(U-WIRE) WASHINGTON – The Cleveland Clinic became the first institution to receive approval of human facial transplants last month, following intense debate on ethical issues and questions of medical and psychological safety.
The practice of transplanting body parts other than critical organs is a relatively new medical practice. The idea behind face transplants came after the success of hand transplants, which took place for the first time six years ago.
The procedure has been widely contested due to the skin’s high risk of immune rejection. The key to a successful procedure is a combination of anti-rejection drugs, which have been effective in about 20 hand transplants worldwide.
However, if an immune rejection were to occur, the face would have to be removed, and doctors would take healthy tissue from other parts of the patient’s body to cover the face. According to a report by the Royal College of Surgeons of England, the estimated risk of rejection would be about ten percent the first year, and 30 to 50 percent for the next two to five years.
In order for the transplant to succeed, the patient would have to take these immune-suppressing drugs for the rest of their lives in order to keep their new faces from being rejected. Another notable and more immediate risk is the failure of the blood supply to the tissue.
The procedure not only brings about medical dilemmas, but ethical ones as well. One such issue is the resemblance of the face when transplanted on the new recipient. Most doctors and experts agree that finding donors of facial tissue will be very difficult. Donor families may object to the procedure because the face is a much more personal part of a body’s persona than traditional organs. The procedure would also leave a defect requiring a closed casket at the funeral.
Some are also concerned that the face would take on the resemblance of the donor, which could cause severe psychological difficulties for the family and friends of the deceased.
“The face is central to our understanding of our own identity. Faces help us understand who we are and where we come from,” said the findings in a report released last November by the Royal College of Surgeons of England.
However, doctors argue that the face would take on more of the skeletal features of the recipient than the soft tissues of the donor. Dr. Maria Siemionow, director of plastic surgery research and training at the Cleveland Clinic, doesn’t believe that resemblance will be an issue.
Another ethical issue is that the face is not a vital organ, such as a heart or a liver, and this procedure therefore may not be worth the risk. However, to those who have been affected by severe facial trauma in their lives, they do not consider this the case.
Gwendolyn Arrington, the victim of a gas explosion in 1989 which resulted in severe burning and scarring of the face, has responded to the news of the experimental surgery with great interest. She has had over thirty operations using grafts and flaps, but these surgeries are flawed. They often result in discoloration and scarring, and allow no facial expressions. Doctors believe that a transplanted face would be able to function much more naturally.
Arrington does not see any moral dilemmas in the idea of a face transplant. “With all the grafts I’ve received, patches here and patches there, I honestly feel like I’m already living with someone else’s face,” she told the Washington Post in a recent article.
Doctors say they would rather reserve this experimental procedure for those with only the most severe injuries, and only on those that are psychologically stable. A few medical boards, including a French ethics board and the Royal College, have concluded that the procedure is unwise and unsafe.
However, burn victims who have lived their lives with social and personal trauma due to their severe facial deformities, say these warnings are far from convincing.
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