The French are Making Faces
Facial transplants. Just the thought might conjure images of science fiction and a certain 1990s movie starring Nicholas Cage and John Travolta. But the concept is now a medical reality, with a French hospital recently performing the world's sixth partial-face transplant. It was for a 30 year-old man who had been disfigured by a 2004 burn incident. His face was so injured that he felt it prevented any real social life. He had been on the organ waiting list for one year. The first partial-face transplant took place in France in 2005, for a woman whose nose, lips, chin, and cheeks had been severely damaged by her dog. As with this April's operation, the recipient's new face came from a brain-dead donor. The other operations happened in the US and China. In the case of the burn victim, the operation was a 30 hour ordeal, with the doctors working in teams. They replaced his scalp, forehead, nose, and ears, as well as his upper and lower eyelids. This means that, essentially, the French have carried out a full facial transplant, albeit it between two separate operations. "Now that we have realized this part, there's really not much point talking about the full face transplant anymore," said Professor Laurent Lantieri, who has performed three of the six facial transplants. "Technically, it is done. You transplant according to the patient's needs."
In addition to transplanting half of his face, the medical team gave the man two new hands that were attached above the wrists. According to the doctors, all relevant nerves, tendons, arteries, and veins were successfully reconnected. It was the first time that a face and two hands were transplanted simultaneously. The potential complications of facial transplants can be serious. While there is uncertainty about recipients' psychological and emotional reactions to receiving a new face, the known physical concerns range from tissue rejection to suicide. Tissue rejection is a fear with any kind of transplant, and with faces it is especially upsetting as the surgery cannot always be redone. There is the possibility that extreme tissue rejection will make eating and breathing very difficult. When this happens, the patient may feel even more ostracized than before, and consider ending a life that no longer seems worth living. There are immunosuppressive drugs aimed at preventing tissue rejection, but it has been suggested that such drugs might lead to cancer or other problems.
With life-enabling transplants involving the heart or liver, these risks are taken since the benefits of the transplant far outweigh them. Still, to someone whose face has been permanently disfigured, disease risk might be worth a second chance at feeling normal. Commentator Arthur Caplan, Ph.D. raises another point in his essay about the risks of facial transplants. What about the feelings of the donors and their families? Although many people are more than willing to donate their internal organs and tissues in the event of their death, do they understand that their faces might end up on someone else? And what about the donor's loved ones, who may eventually come face to face with a person that eerily resembles a deceased friend or relative? Does this lead to even deeper questions about transplants involving reproductive organs? Fortunately, in the meantime, situations like running into a recipient who looks just like their facial donor is unlikely. "You get a hybrid, something between the donor and the recipient. [But] what you get is more like the recipient than the donor," explained Professor Peter Butler of London's Royal Free Hospital, who hopes to be able to carry out a procedure that would include the throat and entire scalp within 12 months. Whatever the risks and downsides of face transplants, the ability itself is phenomenal, and could make all the difference in the lives of people who isolate themselves due to facial disfigurement.