French Breakthrough in Facial Transplants
MELISSA BLOCK, host:
Ethical questions are being raised after doctors in France performed the world's first partial face transplant over the weekend. The patient is a 38-year-old woman who was mauled by a dog. Surgeons transplanted a nose, lips and chin from a brain-dead donor. The French doctors are supposed to give more details tomorrow.
In this country, two institutions are considering whether to perform a face transplant. One of them, the Cleveland Clinic, has the approval of a review board to proceed. Dr. Maria Siemionow is the director of plastic surgery research at the Cleveland Clinic. She'd be one of the doctors performing a face transplant there.
Thanks for being with us.
Dr. MARIA SIEMIONOW (Cleveland Clinic): Well, thank you very much for the invitation, Melissa.
BLOCK: And, Dr. Siemionow, based on what you know about the surgery in France, what do you think?
Dr. SIEMIONOW: We don't know that much. We know only what the media has said--presented to us. The protocol which was applied to the lady in France, it differs quite significantly from what we were having in mind when considering facial transplantation.
BLOCK: In terms of who would be eligible?
Dr. SIEMIONOW: In terms who would be eligible, who are the potential candidates. We want to be sure that the candidates whom we would be considering will be people who have already exhausted all conventional and traditional methods of helping them with their disfigurement.
BLOCK: This would be sort of a surgery of last resort, from what you're saying.
Dr. SIEMIONOW: That's correct.
BLOCK: Are there also concerns about who would be a donor for this surgery?
Dr. SIEMIONOW: This is also of the concern, to be sure. We have a donor consent protocol, so we want to be sure that the potential donor or donor's family will be informed towards the so-called facial transplantation is about, to explain that this is not identity transfer; this is really only a transfer of the skin for resurfacing of the patients whose skin was very badly injured.
BLOCK: Well, help me understand that, because I would assume if you're transplanting a face, that the recipient would end up looking very much like the donor. Is that not the case?
Dr. SIEMIONOW: No, because in our protocol, we had outlined it very clearly that the candidate will be the patients who still have naturally their own framework--they have skeleton; they will have their own muscles. And we will be just taking facial skin, which is very unique in our bodies, from the donor and covering or resurfacing the skin which was previously damaged. They will still have their own, you know, size of the head, the same framework of the bony structures. They will have the same contour, their own eyes, their own voice, their own gesture. So that will be very unlikely that the recipient will look like a donor.
BLOCK: One ethical concern that comes up when people talk about face transplants is that this isn't life-saving surgery. It's not like transplanting a heart or a liver.
Dr. SIEMIONOW: This is the very legitimate question, but what kind of life it is to stay somewhere in the house and never be able to face the society? We think the life is not Halloween to do it for all your life.
BLOCK: What about some of the long-term risks that would go along with face transplant? One of them, I guess, is the risk of rejection.
Dr. SIEMIONOW: Well, the risk of rejection is, of course, the risk which has to be presented to the patient, and that's a very important question you're asking here, Melissa. However, for them, the quality of life and ability to go back to the society may be everything they want, and that may be so important that they will consider to take the risks.
BLOCK: You know, we're talking about this pretty dispassionately, but there is something "Brave New World"-ish about what we're talking about here, about transplanting someone's face.
Dr. SIEMIONOW: I'm sure that for some people, it should be more explained, and I think we should take the odium off the fact that this is a Hollywood, this is for vanity, this is for someone maybe who has a wrinkle here and there. And tomorrow, we will, in detail, explain who are the potential candidates, why this procedure was outlined, who was in the need and why. Then maybe this society will also accept it or at least understand why we are doing that.
BLOCK: Dr. Siemionow, thanks for talking with us.
Dr. SIEMIONOW: Well, thank you very much, Melissa, for inviting me.
BLOCK: Dr. Maria Siemionow is director of plastic surgery research at the Cleveland Clinic in Cleveland, Ohio.