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| First full face transplant |
Royal Free surgeon hopes to carry
out world first after ethical backing
Dr Peter Butler |
THE world’s first full facial transplant could be performed
at the Royal Free after the hospital’s ethics team gave surgeons
the go ahead last week.
The decision has drawn criticism from some experts who say more
research is needed into the psychological aftermath of surgery.
Dr Peter Butler, the hospital’s consultant plastic surgeon
has said he is looking for a patient who needs a face transplant.
But Consultant facial surgeon Iain Hutchison - one of the country’s
leading facial surgery experts who works at St Bartholomew’s
Hospital and lives in Belsize Park said the operation threw up ethical
issues.
Two weeks ago French surgeons performed the world’s first partial
face transplant. Any operation at the Royal Free Hospital –
which could take place within the next six months – would be
the first time an entire face has been replaced by another.
The recipient would not bear any resemblance to the donor, however,
due to the difference in bone structure.
“If I took off my face and put it on my colleague it would
adapt,” explained Dr Butler. “It would be a hybrid of
the two.”
Despite researchers knowing how to perform the operation –
which involves the intricate stitching of blood vessels and muscle
tissue – for a number of years, surgeons had held back for
ethical reasons.
There is also a strong likelihood that the body could reject the
transplanted face.
The donor must agree to the transplant when close to death, so that
after death his blood can be kept artificially flowing in order
to prevent the facial tissue to be transplanted from decaying.
Critics are concerned the psychological effect of living with a
new face has not been thought through and that this medical landmark
could lead to unscrupulous surgeons performing operations for cosmetic
or even criminal reasons.
Since the operation in France, however, Dr Butler believes facial
surgery should not be denied.
Dr Butler, who has been approached by more than 20 potential patients
in the seven years he has spent researching the operation, revealed
he was yet to find a suitable candidate for the controversial surgery.
He said: “We have been approached by a number of donors who
really want to help. But we are still looking for a patient. We
are happy to assess anybody with severe facial deformity.”
Dr Butler said the cost of a face transplant could be as little
as £17,000, with a following £5,000 per year in drug
treatment.
The advances in affordable facial surgery at the Royal Free have
been heralded as a giant step for British science by the transplant
team.
Dr Butler said facial transplant would restore confidence in those
forced into recluse lifestyles on account of facial deformity.
He said: “There are half a million people with severe deformity
– 60 per cent of those live in social isolation. They are too
uncomfortable to go out and do their shopping.”
But Mr Hutchinson believes hospitals must tread carefully when considering
surgery. He said: “We are talking about quality of life operations
rather than life-saving operations that have many implications for
the recipient and donor’s families.
“The recipient chooses to take the risk of the operation failing
if the blood vessels become blocked. There is a medium-term risk
of the drugs failing to control rejection of the donor tissue, and
a long-term risk of the drugs causing cancers.”
Dr Butler said he would take into account the psychological state
of the patient. He said: “The biggest challenge is to identify
the right patient. Patients need to take drugs to stop the face
rejecting the body. We need to be sure a patient will take these
pills daily.
“Psychologically, we need someone robust enough to handle the
facial transplant.”
Dr Butler dismissed claims that the surgery would be used for cosmetic
purposes.
He said: “Seventy to 80 per cent of the face will work but
there will be parts that don’t. This will preclude use in cosmetic
application.”
Andrew Way, chief executive of the Royal Free, said: “Further
ethical approval is required to ensure the patient can give appropriate
consent.
“Much painstaking work still needs to be done. We are determined
to do this the way we think is right.” |
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