Face Transplant in France Produces Ethical Concerns

On November 27, French surgeon Jean-Michel Dubernard and his team performed the world's first face transplant on a woman whose face had been half ripped away by her pet dog.  The ethical questions have been swirling ever since.  They were nicely summarized by Michael Mason and Lawrence Altman in the NY Times on Dec. 6 in "Ethical Concerns on Face Transplant Grow."  The basic concerns are these:

• the use of stem cells from donor bone marrow to help stave off rejection of the transplanted tissue combined two experimental regimes; the surgeons have made it virtually impossible to know whether the success or failure will be due to some aspect of the surgery or the use of stem cells;
• "the transplant was performed months after the woman's injury, and before any attempt at conventional reconstructive surgery"; radically experimental surgery is generally made available only after the patient has attempted to live with the alternatives, including traditional surgery;
• British papers report that the woman was mauled by her Labrador retriever after she had overdosed on sleeping pills; this raises the question of the patient's emotional stability, which in turn raises questions of her ability to stick with the post-surgical medical regime required to avoid rejection of the graft, and the absence of longer-term psychological assessments leave open the question whether the patient will be able to withstand the emotional pressures that will follow.

Despite all this, the AP reported on Sunday that the patient reportedly stated that she has no regrets about undergoing the first face transplant:

"When I looked at my new face I knew straight away that it was me," Britain's Daily Mail quoted the 38-year-old patient as saying. "It was amazing to see a nose and mouth on my face again."

The newspaper did not explain how it obtained the woman's comments. The article was datelined from Valenciennes, northern France, where the woman lives, though she is convalescing 400 miles to the south at a hospital in Lyon.

The woman said she still had no feeling in her face, as the nerves were not yet working correctly, the Daily Mail reported. Doctors hoped feeling would return in six months to a year, she said.

The patient said she had taken a walk in the hospital, but was "very scared of leaving" and being recognized as the face transplant recipient, the paper said.

"I just want to live a normal life, without being stared at all the time," she said. "It's still too early to think about the future. But I regret nothing - if I was asked again, I would do it again."

The AP article also raises the possibility of a previous suicide attempt, which her surgeon continues to deny. [tm]