FIVE men and seven women — all severely disfigured — have been shortlisted in the “face race” to receive the world’s first face transplant.

In the next few weeks the 12 applicants will visit the renowned Cleveland Clinic in the United States, which will select the first recipient of a new face from a cadaver. The clinic received approval for the pioneering operation from its ethics board last year, though regulators in Britain and France had rejected the surgery.

But Maria Siemionow, who is leading the project, admits that the chance of the donor’s body rejecting the new face could be as high as 50 per cent. The clinic’s “consent form” says that the surgery is so novel that doctors do not think informed consent is even possible. The transplant does not guarantee they will ever look “normal”, and their appearance could even get worse, according to the form.

At the interviews Dr Siemionow, 55, will ask would-be transplant recipients to smile, raise their eyebrows, close their eyes and open their mouths. Then she will ask: “Are you afraid that you will look like another person?”

As part of her preparations, Dr Siemionow rented a video of the 1997 film Face Off, starring John Travolta and Nicholas Cage, in which two characters swap faces. But Dr Siemionow says that unlike the film, the transplant recipient will not resemble the face donor because the underlying bone structure remains the same.

The unprecedented surgery touches on the deepest human feelings about identity. Some ethicists contend that facial disfigurement is not life- threatening and therefore not worth a lifetime on immuno suppressant drugs, which can be justified for other organ transplants. Dr Siemionow and other doctors argue that many disfigured patients are tormented by shame and depression. “For many patients, being able to go back to their normal lives is worth the risk of taking lifelong immuno suppression,” she says. “Many of those patients do not leave their houses.”

The surgery offers the promise of allowing patients to eat, drink and communicate again through the wide variety of facial expressions and mannerisms that most people take for granted. The Cleveland Clinic is the first hospital to be allowed to perform a face transplant. The University of Louisville’s plastic surgery research laboratory is also seeking permission for ten face transplants on burns victims.

Technically, the microsurgery involved in a face transplant has been possible since at least 1999 when the University of Louisville performed America’s first hand transplant — an operation that has since been repeated 25 times in the US.

Dr Siemionow’s team has experimented with face transplants on animals, and performed mock transplants on dozens of cadavers.

Donors and recipients will be matched for tissue type, age, sex and skin colour. Within six hours of death, the donor’s face will be “degloved” from the hairline to the jawline, complete with the epidermis, underlying fat, nerves and blood vessels, but no musculature.

In a ten-hour procedure, the patient’s face will be removed, and the new facial “flap” attached to the recipient’s blood vessels and nerves. The patient is expected to remain in hospital for ten to fourteen days.

Complications, doctors say, could include infections that turn the new face black and require a second transplant with skin grafts. The lifelong regimen of immuno suppressant drugs to prevent rejection carries a risk of kidney damage and cancer. Transplant recipients also face the possibility of psychological problems after the operation — and are likely to be exposed by the media.

Most of the shortlisted candidates are burns victims who are otherwise healthy, enabling them to endure the anti-rejection drugs. For this reason, cancer patients and children are not being considered. Nor is anyone who has threatened to attempt suicide or has a weak support network.

Dr Siemionow insists that potential recipients will not be allowed to see their new face before the operation begins. “It’s not a shopping mall. They need to rely on our judgment. If they are starting to shop, they are not good candidates,” she said.

People afflicted by facial disfigurement differ on the value of face transplants. Christine Piff, a cancer survivor and the British founder of Let’s Face It, a network of people with facial disfigurement, has expressed support for the new operation.

But Betsy Wilson, who lost her lower jaw to cancer 33 years ago, said: “Living with a scarred, different face is not that horrible.”

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