Shelly
11-30-2005, 07:29 PM
First face transplant sparks outcry
STEPHEN MCGINTY
THE world's first face transplant has been carried out in France on a woman whose nose, lips and chin were torn off by a dog. A team of surgeons carried out the highly controversial procedure, which is banned in Britain, in a hospital in Amiens last weekend.
The operation, which involved transplanting the skin, fat and some blood vessels from the face of a dead donor, was a success with the patient, a 36-year-old woman,coming through the first 48 hours when the risk of her body rejecting the new tissue was greatest.
Although the technical ability to carry out such an operation has been available for several years, medical regulators have been reluctant to approve face transplants, for ethical and medical reasons.
There is concern at the consequence of having to remove the new face should the body reject it, and of the effect of taking immune suppressants, which prevent rejection, possibly for the rest of the patient's life. There is also the moral question connected to the change in appearance of "wearing" another person's face.
The recipients would not look identical to the donor as they would still have their own bone structure, facial muscles and fat. However, computer simulations which have been carried out reveal that the person can resemble an amalgamation of themselves and the donor.
The French team, which was headed by Dr Jean-Michel Dubernard who came to prominence when he carried out the first hand transplant in 1998, was given permission to carry out a transplant of only the nose and mouth "triangle".
Last night the British medical establishment questioned the operation. Iain Hutchison, a consultant facial surgeon and chief executive of Saving Faces, the Facial Surgery Research Foundation, said: "This operation throws up many moral and ethical issues. This was a 'quality of life' operation and has many implications for the recipient and donor's families."
Stephen Wigmore, the chairman of the Ethics Committee of the British Transplantation Society, said: "Several major ethical and moral issues also surround face transplantation. Computer simulations predict that facial appearance after face transplantation results in an appearance which is intermediary between that of the donor and that of the recipient."
The identity of the donor and the patient is being kept secret, but it is understood that permission was obtained from the relatives in the same way as for organs such as heart and liver.
It is believed the patient, who remains in intensive care, was attacked in January and has gone through extensive counselling to prepare her for the pioneering surgery.
A source at the hospital said yesterday: "The team were very excited after the operation.
"The patient is still in a critical condition, but it is a world first which has massive implications for many badly disfigured people around the world."
When the patient's identity is under the knife
How is it done?
Skin, fat, blood vessels and connective tissue are removed from the donor by plastic and maxillofacial surgeons and placed over the recipient's skull and muscle. The blood vessels are then reconnected.
The face should flush pink with blood. Although lengthy, the procedure is no more complex than much other transplant surgery.
What is the prognosis?
Good. The patient in Amiens has got through the first 48 hours, when the risk of her body's immune system rejecting the tissue was highest. If this had happened the graft would have had to be replaced with another or with skin from the patient.
As with any transplant, she must remain on immuno-suppressant drugs for the rest of her life. This can increase the risk of cancer.
Are there serious psychological questions?
Teams around the world have been researching the effects on the patient, the donor family and society in general.
The recipients must be chosen carefully and counselled thoroughly. They will not resemble the donor, but will have a "hybrid" face made up of their own bone structure with new skin and fat.
Ethics organisations had been reluctant to approve the surgery. The Royal College of Surgeons voiced its concern in 2003.
What kind of patients would be considered for surgery?
Only those with the most severe facial injuries, burns and deformities, when other options have been exhausted.
Which surgeons have been trying to do it?
Four teams, in London, Paris, Louisville, Kentucky, and Cleveland, Ohio.
Professor Peter Butler, who is based at the Royal Free Hospital in Hampstead, London, has been carrying out extensive research on the psychological impact, how to select a patient and identity issues.
This article: http://news.scotsman.com/health.cfm?id=2330392005
Last updated: 01-Dec-05 00:07 GMT
STEPHEN MCGINTY
THE world's first face transplant has been carried out in France on a woman whose nose, lips and chin were torn off by a dog. A team of surgeons carried out the highly controversial procedure, which is banned in Britain, in a hospital in Amiens last weekend.
The operation, which involved transplanting the skin, fat and some blood vessels from the face of a dead donor, was a success with the patient, a 36-year-old woman,coming through the first 48 hours when the risk of her body rejecting the new tissue was greatest.
Although the technical ability to carry out such an operation has been available for several years, medical regulators have been reluctant to approve face transplants, for ethical and medical reasons.
There is concern at the consequence of having to remove the new face should the body reject it, and of the effect of taking immune suppressants, which prevent rejection, possibly for the rest of the patient's life. There is also the moral question connected to the change in appearance of "wearing" another person's face.
The recipients would not look identical to the donor as they would still have their own bone structure, facial muscles and fat. However, computer simulations which have been carried out reveal that the person can resemble an amalgamation of themselves and the donor.
The French team, which was headed by Dr Jean-Michel Dubernard who came to prominence when he carried out the first hand transplant in 1998, was given permission to carry out a transplant of only the nose and mouth "triangle".
Last night the British medical establishment questioned the operation. Iain Hutchison, a consultant facial surgeon and chief executive of Saving Faces, the Facial Surgery Research Foundation, said: "This operation throws up many moral and ethical issues. This was a 'quality of life' operation and has many implications for the recipient and donor's families."
Stephen Wigmore, the chairman of the Ethics Committee of the British Transplantation Society, said: "Several major ethical and moral issues also surround face transplantation. Computer simulations predict that facial appearance after face transplantation results in an appearance which is intermediary between that of the donor and that of the recipient."
The identity of the donor and the patient is being kept secret, but it is understood that permission was obtained from the relatives in the same way as for organs such as heart and liver.
It is believed the patient, who remains in intensive care, was attacked in January and has gone through extensive counselling to prepare her for the pioneering surgery.
A source at the hospital said yesterday: "The team were very excited after the operation.
"The patient is still in a critical condition, but it is a world first which has massive implications for many badly disfigured people around the world."
When the patient's identity is under the knife
How is it done?
Skin, fat, blood vessels and connective tissue are removed from the donor by plastic and maxillofacial surgeons and placed over the recipient's skull and muscle. The blood vessels are then reconnected.
The face should flush pink with blood. Although lengthy, the procedure is no more complex than much other transplant surgery.
What is the prognosis?
Good. The patient in Amiens has got through the first 48 hours, when the risk of her body's immune system rejecting the tissue was highest. If this had happened the graft would have had to be replaced with another or with skin from the patient.
As with any transplant, she must remain on immuno-suppressant drugs for the rest of her life. This can increase the risk of cancer.
Are there serious psychological questions?
Teams around the world have been researching the effects on the patient, the donor family and society in general.
The recipients must be chosen carefully and counselled thoroughly. They will not resemble the donor, but will have a "hybrid" face made up of their own bone structure with new skin and fat.
Ethics organisations had been reluctant to approve the surgery. The Royal College of Surgeons voiced its concern in 2003.
What kind of patients would be considered for surgery?
Only those with the most severe facial injuries, burns and deformities, when other options have been exhausted.
Which surgeons have been trying to do it?
Four teams, in London, Paris, Louisville, Kentucky, and Cleveland, Ohio.
Professor Peter Butler, who is based at the Royal Free Hospital in Hampstead, London, has been carrying out extensive research on the psychological impact, how to select a patient and identity issues.
This article: http://news.scotsman.com/health.cfm?id=2330392005
Last updated: 01-Dec-05 00:07 GMT