The news was just publicly announced that the University of Maryland is now the 2nd hospital to perform full face transplant in the US. Just a handful of these procedures have been performed around the world, and they are enormously complex ethically, surgically and medically.
To begin with, long before the surgery even became a possibility, there have been years of work put into setting up such a novel transplant program. Besides obtaining approval for what is still an experimental procedure from an IRB, it is necessary to very carefully screen a population of potential recipients. A face transplant is still quite high risk, especially if the surgery fails because it has the potential to cause serious morbidity and mortality. So, patients selected for transplant have to be vetted very carefully. In the case of the first Chinese transplant, the patient stopped taking immunosuppressive drugs in favor of traditional Chinese remedies, and died soon after. This emphasizes the importance of choosing potential recipients that will reliably take their medications as rejection can be catastrophic.
This surgery took approximately 32 hours from start to finish, and involved a huge multidisciplinary team including multiple transplant and plastic surgeons to perform the procedure. These procedures involve very complex microsurgery to reattach the vascular supply, muscles and nerves to the graft, and, since the jaw and tongue were also transplanted, bones as well.
The surgery is also just the beginning. A life-long course of immunosuppression is required, at least until we can reliably determine how to induce immune tolerance to transplanted organs (this is an exciting field which has also been in the news). And since the jaw contains marrow, there is a risk of graft versus host disease from the transplanted bone.
Then there are the complex ethical issues with facial transplant.
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How about the ethics of face transplant? It is unusual as a procedure since, even when successful, it has a high probability of shortening the patient’s life span. After all, immunosuppressant therapy has serious side effects, and the surgery is not a life saving or life-extending one like liver or kidney transplant. It represents a decision made on the part of doctors and patients to decide to potentially shorten life in exchange for dramatically increasing quality of life. This makes it quite unique. Then, when cost is factored in, we are looking at spending a great deal of money to potentially shorten someone’s life.
I think that, despite these problems, it is an avenue worth pursuing. These procedures will never be common, and pushing the limits of what transplantation can do will have beneficial effects across the field. Right now, these surgeries are being paid for largely by research grants, and aren’t raising anyone’s premiums. But one day, if they become standardized and accepted widely, this may become an issue. Finally, the results in the majority of patients so far have been quite good, and reports indicate the patients are happy with the outcome.
OT – Whenever face transplant comes up I sadly always first think of “Face/Off, one of the worst movies, by one of the worst directors, starring two of the worst, yet inexplicably popular, actors. In the movie, two people of widely different body size and bone structure change roles when their faces are transplanted by what appears to be a laser and a suction cup. If only it were so simple.