not be carried out now.

Strong said recipients would face the risk that their grafts could fail, making things worse.

But other experts agreed with UofL researchers that the time for a transplant is now.

"Our position is that face transplantation could now be performed," wrote three surgeons from Henri-Mondor Hospital in Paris. "The switch from `could' to `should' depends on the ethical conditions surrounding the procedure."

UofL researchers said they are considering all of the critiques as they move forward. They also have to take several additional steps, such as developing a program with Kentucky's organ procurement agency, developing a funding strategy and finding a full clinical team. The team also needs to find a hospital in which to perform the procedure.

Linda McGinity Jackson, vice president for public relations at Jewish Hospital, said there are no plans to let the UofL team do the procedure there. And Tobin said there are no plans to merge the two teams because of the differences in philosophy.

Tobin said he does believe that a face transplant is on the horizon. "It will be a positive contribution to the frontiers of medicine when the time is right," he said.

[CHATSDALE]

this could be a blessing for someone with severe burns or other disfigurement....those it would take a lot of thought and decision on part of pt & md as to who might benefit....i applaud those who research and rethink .. God bless them

[Shotzie]

...an interesting idea.

Many people will automatically be turned off by this but when you think of the devastation to a life that a badly burned face gives someone, it makes me think that a face transplant might not be such a bad thing.

When you examine the idea closely, the new face will not look exactly like the donor face. When you change the bone structure it will change the facial features. It's possible they could even use some of the facial plastic surgery techniques to make sure that family resemblences are kept (sharp cheekbones, slightly more prominent chin, round cheeks etc, etc).

[unknown99, BSN, RN]

I would like to keep my face, but have the body of say.... Jennifer Anniston or maybe Jennifer Lopez.

[RN4NICU, LPN, LVN]

That will be a blessing for sex offenders, escaped criminals, etc. who want to alter their appearance, wouldn't you say?

[hypnotic_nurse]

It would be awful for some burn patient to get a new face and then have it be rejected. I have to think that would be worse than the burns.

However, if it worked -- it would be like getting your life back. It would be so hard to face the world every day with a face that scares children. You could walk down the street with no stares, just one of the crowd.

I really don't think it would change the person's looks much from their original face -- you are just changing the skin on top (so maybe you'd have less wrinkles -- you can get the same thing with a facelift). So all those who want to start a new life would do better just to get a rhinoplasty or chin or cheek implants.

[BBFRN, BSN, PhD]

It would be awful for some burn patient to get a new face and then have it be rejected. I have to think that would be worse than the burns.

You have a really good point there.

I think this procedure will be a good thing to many people. We have worked with facial prostheses for some patients, and had really good emotional psychological outcomes with them. I don't know the exact criteria that will have to be met yet on the transplant pts. It does make sense that the facial features will remain close to the person's previous form.

[RN4NICU, LPN, LVN]

Wouldn't a face transplant change the underlying musculature as well? I'm wondering how deep they would go. Just transplanting the skin? Why not just graft - it seems like that would "take" better without having to knock out the immune system to prevent rejection.

I don't know - the whole idea is a little too sci-fi for me...

[MrsWampthang, BSN, RN]

I seem to remember John Travolta and Nicholas Cage in a movie called "Face Off" I believe. It was an interesting movie, but a little vulgar in places. Anyway, I think this procedure would be great for people with horribly disfiguring scars. I can't see how someone could simply get a face transplant to hide thier identity, that is already and option with plastic surgery anyway. I think if they limit the recipients to those that need it to reclaim a normal life then I'm all for it. JMHO.

Pam :)

[gwenith, BSN, RN]

There was a wonderful article in New Scientist a couple of months ago about this ( I will have a look to see if I can scare up the actual magazine). They showed a girl from India who had had her face ripped off by a threshing machine - the family travelled an mind boggling distance to get help (this is India we are talking about too). They reattached her face and it was successful but she has very little sensation in her face and cannot display full emotions. She is studying to be a nurse.

[RN4NICU, LPN, LVN]

They also reattached the face of that woman who was attacked by a mountain lion on a biking trail in CA. They are doing all this through plastics. She has several surgeries to go, and they are redoing the musculature to make it look more natural. She is looking so much better - it is amazing.