Like people who receive new hearts or other organs, face transplant recipients would have to take medications for the remainder of their lives to prevent the body from recognizing the donor tissue as foreign and rejecting it.
Weighing the risks
The long-term risks of these drugs — and the unforeseeable psychological effect of wearing someone else's face — were cited by the Royal College of Surgeons of England as a reason to delay such surgeries.
A reconstructive surgeon, Dr. Peter Butler, of London's Royal Free Hospital, had prompted a national debate in England when he said he wanted to perform the surgery.
The idea is "worthy of study," the Royal College of Surgeons concluded in its resulting November report, but "until there is further research and the prospect of better control of these complications, it would be unwise to proceed with human facial transplantation."
In the United States, no such official decree is in the works. The Louisville surgeons need only receive consent from their hospital's institutional review board to proceed with the surgery. (Institutional review boards are set up to oversee medical research at a particular medical center or research facility.)
However, American reconstructive surgeons echo some of the same concerns as the British.
"While we can sometimes do wonderful things technically, can we follow up with the other things? The tissue matching. The rejection phenomenon. The social issues. Can we overcome all the other issues?" said Dr. James Wells, a Long Beach plastic surgeon and immediate past president of the American Society of Plastic Surgeons. "They haven't answered all the questions," he said of the Louisville team.
Although donor and recipient would share several tissue-typing characteristics, anti-rejection drugs would still be needed to suppress the recipient's immune system so it wouldn't attack the donor tissue. The drugs carry long-term risks, such as hypertension, diabetes, kidney toxicity and infection.
"It may be time to consider face transplantation in people with absolutely devastating injuries. This would probably give you the best function and cosmetic result," said Dr. Rod Rohrich, president of the American Society of Plastic Surgeons and a plastic surgeon at the University of Texas Southwestern Medical Center in Dallas.
"The problem still is with the drugs. If we could solve that, we'd have face transplants all the time," he said. "But, long-term, these drugs themselves can cause problems. The risk may not be worth the benefit."
It's also possible that the drugs could fail and a recipient's body would reject its new face. Barker said a second transplant would be attempted in such cases.
A candidate for a face transplant would need to understand the ramifications of a failure, said Eric Trump, an ethicist at the Hastings Center, a bioethics research institute in Garrison, N.Y. "A face going into rejection, I think, would be fairly terrifying. There would be bloating, discoloration. Then what would you do?"
Meeting a need
Face transplant candidates may be more accepting of the risks than some doctors. In a recent study conducted by Barker, 300 people were asked how much risk they would be willing to accept to receive a new body part, such as a kidney, hand, partial face or complete face. The respondents included people with no experience in disfigurement, people with disfigurements and people who had received organ transplants. Most people said they would take more chances to replace a completely disfigured face.
"This must be the most terrible thing to live with," Barker said. "In society, we don't see these people because they don't go out."
Although some people with devastating facial injuries adjust and thrive, others' lives are ruined, said Amy Acton, executive director of the Phoenix Society, the nation's largest burn survivor organization.