First Face Transplant

mriya3 writes to tell us the BBC is reporting that surgeons in France have performed the first ever face transplant. The medical team, led by Jean-Michel Dubernard, transplanted live tissue to a 36-year old woman whose face had been destroyed by a dog. From the article: "It has been technically possible to carry out such a transplant for some years, with teams in the US, the UK and France researching the procedure. [...] But the ethical concerns of a face transplant, and the psychological impact to the patient of looking different has held teams back."

Comments

Well, whose face did she get?

[jonnythan]

Was it John Travolta's or Nicholas Cage's?

I wouldn't want either.

Re:Well, whose face did she get?

[plover]

Well, at least John Travolta's thetans would be pre-cleansed...

Re:Well, whose face did she get?

[ChrisGilliard]

Yes, I'm always amazed by the technology they used in that movie. How did they get John Travolta to look just like Nick Cage and vice-versa!?!?! Amazing. *sigh*

Ethical concerns?

[Eric Smith]

What ethical concerns?

A live person is missing a face. A dead person doesn't need theirs any more. Where's the problem?

And how could the "psychological impact" be worse than not havin a face? The patient is going to "look different" no matter what is done.

Re:Ethical concerns?

[supra]

> Where's the problem?
What if a person commits a crime and uses this surgery to escape identification and/or conviction.

Re:Ethical concerns?

[Chmarr]

Yeah, I thought that was kind-of daft too.

"Oh, I can live with having a mauled/disfigured/destroyed face, but I CANT live with having someone ELSE's face".

Yeah... right.... :)

However, doing the ID thing would be interesting from then on.

Re:Ethical concerns?

[Darkon]

A live person is missing a face. A dead person doesn't need theirs any more. Where's the problem?

From the article:

"Where donors would come from is one issue that would have to be considered. "The transplant would have to come from a beating heart donor. So, say your sister was in intensive care, you would have to agree to allow their face to be removed before the ventilator was switched off. "And there is the possibility that the donor would then carry on breathing."

Re:Ethical concerns?

[Pudusplat]

You obviously did not RTFA. The donor cannot be dead for this transplant to be successful. The donor would supposedly be someone close to death on life support. The surviving relatives of the "near deceased" would have to give the go-ahead to rip off the face of their beloved, assuming they will no longer need it. This could presumably lead to problems if a miraculous recovery of the donor happened or could adversly affect the donor's family if they see the face of their relative on someoene else's head. Those are the ethical concerns.

Re:Ethical concerns?

[op12]

And then an undercover agent changes his face to that guy's face to learn about him and catch him!

Re:Ethical concerns?

[Eric Smith]

What if a person commits a crime and uses this surgery to escape identification

There's all sorts of cosmetic surgery they can already use to do that, without resorting to a face transplant. A face transplant is very risky, and there aren't that many surgeons in the world qualified to do it, so it's unlikely that someone can get this done without a lot of publicity.

and/or conviction.

If they are identified, I don't see how a face transplant will help them avoid conviction.

Re:Ethical concerns?

[Eric Smith]

The article failed to explain why it couldn't be someone that died very recently (within minutes). In a hospital, there are people dying all the time, so finding a donor that isn't on life support doesn't seem completely impossible. Just somewhat difficult.

Re:Ethical concerns?

[darkmeridian]

Technically, face transplants are not medically necessary. The surgery would definitely make the person feel better, but it is not life-saving such as heart, liver, lung, or kidney transplants. The side effects of immunosuppresants are still quite severe and perhaps life-threatening, since the immune system is getting shut down for the life of the patient. The question is whether a doctor can allow someone to take these risks for a non-life-saving procedure.

Living donors are not a problem because they're brain dead. So cutting off someone's face is scary; do so while they're still breathing (via ventilator) is really creepy. Yet, we pull hearts out of living people already so what's the face?

Re:Ethical concerns?

[$RANDOMLUSER]

Couldn't we use Japanese for donors? Don't they lose face all the time?

/ducks

Re:Ethical concerns?

[SilverspurG]

The ethical problem is with the doctor. Existing technologies are sufficient to reconstruct the face without the need for immunosuppressants for the rest of the recipient's life.

Transplanting a face is a PR stunt and MAYBE an academic exercise. It should not be standard treatment procedure. The article, by citing "10,000 burn patients in the UK", is trying to trump this sort of thing up to standard procedure.

Re:Ethical concerns?

[tomhudson]

and the psychological impact to the patient of looking different

It doesn't take much brains to realize that someone's going to look different after having their face chewed off by a dog. I should think having a strangers' face is less traumatic than seeing your own looking like a barfed-up big mac.

Better a stranger's face than a strange face.

Re:Ethical concerns?

[Scoth]

Some people consider their identity to be extremely personal, including their appearance. I know a few people who would likely prefer "Disfigured, but it's me!" over "some other guy". I personally would probably go with the transplant if the situation ever came up, but it's definitely not a universal assumption to be made.

Re:Ethical concerns?

[shotfeel]

Exactly, From TFA:

Doctors stress the woman will not look like her donor, but nor will she look like she did before the attack - instead she will have a "hybrid" face.

Re:Ethical concerns?

[Oliver Wendell Jones]

The article failed to explain why it couldn't be someone that died very recently (within minutes). In a hospital, there are people dying all the time, so finding a donor that isn't on life support doesn't seem completely impossible. Just somewhat difficult.

"Hey, little Timmy, we've got good news and bad news. The good news is someone just died a few minutes ago so you're getting a new face. The bad news is the person who's recently died is a 96 year old {insert optional racial type of your choice} woman..."

Re:Ethical concerns?

[ScentCone]

Wull, mghuh-hmm-srtch-hmmm.

Sorry, I couldn't quite get that out - I was finishing a hamburger. You know, putting some foreign tissue into my body. I think it's pretty obvious why... wait... [smack!]. Sorry, I had to swat a mosquito. It was busy getting some of its fluids into my body. In fact, that reminds me of how I was in an elevator this morning respirating the same damp air as the other ten people in there. Other people's exhalations, microbes, viruses and all!

Look, you stand way more of a chance of getting a disease from sitting on a public toilet than you do from a highly scrutinized tissue transplant. In fact, you could just as easily die from an anti-biotic-resistant lung infection picked up environmentally while you're in the hospital having your own blood transfused back into you.

I think you doth protest too much, and that your issue is strictly a superstitious one, similar to those that prevent people from donating their loved ones' perfectly good organs after an accidental death. I'm always amazed that people would rather bury a good liver in the ground (or burn it) than let some poor kid get a new lease on life. But I'm even more amazed by someone who would rather die than take in an organ from a screened donor. That's OK though - helps us evolve more rational people.

Re:Ethical concerns?

[teknopagan]

A "hybrid" face?

What kind of gas mileage will she get on it?

Re:Ethical concerns?

[mgv]

"Where donors would come from is one issue that would have to be considered. "The transplant would have to come from a beating heart donor. So, say your sister was in intensive care, you would have to agree to allow their face to be removed before the ventilator was switched off. "And there is the possibility that the donor would then carry on breathing."

This doesn't happen if the brain death testing is done properly. In Austraila one of the tests for brain death is that the person is disconnected from the ventilator for 20 minutes. If they breathe, they aren't truly brain dead. If you have proper criteria for brain death - A known cause of brain injury, meet several inclusion criteria (such as the aponea test mentioned above) and don't have any exclusion criteria that can look similar (eg recent anaesthesia/ low body temperature) then you can be considered as an organ donor.

In reality, people without brainstem function are very hard to keep alive on a ventilator, because the brain regulates alot of things. For example, the brain constantly releases a constant stream of anti diuretic hormone from the pituitary gland to regulate the total amount of water in your body. With brain death this stops and the kidneys will produce the maximal amount of urine (20+ litres/day), so fluid balance fails drastically.

I have seen less experienced people not understand the proper definition of brain death - I think that this is where you get the stories about turning off ventilators and people surviving. Brain death is a rapidly termainal condition. That is why so many heart transplants are done in the middle of the night - its hard to keep the donor alive until even the next morning.

Just FYI

Michael

In other news...

[Penguinoflight]

The team of surgeons deny that The Silence of the Lambs played any influence in their technique.

I'm confused..

[RapmasterT]

No seriously, what exactly are the "ethical considerations" of a face transplant? What makes it more ethically significan't than a skin transplant anywhere else?

And the "psychological impact" to the patient of looking different?? Looking different from a hideously scarred accident victim? Isn't that why they want surgery in the first place?

This seems to me like a story desperately in search of sensationalism.

Re:I'm confused..

[Have Blue]

The face isn't just an organ, it's a large part of your personal identity and how you distinguish yourself from the rest of the world. It's the only part of the body that is almost universally exposed to general scrutiny, and it's how you are known by others. I'm no psychologist, but I can imagine there's a difference between looking in a mirror and saying "that used to be me", no matter how mangled you are now, and looking in a mirror and saying "that is someone else".

The ethical implications would come from the process of removing the identity from someone who may or may not be dead and effectively erasing the identity of the recipient when the transplant is complete and he looks like someone different.

Re:I'm confused..

[BarryNorton]

No seriously, what exactly are the "ethical considerations" of a face transplant?

And the "psychological impact" to the patient of looking different?

It's about having, to some degree, someone else's face.

This is also why they're at pains to point out that the recipient does not look exactly like their donor.

Just as people look back and can't understand why people were uncomfortable with the idea of someone else's blood running around their veins, or someone else's heart beating in their chest, so people might get over this idea - you apparently have.

Have some imagination, though, and see why people have (it's true, and well-documented, not just sensationalism) been creeped out by this idea for decades...

Re:I'm confused..

[Anne_Nonymous]

>> Or mug shots or headshots used in a pictorial line up or even a real line up? There is little ethical consideration for getting your bobbies bigger.

Of course I'm sure officer! I'd recognize those breasts anywhere!

Re:I'm confused..

[Bastian]

I'm no psychologist, but I can imagine there's a difference between looking in a mirror and saying "that used to be me", no matter how mangled you are now, and looking in a mirror and saying "that is someone else".

Luckily, a lot of your appearance comes not from the soft tissue of the face, but from the underlying bone structure. A person who gets a face transplant wouldn't have the same visage as they used to have, but they wouldn't have the visage of the donor, either.

I would assume that the "looking in the mirror" problem would be no greater for a face transplant recipient than it would be for a person who experiences some other massive change to their face, such as whatever damaged it so much in the first place or reconstructive surgery.

Best of both worlds

[konaforever]

Now I can be good looking and smart!

Re:Best of both worlds

[drinkypoo]

Now I can be good looking and smart!

Settle down, champ. They didn't say anything about a brain transplant.

In other news

[ankarbass]

Michael Jackson is in france this week for an undisclosed medical procedure.

Face Jacking?

[KrackHouse]

I've heard the rumors of organ snatchers where you wake up in a bathtub with stitches and one kidney. Should we incredibly good looking people fear knife weilding hoardes of uglypeople hell bent on revenge?

yuck

[machine of god]

they can't reconnect the nerves can they? Wouldn't it feel like having a thick layer of dead skin on your face all the time, I mean I'd want to pull it off continually.

So that's how

[hypergreatthing]

Bin laden got away from afghanistan with no problems. Now he's mascarading as Dick Cheney.

you dont look the same

[jmazzi]

Even if you got a face transplant, you wouldn't look like the face of the donor. Your bone structure etc is what makes up most of your appearance. Although, you wouldn't like you use to. So I don't see how ethics would really take a roll in this matter.

We can regrow ears !

[zymano]

What is so difficult about a face but we can grow other parts.

http://www.pbs.org/saf/1107/features/body.htm

Is there a doctor in the house?

[DG]

Given that skin cells are constantly being shedded and regenerating, wouldn't this (slowly) transform back into the recipiant's original face?

Or would a skin sample from the transplant area show different DNA for all time?

I'm genuinely curious. Is there a doctor in the house?

DG

Re:Is there a doctor in the house?

[jonnythan]

The graft is living tissue that divides. The exterior layers are replaced by the basal layers, therefore I'm pretty sure it will show the same DNA for all time.

Re:Government and Health Care

[pnewhook]

The same Canada that just voted their Congress out of office?

Congress was not voted out of office. The opposition got together and forced the government to resign (a vote of non-confidence). This is extremely democratic - moreso than in the US where you are essentially stuck with the guy for four years, unless you actually manage to impeach the guy for something criminal.

The same Canada that almost killed a friend of mine whose plane was grounded on 9/11, got a stomach flu and almost died in a Canadian hospital while he waited THREE DAYS for a doctor to see him?

If it was just a stomach flu why didn't he just go to a walk-in clinic? He would have been assessed (for free) and had a prescripion in under an hour. If it was more serious, he would have been referred to a hospital that would then have been notified that he would be arriving and be ready for him.

The same Canada where people are on waiting lists for years for a basic MRI that I can drive down the street here in the States and get in a mere hours?

Years? Give me a break. I do agree that the wait time is long, and a huge issue, but it is on the order of weeks not years. Also if it is high priority, then there is no wait time - the scan gets done immediately.

The Canadian health care system is a mess. I pray I am never doing business in Canada when I get ill.

Funny, most people I know pray they don't live in the US when they get ill, as a major illness effectively means bankruptcy.

Psychological impact?

[idommp]

I grew up with one-quarter of my face missing in action. When I was two, doctors removed the upper left quadrant of my face including the eyelids and the skin down to the bottom of my nose. Twenty operations and fifteen years later I finally got working (but not very pretty) eyelids again. The person undergoing the face transplant has already suffered the psychological impact of loosing their original face and the impact of being treated like some kind of monster. The trauma of getting a different face can't possibly be any worse.

Re:Psychological impact?

[Tim C]

The person undergoing the face transplant has already suffered the psychological impact of loosing their original face and the impact of being treated like some kind of monster.

That really depends on the circumstances. I imagine that a lot of these operations would be performed immediately or very soon after the injuries were sustained (eg burns victims, etc). They may well still be adjusting to the idea of being disfigured, and - if the operation was performed soon enough - may not have had any contact with anyone other than medical staff, friends and family.

Whoa, whoa, whoa

[Marc2k]

What about maintenance? Supposing a poor person could afford a procedure, how on earth would they pay for prescriptions? Prices have skyrocketed in the past few decades, meanwhile, Merck spends over 60% of their budget on Marketing, mostly in telling the middle and upper classes what designer drugs they should ask their doctor about, as well as random kickbacks for doctors to prescribe their brand exclusively.

What about malpractice insurance? This is probably the #1 cause of inflated health care prices, our overly-litigious society is effectively killing services, private and governmental, while trial lawyers are cleaning up.

It's not all the government's fault, Captain Industry.

Not at all true.

[Marc2k]

Did you know that in the US in 2006, more children will grow up in homes that have declared bankruptcy than will grow up with divorced parents?

Did you also know that as of 2004, over 50% of all bankruptcies in the US are directly related to a major medical illness somewhere in the family?

50% Medical Bankruptcy article (2005)
Article stating number of bankruptcies in 1999 (~ 500,000 families)
Article stating number of bankruptcies in 2001 (~ 1.5 million families)

Re:Government and Health Care

[mr_matticus]

I'm with you 100% on personal responsibility, but I think you'll have to agree that other major Western democracies with healthcare systems do not produce these results. Canadians are much slimmer than Americans, as are the people in all of the EU states. The United States is one of the only (or maybe THE only) Western democracy without funded healthcare programs for its citizens. 65% of Americans are overweight or obese now. There's not really a causal relationship there, though.

Fat and wasteful are becoming almost objectives in and of themselves for the "average" American. I don't think a functioning health care system in the US would lead to fatter people. I do think that people would continue getting heavier and lazier, but not having to pay out of pocket isn't the cause. Being American is the cause, with the mentality that has come to be dominant in our country.

You get used to it

[Atario]

Having had a big swath of my forehead flesh disconnected from its nerves in a car accident, I can tell you that you get used to it. And, no, you don't want to pull it off. When it first happens, it's an injury and you do all you can to avoid touching it altogether. After it heals, you're used to not messing with it. By that point, you're accustomed to the way it feels anyway.

Wrong media

[Anubis350]

Science takes its cues from Nip/Tuck. How frightening!

no, from Tony Hawk, after all, they just did a faceplant...

Karma, karma burning bright...