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MELISSA BLOCK, host:

From NPR News, this is All Things Considered. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris. Today surgeons at the Cleveland Clinic described the country's first face transplant. It was performed about two weeks ago on a woman who was severely disfigured in an accident. NPR's Patti Neighmond reports.

PATTI NEIGHMOND: The patient suffered severe trauma and had extensive reconstructive surgery over a number of years, but most of that was unsuccessful. The patient was missing her right eye, her nose, and upper jaw. She couldn't smell or taste, had trouble speaking, and according to doctors, children would shriek and run away from her when they saw her in public. Plastic surgeon Frank Papay was part of the 12-member surgery team and describes how the transplant proceeded.

Dr. FRANK PAPAY (Chief of Dermatology and Plastic Surgery, Cleveland Clinic): We transferred not only the skin, we transferred the skin, all the facial muscles in the upper face, in mid-face, the upper lip, all of the nose, most of the sinuses around the nose, the upper jaw, including some teeth, the facial nerve. And the facial nerve is important in the sense that that's what gives us - once it's connected - the ability to smile and to blink our eyes. So our hopes are that once it is connected and the new facial nerve grows through that she will be able to smile again.

NEIGHMOND: The new face will not look just like the dead donor's face, say doctors. It will be sort of a third face, a combination of the patient's own muscle and bone structure along with the overlay of the donor face. The transplant was performed about two weeks ago at the Cleveland Clinic. Microsurgeon Dr. Maria Siemionow headed the surgery team.

Dr. MARIA SIEMIONOW (Director of Plastic Surgery Research and Head of Microsurgery Training, Cleveland Clinic): The surgery took 22 hours. The preparation to the surgery took over 20 years of work in the field of composite tissue transplantation.

NEIGHMOND: This is not the first face transplant. Three years ago, a transplant was performed on a French woman who had been mauled by her dog. Similar transplants were done in China on a farmer who had been attacked by a bear and elsewhere in Europe on a man who was disfigured by a genetic condition. At the request of the patient's family, officials are not releasing any details on her identity or how she was injured, but doctors say the Cleveland Clinic transplant is the most complete, a "near total" face transplant, they say. The hospital's ethics committee approved facial transplantation three years ago, and since then Siemionow and her team have searched for an appropriate candidate.

Dr. SIEMIONOW: Only patients who are the most disfigured and exhausted already all existing procedures, which are conventional procedures, will be the potential candidates.

NEIGHMOND: Siemionow says the patient's quality of life was indeed grim enough to warrant the risky transplant along with the also risky anti-rejection drugs that must be taken for the rest of the patient's life. And while these procedures can be incredibly life-enhancing, medical ethicists worry patients must completely understand they are putting themselves at great risk for surgery that is not life saving. Ethicist Karen Maschke with the Hastings Center.

Dr. KAREN MASCHKE (Ethicist, Hastings Center): In a context where a transplant does not involve a bargain to stay alive, but is to improve the quality of life that I would have without the transplant, then the risks of the surgery and the risks of the lifetime drugs become more magnified. And that's where we start to look at more carefully, are those risks justifiable in a context that's not life-threatening?

NEIGHMOND: According to doctors at the Cleveland Clinic, this patient and her family were absolutely certain they wanted to take those risks. Doctors say it will be at least six months before the patient gains back a sense of smell and taste and normalcy. For now, they say, she is extremely happy just to be able to take her hands and feel her nose and the sides of her face. Patti Neighmond, NPR News.

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