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For the First Time in U.S., Extensive Face Transplant Is Performed

By Rob Stein
Washington Post Staff Writer
Wednesday, December 17, 2008

Surgeons have performed the first face transplant in the United States, the Cleveland Clinic announced yesterday.

The clinic refused to release any details other than to say that a team led by reconstructive surgeon Maria Siemionow replaced about 80 percent of a disfigured woman's face with that of a deceased female donor within the last two weeks. Neither the recipient nor the donor were identified.

"The patient's information will remain confidential, as will the donor's information," said Eileen Sheil, a spokeswoman.

The clinic plans a briefing today to release more information about the procedure, which was far more extensive than the three previous face transplants, which were performed in France and China.

"We call it a near-total face transplant. It was substantially more involved than what's been done to date," Sheil said.

The first partial face transplant was performed in France three years ago on a woman who had been mauled by her dog. That operation set off an international firestorm, with critics questioning whether it was ethical. Another face transplant was subsequently performed on a European man who was disfigured by a genetic condition, and a third was reported on a Chinese farmer who had been attacked by a bear.

Such transplants are controversial because they are aimed at improving a patient's quality of life rather than saving it, and recipients must take powerful immune-suppressing drugs for the rest of their lives.

The ethics of doing transplants for other than lifesaving reasons arose in 1998, when French surgeons conducted the first human hand transplant from a cadaver. Dozens of hand transplants have been performed since, along with other non-lifesaving procedures, including a larynx transplant to restore speech and a tongue transplant.

Beyond the surgical and medical challenges, experts say a recipient's psychological state is important because of the unique nature of a person's face.

Despite the initial uproar over the first face transplant, that recipient appears to be doing well. Isabelle Dinoire, who at age 38 lost her lips, cheeks, chin and most of her nose when she was mauled by her dog, gradually regained normal skin sensation and control of her facial muscles. The face she got from a 46-year-old brain-dead donor was attached like a mask in a 15-hour surgery.

Her recovery was, however, at times difficult. Her immune system twice mounted violent reactions against the new tissue, and the immune-suppressing drugs she must take caused infections and at one point kidney failure.

Some experts remain uncomfortable with the procedure.

"One case is merely an anecdote. It doesn't create a scientific basis to say it's safe for a patient to do this," said Carson Strong, a professor of human values and ethics at the University of Tennessee College of Medicine. Strong remains concerned that patients may reject the graft, which would require removing it.

"The effect of that would be essentially a huge wound on the patient's face where that graft had been removed. In that event, you could reasonably say the patient would be much worse off at that time than he or she had been before the transplant had been attempted," Strong said.

Several other U.S. hospitals are considering similar operations.

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