THE search is on for a volunteer to undergo the world’s first face transplant after a hospital in Ohio granted permission to attempt it.
The pioneering medical team will be led by Dr Maria Siemionow, a Polish-born plastic surgeon at the Cleveland Clinic. Although she has avoided the limelight until now, she feels that the time has come to persuade the public of the ethical and medical benefits of a dramatic, risky and potentially shocking procedure.
“When you mention a face transplant, people think you are talking about vanity, that someone healthy is going to be walking around with someone else’s face,” Siemionow said. “But within the surgical community we perceive it as a step forward for these traumatised patients.”
A dozen badly injured volunteers have already approached the clinic seeking to replace their disfigured faces. Only the most extreme sufferers, such as victims of fires or car accidents, are being considered and not all are suitable candidates.
Cancer patients are being excluded, as are 90% burns victims. “If your face rejects the new transplant you would have to be able to use skin grafts from the rest of your body,” the clinic pointed out.
It is a sobering reminder of just how experimental the procedure is. Although comparisons have been made with Face/Off, the 1997 film starring John Travolta and Nicolas Cage who swapped their looks and identities, it is far from being realised.
“It was okay if you like Travolta,” said Siemionow, who rented the video. “But it was just science fiction.”
In a real-life operation, the facial tissue of the donor corpse from the hairline to the jawline must be removed with its layer of fat, nerves and blood vessels within six to eight hours of death, while in a nearby theatre the skin of the transplant patient is detached. The blood vessels are clamped and the muscles and nerves left in place.
The flap is then flattened on to the recipient’s face and the vessels and nerves are painstakingly connected to the donor’s tissue in an operation lasting up to 24 hours.
If the patient rejects the face, he or she will have lost their old one along with the new.
Even after a successful operation the recipient is unlikely to look much like the donor, which could be reassuring to the dead person’s family. But nor will they look like their old pre-traumatised self. They will also face a lifetime on immunosuppressant drugs.
For Eric Trump, an ethicist formerly with the Hastings Center in New York, the moral gamble and medical risks of the procedure are too great.
“I’ve had a kidney transplant, so I certainly wouldn’t say no on principle,” he said.
“But skin is highly prone to rejection. They wouldn’t be transplanting the face’s musculature so there is a very high chance that it would be rejected, leading to more skin grafts and scarring.”
One of the most poignant advocates of a face transplant is Jaqueline Saburido, 27, who lives in Florida. She was a pretty brunette student at a university in Texas when her car was hit by a young drunk driver in 1999.
Waking up in hospital with third degree burns over 60% of her body, she found herself transformed. Her ears and nose and lips were burnt off, leaving one eye popping out of her face, while the other, blinded, was hidden behind a flap of skin.
When she heard that the University of Louisville in Kentucky, which had been treating her, had applied for permission to perform a face transplant, she immediately volunteered. The university is still seeking approval from its ethics panel. “I hope I can do so soon because life is now,” Saburido said at the time.
Yet now that there is a realistic prospect of undergoing the operation, Saburido is no longer sure that she wants one. According to a confidant, she is growing more used to her looks.
Subarido’s eyes have improved greatly and she is considering reconstructive surgery to her nose and ears. But the main improvement to her life has been psychological.
Saburido has been promoting anti-drink driving campaigns and is being encouraged to talk to soldiers who have been badly wounded in Iraq. After more than 40 operations and years of suffering, she feels that she has found a role.
Gwendolyn Arrington from Cleveland also considered volunteering for a transplant after a gas explosion in her home 15 years ago consumed her face in a fireball.
Tempted though she is by the prospect of a transplant, she too has found a life. She has had two more children, studied for a BA and now works for an insurance company. The Cleveland Clinic says Arrington remains supportive of the cause but is not applying for the procedure.
It is likely that the first patient to undergo the operation will be a relatively recent victim of trauma who, unlike Arrington and Saburido, has not undergone a series of skin transplants, grafts and attempts at regeneration.
As a young doctor in Finland, Siemionow watched a surgeon reattach the hand of a woodcutter. “That you could restore to people a part of themselves that had been lost, and actually see it become vital again, was miraculous to me,” she said.
