First Human Face Transplant

[Corals]

US doctors prepare for first human face transplant

· Clinic to select patient after getting go-ahead
· Critics warn of serious mental and medical risks
Dan Glaister in Los Angeles
Monday September 19, 2005


Guardian
Doctors at a US clinic will start interviewing potential recipients for the world's first face transplant in the next few weeks, after winning approval from the clinic's internal review board.

The medical team at the Cleveland Clinic in Ohio is led by Maria Siemionow, a 55-year-old surgeon who has spent years conducting research into face transplants, including experiments on animals and human cadavers.

"You want to choose patients who are really disfigured, not someone who has a little scar," she told Associated Press.

The procedure is intended to help patients whose faces are disfigured because of an accident or genetic fault. Many patients spend years enduring painful reconstructive surgery. It is a process that has been labelled "life by 1,000 cuts".

Proponents of face transplants argue that the procedure could remove the need for years of operations by applying a new sheet of skin in one operation. While the capability to perform face transplants has existed for years, nobody has attempted it. Teams of surgeons in Britain, France and the US have previously announced that they are close to performing face transplants, but concerns over the ethical implications of the procedure have halted or delayed their plans.

Although the Cleveland Clinic team has won approval from an internal review board, critics say an independent review board should determine whether the procedure can go ahead.

Last year a team at the University of Louisville in Kentucky, which had successfully transplanted a human hand, decided not to go ahead with face transplants after examining the ethical issues. "At stake is a person's self-image, social acceptability and sense of normalcy," wrote Osborne Wiggins, a philosophy professor and clinical investigator at the university, in the American Journal of Bioethics.

In the same journal, Carson Strong, a bioethicist at the University of Tennessee, wrote: "It would leave the patient with an extensive facial wound with potentially serious physical and psychological consequences."

But Dr Siemionow's team argues that the possible gains are worth the risk involved. "Really, who has the right to decide about the patient's quality of life?" she asked. "It's very important not to kind of scare society ... We will do our best to help the patient."

The operation is expected to last up to 24 hours hours. A "skin envelope" from a donor is attached to the recipient using one or two pairs of veins and arteries on either side of the face. About 20 nerve endings would also be attached.

The recipient should look similar to the way they did before the operation, the Cleveland Clinic tells potential donors and patients. This is because the skin is grafted on to existing bone and muscle, which determine the shape of a face. Similarly, expressions and facial characteristics are determined by the brain, and are not the product of facial tissue.

Other researchers suggest, however, that the final result will resemble a combination of the recipient and the donor.

Opponents are most concerned about the possibility of rejection of the transplanted tissue and cultural and ethical problems. They are also concerned that the procedure, if successful, could be exploited for cosmetic surgery. Should the recipient's body reject the transplant, it raises the possibility that the patient will be left worse off than before.

Many critics also question whether a person already traumatised by facial disfigurement would be equipped to cope. Although the Cleveland Clinic tells prospective recipients that it will do its best to shield their identity, it concedes that the press will probably discover it. The clinic also tells patients that the risks are so unknown it does not think informed consent is possible.

Dr Siemionow and her team expect to interview five men and seven women in the coming weeks. But she warned that applicants should not have unrealistic expectations about the results.

"It's not a shopping mall," she said. "They need to rely on our judgment. If they are starting to shop, they are not good candidates."

How the operation works

How would doctors carry out a face transplant? Read more

http://www.guardian.co.uk/medicine/s...573301,00.html

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Wow! I do agree on the point that such a procedure could be exploited for cosmetic surgery. Can you imagine that happening?

[saraphen]

I saw this in the news. I have seen people so grossly disfigured by accidents, fire, explosions, etc. It would be a blessing for them to be able to live without people staring at them. But I'm sure somebody would exploit this....like that movie with Nicolas Cage where he changed faces....Face/Off

[Chelbe]

This sounds very risky. I can also see how this could have its advantages and disadvantages. Maybe I read over this part, but I wonder who qualifies as a donor.

[saraphen]

Originally Posted by Chelbe

This sounds very risky. I can also see how this could have its advantages and disadvantages. Maybe I read over this part, but I wonder who qualifies as a donor.

I checked off "organ donor" on my Driver's License. But I don't want somebody going around with my face after I'm dead.

[DBlack]

Originally Posted by saraphen

I checked off "organ donor" on my Driver's License. But I don't want somebody going around with my face after I'm dead.

LOL, yeah that would be a trip. Just imagine if someone that knew you saw this person in a photo or even worse, in person! That would be creepy!!!!

[Corals]

Partial Face Transplant Done in France

By CAROLE BIANCHI, Associated Press Writer
42 minutes ago

Doctors in France said they had performed the world's first partial face transplant, forging into a risky medical frontier with their operation on a woman disfigured by a dog bite.

The 38-year-old woman, who wants to remain anonymous, had a nose, lips and chin grafted onto her face from a brain-dead donor whose family gave consent. The operation, performed Sunday, included a surgeon already famous for transplant breakthroughs, Dr. Jean-Michel Dubernard.

"The patient's general condition is excellent and the transplant looks normal," said a statement issued Wednesday from the hospital in the northern city of Amiens where the operation took place. Dubernard would not discuss the surgery, but confirmed that it involved the nose, lips and chin.

"We still don't know when the patient will get out," he said. A news conference is planned for Friday.

Scientists in China have performed scalp and ear transplants, but experts say the mouth and nose are the most difficult parts of the face to transplant. In 2000, Dubernard did the world's first double forearm transplant.

The surgery drew both praise and sobering warnings over its potential risks and ethical and psychological ramifications. If successful — something that may not be known for months or even years — the procedure offers hope to people horribly disfigured by burns, accidents or other tragedies.

The woman was "severely disfigured" by a dog bite in May that made it difficult for her to speak and chew, according to a joint statement from the hospital in Amiens and another in the southern city of Lyon where Dubernard works.

Such injuries are "extremely difficult, if not impossible" to repair using normal surgical techniques, the statement said.

"For pushing the bounds of science, they are to be applauded, as long as they have got full informed consent from the patient and the donor's family," added Dr. Iain Hutchison, chief executive of the London-based Facial Surgery Research Foundation.

Scientists around the world are working to perfect techniques involved in transplanting faces. Today's best treatments leave many people with facial disfigurement and scar tissue that doesn't look or move like natural skin.

A complete face transplant, which involves applying a sheet of skin in one operation, has never been done before. The procedure is complex, but uses standard surgical techniques.

Critics say the surgery is too risky for something that is not a matter of life or death, as regular organ transplants are.

The main worry for both a full face transplant and a partial effort is organ rejection, causing the skin to slough off.

"It is not clear whether an individual could be left worse off in the event that a face transplant failed," said Dr. Stephen Wigmore, chair of the ethics committee of the British Transplantation Society.

Read More

http://news.yahoo.com/s/ap/20051130/...ltBHNlYwM3MTY-

[MadameX]

Update: At the beginning of this month, CCF recieved full approval to start conducting complete facial implants. They are still currently looking for patients.

[Corals]

Face op woman 'had tried suicide'

The woman who received the first ever face transplant sustained her injuries when her dog tried to wake her after a suicide attempt, her family has said.

Surgeons have been giving details of the pioneering operation - which they called an "exceptional case".

Facial tissue from a donor was used to repair severe damage from the top of her nose to her chin.

But one doctor said traditional reconstructive surgery should have been used to help her.

It is precisely because there was no way to restore the functions of this patient by normal plastic surgery that we attempted this transplant
Caroline Camby, French health ministry adviser

The patient's 17-year-old daughter said the dog had probably saved her mother's life.

The teenager added: "After that we don't know what happened with the dog, whether it bit or clawed her, but it managed to pull her awake. In a way, it was lucky for her that the dog was there."

The dog was later put down, against the family's wishes.

Dr Bernard Devauchelle, a facial surgeon who led the operation, said: "We decided to go ahead with a transplant of part of the face because it restored the anatomy and the aesthetics, but also the function of this face."

'Thank you'

The facial tissue was taken from a multi-organ donor in the northern city of Lille, who was brain-dead. Read More
http://news.bbc.co.uk/1/hi/health/4491310.stm

[saraphen]

Oh my, I never imagined that the dog had saved her life. That is quite a story.

[Corals]

The Sunday Times December 04, 2005

Revealed: tragic death of woman who donated her face
Matthew Campbell, Valenciennes

THE woman whose nose, lips and chin were used in the world’s first face transplant had committed suicide, it was revealed last night.

The 38-year-old French woman hanged herself, doctors said. Her family allowed her face to be removed so that another woman with severe facial injuries would have the chance of a normal life.

Isabelle Dinoire, also 38, who has made medical history as the recipient, expressed her gratitude to the donor’s family yesterday for letting the operation go ahead.

In her first public comments since the surgery, Dinoire said that she had also tried to kill herself six months ago. It was while she was unconscious after an overdose that her dog had attacked her, leaving her with what she called “terrifying” injuries.

“I am very grateful to this woman,” Dinoire said. “I thank her family for giving their permission for this operation. I thank them from the bottom of my heart.”

Olivier Jardé, a professor of ethics at Amiens University hospital centre and who was involved in the preparations for the operation, said that the donor was brain dead when she arrived at hospital.

She was examined by doctors in the northern city of Lille where her features were later removed, Jardé said. He cited French law in refusing to identify her.

The face was grafted on to Dinoire in a 15-hour overnight operation that ended on Monday morning at Amiens, south of Lille. Yesterday Dinoire was able to admire the results.

Dinoire, an unmarried mother of two teenage daughters, admitted that during a sudden fit of depression she had taken an overdose of sleeping pills last May at her council flat near the town of Valenciennes. She declined to say what had prompted her suicide attempt. “It’s a secret,” she said.

Her comments contradicted a statement by her surgeon, Jean-Michel Dubernard, who last Friday denied a French media report that she had tried to kill herself. He claimed that she had taken a pill to try to sleep after an argument with one of her daughters and had just woken up when she was mauled — perhaps after stepping on the dog.

The confirmation that Dinoire had wanted to end her life reinforces an astonishing parallel with her donor’s state of mind, but is likely to stoke an ethical debate over the transplant.

Critics have emphasised the psychological toughness required to adapt to carrying a dead person’s face — and to cope with the intense public scrutiny after such pioneering surgery. Yesterday Dinoire said that her appearance after the attack had been so frightening that she had not hesitated — “not for a moment” — to go ahead and she had no regrets.

Speaking to The Sunday Times and a friend on her mobile phone, she praised the surgeons for having done a “magnificent” job.

http://www.timesonline.co.uk/article...903180,00.html
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Thisi s becoming interesting. The patient herself said that she tried to committ suicide and yet the surgeon is saying that she did not. Why are they conflicting stories from the patient and the surgeon? Did she really needed the surgery? :whistling