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Scowls and smiles over face transplant plan

London, Dec. 26 (Reuters): The prospect of the world’s first face transplant has sparked a fierce debate in Britain over the ethical and medical implications of such a radical procedure.

Consultant plastic surgeon Peter Butler has called for public discussion before he attempts to graft the face of a dead donor onto a burn victim or someone suffering from face cancer as early as next year.

The Irishman and his supporters say the operation could transform blighted lives but critics question whether it could ever serve society’s or even patient interests.

Richard Nicholson, editor of Britain’s Bulletin of Medical Ethics, said the idea strayed too far from medicine’s Hippocratic roots.

“My gut reaction is that we are pressing too far, too fast with ideas that impinge on our understanding of what normality is,” Nicholson said. “I’m concerned that it’s actually one step further down the route of not accepting anything abnormal in this society.”

But Christine Piff, who founded the charity Let’s Face It after suffering a rare facial cancer 25 years ago, welcomed the idea. “If you haven’t got facial disfigurement then it’s very hard to comprehend, because you would do anything to let a loved one have a life again,” she said.

A face transplant, Butler says, could mean a deformity was spotted only at one metre away rather than say 15 at present.

But Butler faces a hard job if he is to convince the British public about such a plan. Most respondents in his own survey, many of them doctors, said they were willing to accept a new face but few would consider donating, a point emphasised by Nicholson.

“I really do wonder how many people would be willing to donate the face of a relative,” he said. “I suspect they would be in pretty short supply.”

Butler, who told his wife to donate his face if he died suddenly, admitted he did not know how to encourage donation but said public opinion would shift.

“Over time, with full and frank debate I feel people’s minds may change... but if I don’t raise the debate we can’t explore a way through this,” the 40-year-old Dubliner said.

And he was keen to stress that no operation should take place until the moral and ethical implications of face transplants were addressed fully. The dilemma for the medical profession, he said, is not “can we do it, but, should we do it'”

Other medical pioneers such as Joseph Murray, who performed the world’s first kidney transplant, initially criticised Butler said, but later became part of the medical mainstream.

Central to Butler’s plan is a new transplant technique that reduces the need for powerful drugs used to stop the body rejecting foreign body tissue.

Instead of subjecting patients to a lifetime of harsh immuno-suppressant treatments, kidney and heart swap patients are already undergoing trials using donor bone marrow to encourage the body to accept new organs. Technically this could be applied to face transplants as early 2003 he said.

But Nicholson doubted the medical basis of Butler’s ideas.

“I think it’s raising hopes unreasonably,” he said. “I suspect they (the patients) don’t understand how much of a rigid mask it may turn out to be... it’s going to be very difficult to get any of the nerves and muscles that control facial expression working again.”

Butler, who eventually wants to see faces supplied through Britain’s donor card system, is reluctant to talk about when this first operation might be. “I’m not really that anxious to be the first. What I am concerned about is to get it explored properly. I would hope to (do it) in the next two years, but I would say that would be a very hopeful timeframe.”

The disfiguring scars on certain patients remind Butler why he first made such a radical proposal. He tells the story of one 19-year-old man who set himself alight after breaking up with his girlfriend. The patient still looked severely burned after more than 30 procedures by Butler and his team.

“If he had a problem with his girlfriend at 19, he’s definitely going to have it for most of his life. If I could have said to him ‘look we could potentially reconstruct your face with somebody else’s’, he might have gone for it. What that case brought home to me (was) that we are so limited in our ability to reconstruct these types of injuries. Skin from your abdomen or leg is not like your eyelid.”

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