British surgeons seek five patients Go-ahead for first full face transplants Ian Sample, science correspondent
Friday December 16, 2005
The Guardian
French surgeons perform the world's first partial face transplant on a 38-year-old woman in Amiens. Photograph: AP
British surgeons are preparing to carry out an unprecedented full face transplant operation next year after being granted ethical approval to actively seek patients. The 30-strong team headed by Peter Butler, a leading plastic surgeon at the Royal Free Hospital in Hampstead, London, was given the go-ahead by the hospital's bioethics committee yesterday. The announcement follows the partial face transplant in France last month of a woman whose face was mutilated by a dog.
The controversial operation has raised concerns, not least that some patients could suffer psychological trauma because their new appearance will resemble that of the donor. But several teams around the world have been pressing ahead, with surgeons in China and America among the contenders to perform the operation first.
Mr Butler's team spent more than 10 years researching the clinical and psychological aspects of the operation before spending the past three years clearing ethical hurdles. "We've had around 20 patients contact us in the past, but until now we've not been in a position to assess them for the operation. Now we can actively recruit patients," he said.
The team will initially select five patients with severe facial burns who will be subjected to psychological screening.
"The main concern from the psychological point of view is that we choose the right patients. We'll be looking at how well they coped with their original disfigurement and how they coped with their surgery afterwards. You need a psychological robustness to be able to deal with this," Mr Butler said.
During the operation, one team of surgeons will remove skin grafts and any other reconstructive surgery from the face of the patient while another team removes the face from the donor. Only skin, the underlying fat and blood vessels are removed. The donor's face is then kept on ice and transported to the patient and sutured into place.
Because the transplanted face is stretched over the patient's original bone structure and facial muscles, surgeons expect the outcome will be a hybrid face with features such as skin tone, texture and hair being the same as the donor's.
The surgeons expect the operation to take 14 hours, after which the patient will need to take immunosuppressant drugs for the rest of their lives to prevent the face being rejected.
The operation will cost around £20,000 and Mr Butler's team is seeking private and charitable donations to fund the first five, which will be carried out at the hospital as soon as the resident ethics committee declares it is satisfied that the patients have given informed consent. Information for potential patients can be found at
facetransplant.org.uk.
Daniel Sokol, a medical ethicist at Imperial College, London, said: "With a full face transplant, the issue is how [people] cope with having a whole new face. It's like no other transplant because it deals with such an expressive part of who we are."
Iain Hutchison, consultant oral and maxillofacial surgeon at Bart's and the Royal London Hospital and director of the facial research charity Saving Faces, warned that rejection could be a serious issue. During the first year, 10% of transplanted faces are likely to be rejected, rising to 30% to 50% in the following five years, he said. Immunosuppressant drugs are also known to cause skin problems and fatal cancers. "The other issue is that for a donor's family; this could well interfere with the grieving process."
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