HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Wednesday, December 17, 2008

Face Transplant

The New York Times reports on the face transplant that took place this week at the Cleveland Clinic.  It is truly an amazing story raising lots of complicated ethical issues.   

Only the forehead, upper eyelids, lower lip, lower teeth and jaw are hers.  The rest of her face comes from a cadaver.  In a 23-hour operation, transplant surgeons have given nearly an entire new face to a woman with facial damage so severe that she could not eat on her own or breathe without a hole in her windpipe, doctors at the Cleveland Clinic said here on Wednesday.

The highly experimental procedure, performed within the last two weeks, was the world’s fourth partial face transplant, the country’s first, and the most extensive and complicated such operation to date. Dr. Maria Siemionow led the surgical team, which took turns at the operating table so the doctors could rest, sleep and share expertise. The woman’s identity was not disclosed, nor was the cause of her injury or the donor’s identity.

The woman is eventually expected to eat, speak and breathe normally and even smell again, her doctors said at a news conference. Feeling should return to her face in six months, and most facial functions in about a year, leading to her ability to smile after physical therapy to help train the muscles for that function. But because facial structure varies among people, the woman is not expected to look like her donor, the doctors said.

The woman will need to take antirejection drugs for the rest of her life, but those drugs do not guarantee success. Although rejection reactions seem more common in the first few months, they can occur at any time. Doctors can often reverse such reactions by adjusting the drug regimen.  The woman has cleared the earliest hurdle: she has not rejected the new face. The doctors said she was doing well but emphasized that they could not predict the future, as she faces potential complications like infections and cancers resulting from the immunosuppression treatment.  The clinic team said that if the transplant ever failed, it would be replaced with a skin graft taken from parts of the woman’s body. . . .

Dr. Kodish said that in psychological testing she was asked questions like these: Is it you or someone else in your family who wants you to have the face transplant? How do you feel about the prospect of living with a face from a dead person?  Under the clinic’s scientific blueprint, Dr. Kodish said, the patient was not allowed to see a photo of the donor, in part because it could lead her to believe she would look like the donor.  The trauma cost the woman sight in her right eye, and vision from the left eye is impaired. Before the transplant, she could make out the faces of her doctors.

As she awakened from heavy sedation, Dr. Chad Gordon, a plastic surgeon, said she gave a thumbs-up sign when asked how she was feeling. As she recovers in the clinic, she communicates mostly in writing.  Dr. Siemionow said, “I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw.” Dr. Siemionow, 58, a native of Poland, said she began preparing for the face transplant 20 years ago. Her research has involved transplants on animals and cadavers and ethical concerns. . . .

Medical ethicists said Wednesday that in face transplant surgery the risks and benefits to the patient must be weighed carefully. “Not to downplay the difficulties of having a facial disfigurement, but one can live a long life and be disfigured,” said Stuart G. Finder, director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles. But the benefits of a face transplant are not only cosmetic, Dr. Finder said, adding, “The repair of the face can also have significant social consequences — like the ability to speak, or the ability to eat, that can be replaced because of having lips.”. . . .

A major obstacle was finding donors whose sex, race, age and blood type matched that of potential recipients. Specific consent procedures were developed. . . .

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