The United Kingdom’s first voice-box transplant may be less than a year away after the Royal College of Surgeons gave its seal of approval for trials to take place.
A report by the college said the pioneering procedure could help people who had cancer of the larynx to speak and breathe normally again. The decision gives support to Martin Birchall, professor of laryngology at the University College London Ear Institute, who was the lead scientist involved in the groundbreaking 18-hour operation on a woman in the United States in October last year.
Brenda Charett Jensen had been able to communicate only with a hand-held electronic device for 11 years and breathed through a tracheotomy tube. Two weeks after the operation, she was able to speak her first words and can now talk normally. “This operation has restored my life,” she said. “I feel so blessed to have been given this opportunity. It is a miracle. I’m talking, talking, talking, which just amazes my family and friends.”
Birchall, who has two British patients lined up, said he could apply for funding to begin the complex operations in the UK early next year, given that he now had the backing of the Royal College of Surgeons. “It has given us the green light to apply to launch a programme. There is a difference between doing a one-off, as we did in California, and having a properly established programme,” said Birchall.
He believes there will be a growing need for the operation. “Patients are few and far between. But when you start doing something highly innovative — firstly, there are more patients than you realise, then the threshold drops as your experience grows. From liver transplants to advanced eye surgery, we have seen that happen.”
The backing of the Royal College of Surgeons is not a foregone conclusion, because the surgery is not life-saving but rather an improvement to people’s quality of life. That means the risks involved in the highly complex procedure and in the lifetime’s course of medicines to suppress the immune system have to be taken into account.
The Royal College of Surgeons’ report says that as many as 1?000 patients a year whose larynges have been destroyed in accidents or through cancer could benefit from the procedure. But some patients, such as those with recurrent or advanced cancers, would be unsuitable.
Further research is needed on nerve regeneration and care must be taken in the selection and aftercare of patients, the report warns. New surgical techniques and understanding of organ rejection had opened up exciting possibilities in transplantation, said Professor Tony Narula, chair of the group that produced the report.
“But just because something is possible, it doesn’t necessarily mean it is in the best interests of patients. When putting this procedure to trial, the medical team must meet the highest ethical standards and submit their plans to independent open scrutiny.”
Birchall said that the loss of the larynx removed “many things that make us quintessentially human, through loss of speech, swallowing and altered appearance”. He believes that embarking on highly innovative procedures brings benefits for medicine and society in general.
The change to Charett Jensen’s life had been clear, Birchall said. “One of the anti-rejection drugs is able to promote nerve regeneration. Her nerves healed at a rate more than twice the speed expected.” That could offer enormous gains for restoring the health of people who had suffered nerve damage to a leg or hand, he added.
A patient who receives a donated larynx will not have the voice of the dead donor, but may not have exactly their own original voice either. “It is unclear how the patient with a transplanted larynx will sound in comparison with his or her original voice quality,” states the report.
The larynx, which contains the vocal cords, comes from a donor but the nose and mouth, which form a resonating air chamber, are unchanged by surgery. A person’s accent comes from the interaction of the lips, cheeks, tongue and palate and would remain the same. —