CLEVELAND — How bad must it be for people to hate their face so much that they would take a new one, unseen, from a corpse? Dozens of burn victims and others so horribly disfigured that they can’t go out in public have begged a Cleveland surgeon for just that chance.
About two weeks ago, Dr. Maria Siemionow chose one, a woman, and gave her the nation’s first near-total face transplant.
In a bold and controversial operation certain to stoke the debate over the ethics of such surgery, Siemionow and a team of other specialists replaced 80 percent of the woman’s face with that of a female cadaver, the Cleveland Clinic announced Tuesday.
The transplant was the fourth worldwide; two have been done in France, and one in China.
The patient’s name and age were not released, and the hospital said her family wanted the reason for her transplant to remain confidential. The hospital plans a news conference today.
“There are patients who can benefit tremendously from this. It’s great that it happened,” said Dr. Bohdan Pomahac, a surgeon at Harvard-affiliated Brigham and Women’s Hospital in Boston who plans to offer face transplants too.
Unlike operations involving vital organs like hearts and livers, transplants of faces or hands are done to improve quality of life — not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and many other problems.
Arthur Caplan, a leading bioethicist who has expressed grave concerns in the past about such surgery, withheld judgment on the Cleveland case but said the woman’s doctors should give her the option of assisted suicide if they wind up making her life worse.
“The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell,” said Caplan, bioethics chief at the University of Pennsylvania. “If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying.”
Siemionow, 58, a hand microsurgeon, has been testing the surgical approach and ways to temper the immune system’s response in experiments for more than a decade.
Details of the Cleveland surgery are not known, but surgeons generally transplant skin, facial nerves and muscle, and often other deep tissue. That is done so that the new face will actually function and not just be a mask.
The world’s first partial face transplant was performed in France in 2005 on a 38-year-old woman who had been mauled by her dog. Isabelle Dinoire received a new nose, chin and lips from a brain-dead donor. She has done so astoundingly well that surgeons have become more comfortable with a radical operation considered unthinkable a decade ago.
