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Face-Transplant Patient 'Satisfied'

face transplant before and after
From left, the patient in 2001, four years before the injury; one year after transplantation, the patient with makeup on, Nov. 2006; the patient in June 2007, 18 months after the transplant, without makeup. (The New England Journal of Medicine)

"It is a success," Dubernard said. "It gives hope to patients with total disfigurement."

Two other face transplants have since been performed, in China and in France by a different team. Neither has described the results, but the new report suggests that the field has a future, said Warren C. Breidenbach, a member of Kleinert Kutz and Associates, a surgical team developing methods for face and other complex transplants at the University of Louisville and the Jewish Hospital there.

"This is a better reconstruction than you could obtain from conventional methods," such as using small skin patches from the patient's body, said Breidenbach, who in 1999 helped perform the first successful U.S. hand transplant. That procedure also drew criticism because it was not crucial for survival, but it has now been done dozens of times around the world.

Studies indicate that most people with severely deforming facial injuries would risk kidney failure to get a new face. Nonetheless, Breidenbach said, Dinoire's difficult course is sure to feed the debate about what constitutes a successful face transplant and who should decide if the risks are worth it.

Several experts said they still have concerns.

Maria Siemionow, director of plastic surgery research and training at the Cleveland Clinic, which has been planning to do face transplants, expressed concern about Dinoire's "unexpectedly aggressive immune response." Scientists need better ways to prevent rejection of large, complex tissues such as faces, she said.

Even more problematic, she and others said, was that Dinoire has not undergone a formal psychological evaluation since her transplant.

"A thorough evaluation would give a lot more information about whether the patient is accepting it or is thinking, 'Maybe I should never have done this,' " Siemionow said.

The lack of psychological follow-up reflects a disturbing pattern with tests of new surgical techniques, said Karen Maschke of the Hastings Center, a bioethics think tank in Garrison, N.Y. Instead of running them as medical experiments, with careful collection of data, they are promulgated as "innovations," often without proper consent in advance or analysis after, she said.

"Research protocols have endpoints by which success can be measured. But where is the protocol? What kind of testing was supposed to be done? Is it still a success if she has total kidney failure four months from now?" Maschke asked. "This is not the end of the discussion on face transplants."

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