United States scientists are preparing to perform the world’s first full-face transplant. The 24-hour operation involves lifting an entire face from a dead donor — including nose cartilage, nerves and muscles — and transferring them to someone hideously disfigured by burns or other injuries.
A team at the University of Louisville in Kentucky has submitted a 30-page request to the university’s ethics committee, New Scientist reports today.
Peter Butler, a surgeon at London’s Royal Free Hospital, called for a debate on the procedure in 2002. The Royal College of Surgeons urged caution and decided last year that, for the time being, the risks outweighed the possible benefits.
But John Barker, leader of the Louisville team, told New Scientist: ”Caution by itself will not get us any closer. If Christopher Columbus were cautious, I’d probably be speaking with a British accent.”
Faces have been replaced before. In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin.
There have been similar successes in the US and Australia. Hands have been transplanted, as well as thighs and knee bones, and a one-month-old baby girl survived a hand and arm transplant. Transplants of kidneys, lungs, hearts and other tissue are now routine: the only constraint is a shortage of donors.
But a full-face transplant — of the kind used on Nicolas Cage and John Travolta in the science-fiction thriller Face/Off — is a bigger challenge. More than 30 muscles are involved in facial movements — it takes 17 muscles simply to smile.
Surgeons would need to save not just the donor’s skin — from hairline to jawline and from ear to ear — but also the nose, mouth and lips, eyebrows and eyelids, subcutaneous fat, some of the muscles, the nasal substructure and the nerves.
Then they would have to painstakingly reconnect all of this to someone rendered almost unrecognisable by burns or scarring. The recipient would then require a lifetime’s supply of immunosuppressive drugs to maintain the new face.
Some burns victims have had more than 50 skin-graft operations to rebuild faces that they believe to be still hopelessly disfigured. Surgeons argue that whole-face transplants would produce better results.
New Scientist worked with a television company, Mentorn, and an animation firm to conduct a ”virtual transplant”, stretching the facial skin of a virtual donor over the bone structure of a virtual patient.
Appearance is dictated not just by skin, but by bone structure, and surgeons are not sure how closely a reconstructed face would resemble a donor’s at the end of the operation. The technical challenges are huge. So are the ethical dilemmas.
”The main problem in these people is coming to terms with their new appearance. And they’d have to come to terms with a new appearance anyway. So why are you doing it? If they have to come to terms with a new identity they may as well come to terms with their altered identity as with someone else’s identity,” said Peter Rowe, chairman of the ethical committee of the British Transplantation Society.
”Then there is the disfigurement of the potential donor. One has a duty to respect corpses. They were once living people and one should treat a corpse with respect. All these things are arguable, but they are likely to cause profound disquiet among a substantial sector of the population, we feel.” – Guardian Unlimited Â