- LONDON (Reuters) - The prospect
of the world's first face transplant has sparked a fierce debate over the
ethical and medical implications of such a radical procedure.
Consultant plastic surgeon Peter Butler has called for public discussion
before he attempts to graft the face of a dead donor onto a burn victim
or someone suffering from face cancer as early as next year.
The Irishman and his supporters say the operation could transform blighted
lives but critics question whether it could ever serve society's or even
patient interests.
Richard Nicholson, editor of Britain's Bulletin of Medical Ethics, said
the idea strayed too far from medicine's Hippocratic roots.
"My gut reaction is that we are pressing too far, too fast with ideas
that impinge on our understanding of what normality is," Nicholson
told Reuters.
"I'm concerned that it's actually one step further down the route
of not accepting anything abnormal in this society."
But Christine Piff, who founded the charity Let's Face It after suffering
a rare facial cancer 25 years ago, welcomed the idea.
"If you haven't got facial disfigurement then it's very hard to comprehend,
because you would do anything to let a loved one have a life again,"
she said.
A face transplant Butler says, could mean a deformity was spotted only
at one metre (yard) away rather than say, 15 at present.
UPHILL BATTLE
But Butler faces a hard job if he is to convince the British public about
such a plan. Most respondents in his own survey, many of them doctors,
said they were willing to accept a new face but few would consider donating,
a point emphasised by Nicholson.
"I really do wonder how many people would be willing to donate the
face of a relative," he said. "I suspect they would be in pretty
short supply".
Butler, who told his wife to donate his face if he died suddenly, admitted
he did not know how to encourage donation but said public opinion would
shift.
"Over time, with full and frank debate I feel people's minds may change...but
if I don't raise the debate we can't explore a way through this,"
the 40-year-old Dubliner said.
And he was keen to stress that no operation should take place until the
moral and ethical implications of face transplants were addressed fully.
The dilemma for the medical profession, he said, is not "can we do
it, but, should we do it?"
Other medical pioneers such as Joseph Murray, who performed the world's
first kidney transplant, were initially criticised Butler said, but later
became part of the medical mainstream.
NEW TECHNIQUE
Central to Butler's plan is a new transplant technique that reduces the
need for powerful drugs used to stop the body rejecting foreign body tissue.
Instead of subjecting patients to a lifetime of harsh immuno-suppressant
treatments, kidney and heart swap patients are already undergoing trials
using donor bone marrow to encourage the body to accept new organs. Technically
this could be applied to face transplants as early 2003 he said.
But Nicholson doubted the medical basis of Butler's ideas.
"I think it's raising hopes unreasonably," he said. "I suspect
they (the patients) don't understand how much of a rigid mask it may turn
out to be...it's going to be very difficult to get any of the nerves and
muscles that control facial expression working again."
Butler, who eventually wants to see faces supplied through Britain's donor
card system, is reluctant to talk about when this first operation might
be.
"I'm not really that anxious to be the first. What I am concerned
about is to get it explored properly."
"I would hope to (do it) in the next two years, but I would say that
would be a very hopeful timeframe."
PETROL BURNS
The disfiguring scars on certain patients remind Butler why he first made
such a radical proposal.
He tells the story of one 19-year-old man who set himself alight after
breaking up with his girlfriend. The patient still looked severely burned
after more than 30 procedures by Butler and his team.
"If he had a problem with his girlfriend at 19 he's definitely going
to have it for most of his life. If I could have said to him 'look we could
potentially reconstruct your face with somebody else's', he might have
gone for it.
"What that case brought home to me (was) that we are so limited in
our ability to reconstruct these types of injuries. Skin from your abdomen
or leg is not like your eye-lid."
Initially Butler's five-man team hope to take skin and fat from a donor's
face and reconnect blood vessels using microscopic surgery, resulting in
a "hybrid" appearance of both the recipient and donor.
But in an echo of the sci-fi thriller "Face Off", patients could
end up looking almost exactly their donors if doctors are able to transplant
facial bone as well as skin, muscle and nerves.
The film could help shift attitudes though, he said.
"If it raises consciousness and fuels debate that people can identify
with, that actually makes it easier."
Like some other doctors and lay people, Nicholson finds this prospect even
more alarming.
-
- "How far off a head transplant are we now?,"
he said.
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