Risk versus benefit: facing a question of balance

APPROVAL for the world’s first full face transplant in Britain has raised the difficult question — is the complicated procedure worth it?

It has never been performed before and the risks to a patient are high.

Problems include an increased chance of cancer, the possibility of a shortened life expectancy and a high likelihood that the body will reject the new skin. Skin is the most sensitive of all body parts and the most likely to be rejected.

Doctors have developed immunosuppressant drugs, but a patient may have to stay on these drugs for the rest of their life.

Robert Page, president of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), said several factors had to be considered before surgery.

“It is a question of balance. If you do not have a face and you have this operation done, a number of things may happen to you.

“It may reduce your lifespan, but your quality of life overall may be significantly improved.

“This is the difficulty — it is all about risk and benefit. It is very difficult to know what it feels like to not have a face. The psychology surrounding the operation is important.”

Partial face transplants have already been carried out on two occasions.

In November 2005, a team of surgeons led by Professor Jean-Michel Dubernard operated on Isabelle Dinoire, 38. She received a section of a nose, lips and a chin in the transplant surgery after she was mauled by her pet Labrador.

Her new face was taken from a woman of 46 who died from a severe loss of blood to the brain and was technically “brain dead” when the transplant was performed.

The operation, carried out at the Centre Hospitalier Universitarie Amiens, lasted about five hours.

In April this year, Chinese farmer Li Guoxing, 30, underwent surgery in Xijing Hospital in the central Chinese city of Xi’an.

He lost almost the whole right side of his face in 2003 after a black bear attacked him when he tried to chase it away from his cows. A team of 15 doctors gave him a nose, upper lip, cheek and eyebrow from a brain-dead donor in a 15-hour procedure.

Mr Page said: “Two facial transplants have been carried out and been successful so far, so I think the operation has gone beyond the experimental stage.

“The technical aspects are challenging but we already know how to put back a piece of a person’s skin back on their own face. The technology of joining the skin is established — we know we can do that.”

The difficulty comes when introducing foreign skin to the body, he said.

Changing Faces, a national charity supporting people with disfigurement, expressed concern about yesterday’s decision.

Spokeswoman Winnie Coutinho said a specialist medical committee is still looking into the procedure and is expected to report next month.

“We are not against facial transplants per se,” she said.

“We just feel that it would have been better to have waited for the Royal College of Surgeons’ expert group, which is due to report back in November.

“There are considerable risks attached to the procedure with the risk of cancer, shortened life expectancy and if there is rejection, what is plan B?”

Ms Coutinho said it was too early to determine whether the operations in France and China had truly been a success. She said there needed to be clear guidelines as to who was suitable for the procedure to avoid giving people false hope.

“There is concern from people with disfigurement that they will be asked by people in the street when they are going for their next face transplant,” she said.

“We need to make sure there is real understanding surrounding the issue.”