A rchive Date
[ 05-12-2005 ]
Category
[ Science ]
sub-Categoy
[ Biotechnology ]
|
[http://www.msnbc.msn.com/id/10313005/site/newsweek/
The Ultimate Transplant
Surgeons are ready to offer burn victims entire faces from donors, but there are risks.
By Karen Springen
Newsweek
Dec. 12, 2005 issue - For thousands of people whose faces have been disfigured by third-degree burns or other injury, life often becomes an endless series of painful operations. Surgery is performed to transfer skin to the face from the back, buttocks, thighs or even scalp; to improve breathing; to enable patients to open and close their eyes; to restore facial expression. A few patients have had as many as 120 operations. "It's a roller coaster. You're healing well, and then you have to go in for another surgery," says Amy Acton, executive director of the Phoenix Society for Burn Survivors.
Now burn victims can consider another option: a face transplant. Last week French doctors performed the first partial procedure when they gave a brain-dead patient's mouth, nose and chin to a 38-year-old woman mauled by a dog. In the United States, doctors at the Cleveland Clinic, whose institutional review board last year approved the experimental treatment, are interviewing potential patients who would receive entire faces from donors. "At this stage, we are planning face transplants only for severely disfigured patients who have exhausted all conventional options," says Maria Siemionow, director of plastic-surgery research at the Cleveland Clinic.
The goal is to help burn victims look normal and function as well as possible by giving them a just-deceased person's facial tissue. Patients will receive skin (but not the underlying muscle and bone) from someone their own age, gender and race. "If we took the bony structure and the soft tissue, then they would look like the donor," says John Barker, director of plastic-surgery research at the University of Louisville. Unlike skin from other parts of the body, facial tissue is uniquely thin and pliable, which makes it easier to stretch around the eyeballs and mouth. As a result, face-transplant recipients shouldn't need to undergo so many operations to try to get a less masklike look.
Transplant doctors acknowledge that a face transplant can fail if patients' bodies reject the foreign tissue or fail to circulate enough blood to it, but they insist a face transplant is no more likely than a kidney transplant to be fatal. Still, the procedure is complex. A brain-dead donor would be kept alive until doctors "harvest" or "de-glove" her face in a four- to six-hour operation. Then, in a 10- to 15-hour procedure, they would drape the donor's facial skin, in one piece, over the recipient's bones and muscles.
While doctors may be bullish on the procedure, many patients and activists worry about potential complications and ethical issues. "The dilemma is, can you give informed consent, because there are so many unknowns," says Acton. Mary Hessel, for one, isn't interested. Nine years ago, Hessel, now 37, survived a gas explosion that left her with third-degree burns over 75 percent of her body.
Since then, doctors have operated on her face 18 times. But her burned face is not "life threatening," she says, and she doesn't want to spend a lifetime on the expensive, risky immunosuppressant medications she would need to keep her body from rejecting foreign tissue. Indeed, the biggest ethical question is, do the risks posed by lifelong immunosuppression drugs justify the benefits of receiving a new face? The $2,000-a-month drugs increase the risk of infection, cancer and metabolic disorders, and can damage the liver and kidneys. "I'd like to see one of the doctors be the first one," says Betsy Wilson, director of the support network Let's Face It.
There is no race to be the first to perform a full-face transplant, doctors insist. "We have a methodical and go-slow attitude," says Dr. James Zins, chairman of plastic surgery at the Cleveland Clinic. The immediate challenge is to find a physically and psychologically suitable patient, someone willing to take a risk—and maybe even become a famous face.
© 2005 Newsweek, Inc
© 2005 MSNBC.com
 World Fact Book (CIA)]
|