A new face for the transplant field

by Shannon MacKay on May 1, 2014

facetransplant

Image shows a computer illustration of the first near-full face transplant.

Face transplants were first introduced in 2005, when surgeons in France took a gamble and performed the first partial face transplant. The first transplant patient’s name was Isabelle Dinoire and she was 38 years old. Dinoire had her nose, lips, chin and parts of her cheeks removed after having been bitten by her dog earlier that year. This operation involved transplanting facial parts from a recently deceased 46-year-old woman. Dinoire reported being “very satisfied” with the surgery and her subsequent progress (The Guardian, 2012). Later, in 2010, the first full face transplant was performed in Spain. A Spaniard named Oscar had accidentally shot himself, resulting in his inability to breathe or eat on his own. Oscar underwent a 24-hour operation in which doctors removed an entire face, “including jaw, nose, cheekbones, muscles, teeth ad eyelids, from a donor and placed it mask-like on Oscar” (The Guardian, 2012). These two surgeries sparked the beginning of a whole new area in the transplant field of medicine. Many after have attempted to achieve the same success and build upon this foundation.

Now, about 10 years after the first facial transplant, 30 face transplant surgeries have been performed all over the world, including: China, United States, Spain, France, Belgium, Turkey and Poland. Recently, the “first comprehensive review of every transplant reported” has been created (Altman, 2014). This report has dispelled any legal and ethical questions regarding the procedures of these facial transplants. Additionally, it affirms that while the operation is risky and expensive, the procedure itself is generally “safe and feasible” (Altman, 2014). Candidates for face transplant surgery must be carefully selected to avoid unnecessary complications. Although there are risks associated with transplants, as there are with any surgery, they can also “ease or erase the grotesque deformities that leave them subject to taunts, discrimination, isolation and serious depression” (Altman, 2014).

In a recap of procedural results, post-transplant patients have been found to “regain their ability to eat, drink, speak more intelligibly, smell, smile and blink” (Altman, 2014). Furthermore, only three out of the thirty surgeries have ultimately resulted in the death of the patient, none of which occurred in the United States. At first the idea of a face transplant, or places someone’s face on another individual, was quite alarming. This technique, however, has proved much more successful and effective than conventional facial reconstruction. Also, “contrary to such fears, no recipient physically resembles the stranger who gave it” (Altman, 2014). According to Dr. Eduardo D. Rodriguez of NYU Langone Medical Center, “it is not as if you would recognize the donor walking down the street” (Altman, 2014).

The over arching reason for these surgical successes appears to be the strong effort to ensure patients stick to post-surgical procedures and precautions. Surgeons need candidates who “would be motivated to stick to an anti-rejection regimen and who had a strong social support system” (Altman, 2014). Working collectively as a surgical team on the many processes involved in a full face transplant also seems to be another component in the success of the surgeries. “One team removes the face and underlying tissues from a donor, while a second team removes the damaged portions of the recipient’s face” (Altman, 2014). The next steps, including arterial and nerve ending connection, must be performed cohesively and quickly, requiring a strong team to perform this procedure.

The leaders in face transplants so far have been the French, who have performed 10 face transplant surgeries. Specifically, Dr. Laurent Lantieri, a French surgeon, has performed seven face transplants. The United States and Turkey follow with the second highest numbers of transplants at seven. This large European “dominance” appears to stem from European national health plans funding the procedure, whereas in the United States private institutions and government grants fund the procedure. The United States may want to consider adopting policies similar to those of the European countries if we want to stay competitive in this matter.

All competition aside, these medical successes have given rise to ethical inquiries and a wish for regulation. Some prominent ethical questions include: “ How long should a severely disfigured individual wait after receiving other therapy before getting a face plant?” and “What should be the youngest age of eligibility?” (Altman, 2014). These ethical questions are soon to be answered as the medical field and government receive continuing pressure from this topic.

Going forward, special attention must continue to be observed during patient selection. By doing this, doctors will be able to have more successful surgeries and establish a more standard procedure for face transplants. Furthermore, legislative and ethical concerns will be addressed as more surgeries occur. This will give more background and evidence towards ideas about this topic. As for right now, face transplantation is a new great procedure that will continue to change the lives of many people, as it eventually becomes a standard technique.

 

References

 

Altman, L. K. (2014). An about-face on a risky transplant. The New York Times. Retrieved from http://www.nytimes.com/2014/04/29/health/an-about-face-on-a-risky-transplant.html?ref=science&_r=0

 

Guardian News. (2012). Face transplants – a short history. The Guardian. Retrieved from http://www.theguardian.com/science/2012/mar/28/face-transplants-history

 

Madrigal, M. (2009). [Image of person pre and post face transplant]. First near-full face transplant a success, so far. The Wired. Retrieved from http://www.wired.com/2009/02/facetransplant/


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