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'Facing' the future of transplants

Doctors are preparing for the first transplant of a human face. Technically, the operation could be performed now, but ethically, should it be performed at all?
/ Source: NBC News

It's still one of the mythic feats of medicine, transplanting the organs of one human being to another. It seemed the stuff of science fiction when Dr. Christian Barnard performed the very first heart transplant operation 36 years ago last month. Liver, lung and kidneys transplants are now almost routine. But surgeons are once again about to go where medicine has never gone before. They're preparing for the first transplant of a human face. Technically, the operation could be performed now, but ethically, should it be performed at all?

It's what makes us unique, the thing most idolized on a model, most cooed over on a baby and the sign age is catching up with us.

“The human face is you,” says Dr. John Barker. “Take that away--could it benefit you to give you a face back? 

Dr. Barker is on the cutting edge of a radical new surgical procedure. He's part of one of at least five medical teams worldwide who are pioneering a new technique that seemed unimaginable until recently -- a total face transplant.

“You drape this tissue on, you sew, you tailor it, you trim around it, you put it in place, and in two or three weeks when the swelling goes down they look like a normal person,” says Dr. Barker.

Farfetched? Not for Dr. Barker,  who, along with his colleagues at the University of Louisville, performed some of the first hand transplants. Does he believe that people can really benefit from facial transplants?

“Absolutely,” says Dr. Barker. “The best way I can answer this is you need to talk to somebody who has severe facial disfigurement.”

It would be an extreme procedure for the most extreme cases, primarily for cancer patients and  seriously disfigured burn victims.

“It was a while after being burned that I realized how badly injured I'd become, nobody was willing to tell me,” says Simon Weston, who survived one of the worst attacks on British troops during the 1980's Falklands war. Weston's life changed forever when an Argentinean bomber made a direct hit on his ship.

“They hit the Sir Galahad, they killed 48, injured 97 of us,” says Weston.

Severely burned over 45 percent of his body, he went to hell and back to get to where he is today. He's become a well known advocate in England for burn victims and others, helping them come to terms as he has.

“My nose comes from my backside,” says Weston, “so whenever I kiss anybody now they don't realize how close they come to kissing my backside. My eyelids they come from my neck here and the inside of my arms. And the back of my head comes from wherever it comes from…I had over 75 major surgical procedures.”

Could a single face transplant be the answer for thousands of patients with severe facial deformities? For some it could be a medical miracle, to others it seems macabre.

“It's only macabre because we've already had the film “Face Off,’” says Weston. “But that was science fiction in movies.”

In that 1997 thriller, characters played by John Travolta and Nicholas Cage swap faces, each taking on the exact appearance of the other. Surgeons say that wouldn't be the case in an actual face transplant. In the proposed procedure doctors would remove the skin, nerves, blood vessels and some underlying fat from a brain-dead donor and carefully re-attach it to the recipient's face.

Dr. Peter Butler of London's Royal Free Hospital says surgeons have the skills to perform the operation now.

“It's already possible because it has been done in limb transplantation,” says Dr. Butler. “The technical part or the surgical approaches of facial transplantation are already worked out.”

Medical technology has advanced so far that a facial transplant is not only possible, but it has a high likelihood of succeeding. Now the question raised  at a  symposium here in London is not can they be done but should they be done.

Dr. Barker was among those invited. The main topic was the ethical implications of such a transplant.

There are severe risks. The recipient would have to take anti-rejection drugs for life, the recipient could even die from infection, and what's more, unlike a heart or lung transplant, this is not a matter of life or death. So, some people have problems with facial transplants because the recipient isn't necessarily near death.

“That is probably at the heart of the ethical debate,” says Dr. Barker. “Transplanting a hand will not save your life, it will better your life, it will increase the quality of your life, and that's also the argument for face.”

While improving the quality of life for disfigured people is a legitimate goal, Dr. Arthur Caplan, a medical ethicist, believes they shouldn't have to risk their lives to do so.

“You're going to get a massive rejection if it doesn't work, if we can't control what's going on in this facial transplant,” says Dr. Caplan. “That will be one of the most miserable and perhaps inhumane experiences anybody could be subjected to.”

Then there is psychological impact of using someone's face. It's their identity. It's who they are. Could there be a possibility that a family member might think that the recipient closely resembles the donor?

“ Absolutely,” says Dr. Barker. “There is that possibility that they will think that.”

And ethicist Caplan worries the controversy a face transplant may generate could jeopardize other donor programs.

“They're people who need kidneys, hearts, livers, if people start tearing up their donor cards and say I don't want my face transplanted,” says Dr. Caplan, “you could cause many more deaths than anyone who's benefited.”

But Simon Weston says only he and many like him really understand the emotional pain of seeing their disfigured faces every day in the mirror, and if relief is possible, they deserve it.

“If somebody has cancer we treat them,” says Weston. “If somebody has a deformed foot we help them.  If somebody has something internal that needs transplanting we help them. Now because this is on the outside, why should we stop that from happening?”

It's still unclear exactly when this procedure might happen. Doctors in Britain say they've already been approached by at least 10 patients eager to undergo a facial transplant.