Shortage of Donors Will Hamper Facial Transplants

by Gopalan on Aug 24 2008 11:01 AM

 Shortage of Donors Will Hamper Facial Transplants
Facial transplants might have made significant advances recently, but post-death few would like to have their faces removed for transplant.
"People are still unsure about it," said Laurent Lantieri, head of the department of plastic surgery at Henri Mondor Hospital outside Paris. "People are thinking, 'Maybe I'm going to see my husband or my son or my sister walking the street after she's dead.' That's not the case."

Although still in its infancy, face transplantation has been performed by surgeons around the world on several disfigured patients. The procedure involves attaching a donor's facial tissue to reconstruct the deformities on the patient.

Dr. Lantieri conducted a face transplant last year on a man who was severely disfigured as the result of a facial tumour. The procedure, as well as its aftermath and the complications that arose, are documented in the medical journal Lancet.

Also reported is the Chinese case where doctors conducted a transplant on a man who lost part of his face when a bear tore it off in a 2004 attack. The 2006 surgery involved connecting arteries and veins, as well as repairing the man's nose, lips and sinuses.

"Facial transplantation could be successful in the short term, but the procedure was not without complications," says the article by Chinese surgeons at the Institute of Plastic Surgery at Xijing Hospital, Fourth Military Medical University. "However, promising results could mean that this procedure might be an option for long-term restoration of severe facial disfigurement."

Three major challenges are involved in face transplantation procedures.

One is the type of technique used to remove tissue from a donor and transplant it successfully to the recipient's face so that the individual is able to feel heat, cold and other sensations once the surgery is complete.

Another challenge is medical complications after surgery. Dr. Lantieri said all face transplant patients experience some form of rejection that must be handled with a variety of drugs.

The third issue is the psychological impact on the patient.

There was originally major concern that patients would be left emotionally traumatized once they were given a new face - and essentially a new identity.

But Dr. Lantieri wrote that his patient, who received a face transplant last year, went from feeling like "a monster" to experiencing himself as "an anonymous person in the crowd."

"You're dealing with a patient that has no more face," Dr. Lantieri said in a telephone interview. "They have no more face and no more human appearance. What we're trying to do is give them back human appearance."

But widely held misconceptions and trepidation about this groundbreaking surgery are major factors in the public's resistance to the idea of facial donation, Dr. Lantieri said.

He said people often mistakenly think of the popular movie Face/Off, in which an FBI agent has a radical surgical procedure to take on the appearance of a criminal and infiltrate his organization.

But in reality, people who have facial transplants do not resemble the donor once the procedure is complete, Dr. Lantieri said. That's partly because an individual's unique bone structure plays a significant role in appearance.


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