Face off

[MaiLuk]

 

 

By Laura Ungar

The (Louisville, Ky.) Courier-Journal

September 19, 2004

 

 

LOUISVILLE, Ky. -- Even as ethicists and others raise concerns, a team of doctors from Louisville and the Netherlands says it is ready to perform a face transplant.

 

"There arrives a point in time when the procedure should simply be done. We submit that that time is now," the team wrote in an article published Friday in The American Journal of Bioethics.

 

The article, by the team from the University of Louisville and the University of Utrecht in the Netherlands, explores the ethical and psychological issues, and physical risks, involved in a transplant that would attach the face of a dead donor to someone with a severely disfigured face, such as a burn or accident victim.

 

Although researchers will not say when such a transplant would be done, they are taking steps toward the first operation, which would be considered clinical research. They also need to find a hospital in which to perform the surgery.

 

The procedure involves removing a donor's skin and other tissue, putting it over the recipient's bone and cartilage and reconnecting it.

 

In addition to seeking comments from peers, they have submitted an application to an institutional review board in the Netherlands and are almost ready to submit one to an independent board in the United States.

 

The Louisville doctors said they would not perform the transplant without approval from one of the boards, which are designed to protect medical research subjects' rights.

 

The team also has evaluated several potential candidates for the transplant -- in both the United States and the Netherlands -- but has not yet found an "optimal" candidate, said Dr. John H. Barker, one of the article's authors and a member of the Louisville-Utrecht team.

 

"The people we're considering are people who have no other options," said Barker, director of plastic surgery research at the University of Louisville.

 

But members of another Louisville team, a partnership of the University of Louisville, Jewish Hospital and Kleinert, Kutz Hand Care Center, do not think a transplant should be performed yet.

 

Dr. Gordon Tobin, a member of that team, said ethical and other issues have not been fully explored, and the public needs a more thorough understanding of the procedure.

 

Face transplants differ from other transplants because the face is an integral part of someone's identity, said the researchers, who helped write the article. "What is at stake," the researchers wrote, "is a person's self-image, social acceptability and a sense of normalcy as he or she subjectively experiences them."

 

Researchers outlined some potential problems, such as misuse of the procedure. Aging rich people, for example, might seek a transplant for cosmetic improvements and criminals might want to conceal their identity, they said.

 

Patients also would see the same risks as other transplant recipients, such as the increased incidence of infection and cancer associated with immunosuppressive drugs.

 

But the benefits are many, researchers said in the article. For example, transplants could restore facial expressions and sensory functions and improve a patient's psychological outlook.