Face Transplant

[Katie]

interesting...and creepy. what if your body rejects it? you're screwed. Apparently this is a one shot deal.

(CNN) -- A severely disfigured woman received the nose, cheeks, upper jaw and facial tissue from a female cadaver in the first near-total face transplant in the United States, the woman's surgeon said Wednesday.


Cleveland Clinic doctors replaced 80 percent of a woman's face two weeks ago in the first such U.S. surgery.

The patient had severe deformity in the middle of her face and was missing her right eye and upper jaw, the Cleveland Clinic doctors said. She could not taste or smell, and she had trouble speaking.

Dr. Maria Siemionow, the head of plastic surgery research at the Cleveland, Ohio, hospital, said many people are "hiding from society because they're afraid to walk to the grocery stores; they're afraid to go to streets because they're called names and humiliated."

"Our patient was called names, and our patient was humiliated," she said. "We very much hope for this special group of patients, there is hope, and one day they will be able to go comfortably from their houses and enjoy the things which we take for granted."

The patient is doing well, the doctors said. Interactive: More details of the surgery »

Details about the recipient, including her name and age, were withheld at her request.

In the surgery, 80 percent of the woman's face was transplanted. The forehead and chin were left intact.

In this transplant, tissue from the donor's face was shaped and fitted into position. Multiple layers of tissue, bone, muscles and blood vessels, nerve grafts and each artery and vein were connected. Watch an explanation about face transplants »

"Our hope is she should be able to smile again," said Dr. Frank A. Papay, chairman of the Dermatology and Plastic Surgery Institute at the Cleveland Clinic.

With physical therapy, surgeons hope the patient will regain her ability to smell and blink and will have other facial functions.

Siemionow said the patient never saw a photo of the donor and said, "the donor never looks like the recipient. The recipient never looks like the donor."

Siemionow had medical and ethical clearance for a full facial transplant since 2004. She said it has taken 20 years of research and four years to find the right patient who understood the risks involved.

The doctors' approach from the beginning was to consider "only patients who are the most disfigured" and had "exhausted all existing procedures," Siemionow said.

"This patient exhausted all conventional means of reconstruction and is the right patient," she said. Watch Dr. Siemionow in the news conference. »

Dr. Eric Kodish, the professor and chairman of the Cleveland Clinic's Department of Bioethics, said doctors thought she would adhere to medications after the surgery.

"This patient had very robust decision-making capacity," he said.

Like with all transplants, there is a risk that the recipient's body could reject the graft. The doctors say they haven't seen any such signs.

The transplant recipient has to take immune-suppressing drugs for the rest of his or her life to prevent rejection of the donated tissue.

In the past three years, facial transplants have been completed in France and China, but these cases have raised medical and ethical questions. Read about the first facial transplant

Some candidates for a face transplant are survivors of trauma, such as burn or accident victims, who have exhausted all other reconstructive possibilities.

The recipient in France, Isabelle Dinoire, had been mauled by a dog, and the Chinese man, Li Guoxing, was attacked by a bear. Both received major facial disfigurements.

In 2007, a French team performed the third partial facial transplant on a man who was disfigured by a genetic disorder that created large tumors on his face. Watch a 2006 report about China's first face transplant

Guo Shuzhong, the face transplant doctor who handled Li's case, confirmed to CNN that he died in July of unknown causes. Li last visited the hospital in summer 2007, and he stayed in his hometown in Yunnan province.

The doctor told CNN that Li had a checkup in a small hospital in his hometown three weeks before his death but that no health problems had been found. Watch an ITN report about the Li's case

The facial transplants in France and China generated much controversy as questions arose about whether the patients were adequately vetted and informed about the risks. Those procedures have been "under an ethical cloud," said David Young, a professor of plastic surgery at the University of California, San Francisco.

The current face transplant patient understood the risk of rejection and of immunosuppressants, doctors said.

Criticism of facial transplants

Critics such as Peter A. Clark, director of the Institute of Catholic Bioethics at St. Joseph's University in Philadelphia, Pennsylvania, said a facial transplant introduces unnecessary risks for a procedure that is not a matter of life and death.

"With something like a liver or kidney transplant, it's a life or death transplant," Clark said. "Even with a kidney or liver [transplant], you have to be put on immunosuppressants with serious side effects."

Bioethicist Dr. Arthur Caplan, chairman of the University of Pennsylvania's Medical Ethics Department, said Wednesday on CNN's "American Morning" that he initially had similar qualms about the facial transplant, which improves the quality of a life rather than saving it, but was gradually convinced.

People with major facial disfigurements "don't come out and basically stay at home and have a huge suicide rate," Caplan said. "They're really up against it."

At the news conference Wednesday, Kodish said the transplant had "abundant moral justification": the face as a personal embodiment as self.

He added that people with disfigurements are often isolated and suffer tremendously and that this case was "not cosmetic surgery in any sense."

Patient's reaction

Doctors at the Cleveland Clinic said that because the patient has limited vision after the surgery, she has yet to see herself.

"At this point she can't see herself but can feel her face," Siemionow said. "She was happy when she could go over her face" and could feel that "she has a nose, she has jaws and has a full face."

After the surgery, the patient was heavily sedated from being on the breathing machine.

As she was slowly awakening, medical staff members asked her how she was feeling and whether she was comfortable.


"She gave a thumbs up, first indication she was comfortable," said Dr. Chad Gordon, a fellow at the clinic's department of plastic surgery. "She has been speaking to us very slightly. Most of communication has been through writing."

Siemionow said the patient will need re-educate her facial motion and need three to six months of nerve regeneration.

[Evenstar227]

To actually respond to the post...

That's an amazing procedure, and I hope it works out for the woman. I feel proud to live in Cleveland where this was done at the Cleve Clinic (which is, incidentally, the same place where my dad & grandma were wonderfully taken care of).

Critics such as Peter A. Clark, director of the Institute of Catholic Bioethics at St. Joseph's University in Philadelphia, Pennsylvania, said a facial transplant introduces unnecessary risks for a procedure that is not a matter of life and death.

"With something like a liver or kidney transplant, it's a life or death transplant," Clark said. "Even with a kidney or liver [transplant], you have to be put on immunosuppressants with serious side effects."

I don't understand this mentality. I'm Catholic, and I see no reason to not have done this despite it not being a "life or death" situation. For crying out loud. It's not like she was having recreational plastic surgery done on her nose or something.* She had trouble speaking and couldn't taste or smell. Oy vey.

*Note: Though I find recreational plastic surgery in general to be a sign of the immense superficiality of society, I can't deny that it can significantly increase a person's quality of life and self-confidence. Who am I to argue with that?

[Ninjinister]

I saw this last night while flipping through channels. I honestly thought that there had been one done here in the US before, but I guess I was mistaken. Anyway, I hope this gives this woman a second chance at a normal life. I couldn't imagine walking around town like I had just lost a 'To the Pain' duel.

The creepy thing is, on the news station that I heard about this (ABC, I believe... I can't recall), they said that the woman whose parts were used was braindead... they didn't make any mention of her situation other than such. CNN just says "cadaver" there. I don't know what to make of this.

[Machias Banshee]

I think what would bother me most is that if I were a relative of the 'cadaver', and saw their face on a total stranger's body. Anyone remember Face-Off?

[Evenstar227]

Originally Posted by The Ninjinister

I saw this last night while flipping through channels. I honestly thought that there had been one done here in the US before, but I guess I was mistaken. Anyway, I hope this gives this woman a second chance at a normal life. I couldn't imagine walking around town like I had just lost a 'To the Pain' duel.

The creepy thing is, on the news station that I heard about this (ABC, I believe... I can't recall), they said that the woman whose parts were used was braindead... they didn't make any mention of her situation other than such. CNN just says "cadaver" there. I don't know what to make of this.

Hmm. Braindead and cadaver are two entirely different states of being. I certainly hope the donor was dead when they took her face! Eep...

Originally Posted by Machias Banshee

I think what would bother me most is that if I were a relative of the 'cadaver', and saw their face on a total stranger's body. Anyone remember Face-Off?

The article states that "Siemionow said the patient never saw a photo of the donor and said, 'the donor never looks like the recipient. The recipient never looks like the donor.' " Besides, parts of the woman's face were left. I would think she won't look like the donor at all.

Also, getting back to this not being a "life or death" situation, would Peter A Clark also object to this surgery and this?

[Buslady]

i dont know much about the topic but it makes sense that they would use a brain dead donor well simply cos the material needed was fresh meat; the blood vessels and nerves would still be nice and pliable for fixing the recipient's face, waiting for new blood to rush right on in there insteald of cold nasty blue contracted blood vessels...like i said...lol i dont know much about it all. just had that...vision...ew.

i hpoe it works out for the gal.

[Machias Banshee]

I thought about this a little more.. considering the number of nerves and muscles in the face needed for facial expressions, talking, involuntary functions (blinking)... It must take several surgeries to connect EVERYthing. And nerve surgery HURTS.

I would be very interested in finding out HOW they do this surgery, instrument-wise...

[Buslady]

maybe using computer controlled robotic tools cos they seem to be able to get the tricky stuff better than human hands that shake all the time.

[Katie]

The lady doc who did the surgery has been practicing this fo something like 22 years if I remember right...doing all sorts of limb reattachments and transplants of all types.

Also, on the brain dead thing.....they do lots of organ donation this way. I have first hand experience knowing this because we donated some of Trent's organs. he was gone for sure, but they had to keep his body alive to preserve the organs. If he hadn't been on life support he would not have been able to sustain life. likely the same for the donor.


Now....one thing that I heard talk of on this was that they should make a special amendment to the euthanasia law to allow this lady to be euthanised if the face is rejected and she shooses to die. Mainly because this was a one shot deal. if she rejects this they cannot do it again. She wouldn't die from the rejection most likely....but could you imagine? What does everyone think of this?

[Machias Banshee]

I hate the idea of any sort of euthanising... couldn't they treat her the way they would a 3rd degree burn victim? I've seen some amazing things done with skin grafting and reconstructive surgery. It would be a long process, but I would personally think it's better than being dead..

[Katie]

The thing is though...they replaced a good bit of her skull and muscle and nerve tissue too. if it rejects...well....not trying to be graphic...but her face and head would litterally be sloughing off.

[Machias Banshee]

Ouch... I forgot the bone transplant as well. The thing though, with the way medicine and technology is advancing at breakneck speeds these days, I wouldn't be surprised to see some sort of synthetic facial replacement in ten years or so.