- US scientists are preparing to perform the world's first
full-face transplant. The 24-hour operation involves lifting an entire
face from a dead donor - including nose cartilage, nerves and muscles -
and transferring them to someone hideously disfigured by burns or other
injuries.
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- A team at the University of Louisville in Kentucky has
submitted a 30-page request to the university's ethics committee, New Scientist
reports today.
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- Peter Butler, a surgeon at London's Royal Free Hospital,
called for a debate on the procedure in 2002. The Royal College of Surgeons
urged caution and decided last year that, for the time being, the risks
outweighed the possible benefits.
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- But John Barker, leader of the Louisville team, told
New Scientist: "Caution by itself will not get us any closer. If Christopher
Columbus were cautious, I'd probably be speaking with a British accent."
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- Faces have been replaced before. In 1994, a nine-year-old
child in northern India lost her face and scalp in a threshing machine
accident. Her parents raced to hospital with her face in a plastic bag
and a surgeon managed to reconnect the arteries and replant the skin.
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- There have been similar successes in the US and Australia.
Hands have been transplanted, as well as thighs and knee bones, and a one-month-old
baby girl survived a hand and arm transplant. Transplants of kidneys, lungs,
hearts and other tissue are now routine: the only constraint is a shortage
of donors.
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- But a full-face transplant - of the kind used on Nicolas
Cage and John Travolta in the science-fiction thriller Face/Off - is a
bigger challenge. More than 30 muscles are involved in facial movements
- it takes 17 muscles simply to smile.
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- Surgeons would need to save not just the donor's skin
- from hairline to jawline and from ear to ear - but also the nose, mouth
and lips, eyebrows and eyelids, subcutaneous fat, some of the muscles,
the nasal substructure and the nerves.
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- Then they would have to painstakingly reconnect all of
this to someone rendered almost unrecognisable by burns or scarring. The
recipient would then require a lifetime's supply of immunosuppressive drugs
to maintain the new face.
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- Some burns victims have had more than 50 skin-graft operations
to rebuild faces that they believe to be still hopelessly disfigured. Surgeons
argue that whole-face transplants would produce better results.
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- New Scientist worked with a television company, Mentorn,
and an animation firm to conduct a "virtual transplant", stretching
the facial skin of a virtual donor over the bone structure of a virtual
patient.
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- Appearance is dictated not just by skin, but by bone
structure, and surgeons are not sure how closely a reconstructed face would
resemble a donor's at the end of the operation. The technical challenges
are huge. So are the ethical dilemmas.
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- "The main problem in these people is coming to terms
with their new appearance. And they'd have to come to terms with a new
appearance anyway. So why are you doing it? If they have to come to terms
with a new identity they may as well come to terms with their altered identity
as with someone else's identity," said Peter Rowe, chairman of the
ethical committee of the British Transplantation Society.
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- "Then there is the disfigurement of the potential
donor. One has a duty to respect corpses. They were once living people
and one should treat a corpse with respect. All these things are arguable,
but they are likely to cause profound disquiet among a substantial sector
of the population, we feel."
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- Guardian Unlimited © Guardian Newspapers Limited
2004 http://www.guardian.co.uk/medicine/story/0,11381,1225537,00.html
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