Partial Face Transplant Raises Ethical Concerns

LONDON (Reuters) - The world's first partial face transplant has given hope to people disfigured by burns or accidents but raises psychological and ethical issues for the recipient and donor family, medical experts said on Thursday.

Although face transplants have been technically possible for several years, concerns about the psychological impact, consent and the long-term risk of drugs to prevent the immune system from rejecting the new face have prevented them. But in a ground-breaking operation on Sunday in the city of Amiens in northern France, a 38-year-old woman who had been savaged by a dog received transplanted tissue, muscles, arteries and veins from a brain-dead donor.

"It is a very exciting breakthrough but we still don't know whether this is going to have a long-term success," said Michael Earley, a plastic surgeon at Mater Hospital in Dublin, Ireland. "It carries a high failure rate, if looked at in terms of other organ transplantation," he added.

The woman, who had been left without a nose and lips following the attack last May, was said to be in an excellent state, according to the hospital. Earley said blocked blood vessels pose a danger in the first few days after the surgery. Long-term risks include the woman's immune system rejecting the face. In other organ transplants, rejection is about 10 percent in the first year after surgery and can be 30-50 percent in the next 2-5 years depending on the organ.

PSYCHOLOGICAL CONCERNS

The surgery performed by Jean-Michel Dubernard, a specialist from a hospital in Lyon who has also carried out hand transplants and Bernard Devauchelle from the Amiens hospital, was an elective, or quality of life, operation. Unlike heart, liver and kidney transplants, it was not life-saving surgery but the woman chose to have it despite the considerable risks.

"There have been objections from psychologists who feel this is uncharted territory and we don't know how the donor's family and the recipient's family will react," said Earley, a past president of the British Association of Plastic Surgeons. Stephen Wigmore, chair of the ethics committee of the British Transplantation Society, said computer simulations suggest the facial appearance after the transplant will be a composite of the recipient and the donor.

"For all transplant patients the acceptance that part of their body is not their own is a difficult concept," he said. "Another aspect is that the public interest in face transplantation will mean that it is likely that the families of the deceased donor may be exposed to images of the recipient and this is likely to present particular difficulties for them," he added.

Dr Daniel Sokol, of Imperial College in London, raised the problem of consent. "Ethically, the main issue is that of informed consent: Did the patient give adequately informed consent to the procedure? Did she understand the risks and implications of the transplant," he asked, adding there is no reason to suggest she did not.

Earley said the breakthrough is likely to spur other surgical teams, particularly in Britain and the United States, to perform similar operations. But he doubts there is going to be a rush of people seeking facial transplants, which will benefit mainly burn patients.