- The Washington Times - Saturday, October 25, 2003

LONDON — A team of American surgeons says it is technically ready to transplant a face from a cadaver to a living person in a surgical milestone that some will regard as miraculous and others as disgusting.

Some believe that a dead persons face animating the living smile of another is the stuff of horror movies. Others argue that this radical surgery is infinitely preferable to living with a face that has been disfigured by cancer, shot away or burned beyond recognition.

There are also technical concerns. How much will the face resemble the donor? Can it show convincing expressions? Will recipients tolerate a lifetime of drugs to prevent their immune system from rejecting the alien tissue?

A leading proponent, Dr. John Barker, director of plastic surgery research at the University of Louisville, plans to announce at a public forum in London on Nov. 19 that the surgical hurdles associated with face transplants have long been overcome.

“Eight years ago, while the surgical techniques had already been worked out, there was still science to be done to demonstrate that the tissues making up the face, primarily the skin, would not be rejected. Today, it is just a matter of getting the right team of experts together to select the patient, perform the surgery and care for the patient afterwards,” Dr. Barker said in an interview.

Current methods for reconstructing major facial deformities use tissues from another part of a persons body, often taking more than 100 operations to reshape them to look and work like a face. Dr. Barker argues that in many ways these are more demanding than a face transplant, which would require only a few operations to achieve a better result.

Dr. Barker cites the success of hand transplants. When the first was conducted on New Zealander Clint Hallam in Lyon, France, in 1998, it triggered a media frenzy — even though the operation is technically simpler than the well-established procedure to reattach an amputated hand, which has often been mangled in an accident.

“Reconstructive surgeons have been doing these reattachments for 20 or 30 years,” he said. Indeed, in the medical literature “several cases have been described where patients faces have been torn off in accidents and have then been successfully reattached.”

Two years ago, Dr. Barkers team completed an application to the Institutional Review Board — a local panel of experts — outlining the risks and benefits of face transplantation. When this application is submitted, it will be a signal that the team is ready to operate.

But face transplants stir much stronger feelings than transplanting a hand. “A face is you,” Dr. Barker said. It does more than any other body part to shape ones identity, and influence how we are treated by others.

Could wearing anothers face be tantamount to adopting another identity? Could it obscure ones own identity, or compromise it? Or will the “soul” remain untouched by a change in countenance? And if not, and the person inside shines out of a shattered face, why bother with a transplant at all?

Perhaps the biggest issue is whether anyone would want to donate his or her face. Many feel squeamish at the thought of donating their faces, or worse still, those of people they love.

The first patients are likely to be serious burns victims, those who have their facial bones intact. Without a transplant they would end up with scar tissue that contracts and distorts, making smiling impossible.

Before the first transplant, there are still a few practical issues to be dealt with. By this, Dr. Barker means assembling a team to do it — not just experts in reconstructive surgery but sociologists and psychiatrists, too; and finding a donor, which he admits will be a major problem, as is the case in all transplant surgery.

“It will be much more difficult when it comes to the face,” he said.

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