UK to pioneer face transplants

Consultant plastic surgeon Peter Butler said he was “delighted” to have been given permission for the pioneering surgery by the committee at the Royal
Free Hospital in Hampstead, north London.

“We can now begin to evaluate patients and draw up a shortlist of four people who want to undergo this procedure,” he said in a statement.

A US medical team led by Maria Siemionow in Cleveland, Ohio, was the first to be given ethical approval to carry out full facial transplants in October
2004, but it has not yet found the right patient.

Dr Butler said he did not want to get involved in what he described on Sky News television as a “face race” to be first. Instead, they would take a “cautious and careful” approach and not be rushed.

The announcement received a mixed reaction from British medical bodies, particularly the Royal College of Surgeons training body, which said minimum requirements must be fulfilled before transplantation can take place.

“The college still has grave concerns about face transplantation and will continue to advocate a cautious approach,” it said in a statement.

The prospect of a full face transplant raises hopes for people with severe facial disfigurement such as burns and comes after surgeons in France carried out the world’s first partial face transplant last year.

Isabelle Dinoire, 38, had her nose, lips and chin replaced in an operation after she was savaged by a dog.

In April this year, a hospital in China conducted what is believed to be the second partial face transplant on Li Guoxing, 30.

Patients selected will only come from Britain and Ireland because of concerns about the long-term care of overseas patients in Britain’s publicly-funded National Health Service.

All the patients are likely to have pan-facial disfigurement, where the whole face has been affected by injury, spreading to the hairline or ears.

The surgery would involve removing skin, underlying fat, blood vessels, arteries and veins from the brain-dead donor with recipients having to take
immuno-suppressant drugs to prevent rejection of the new tissue.

“These patients will have already undergone reconstructive surgery. Perhaps they will have had 50 or 70 reconstructive operations,” said Butler, who has already been approached by 34 patients from across the world.

“They have reached the end of the reconstructive ladder and there’s nothing more it can offer them. They have the problem of integration into society, of being able to walk down the street in society without anybody staring at them.

“That’s all these people want — to be normal.”

The chief executive of the Royal Free Hampstead NHS Trust, which runs the hospital, said the committee gave the green light only after “the most detailed scrutiny” of more than 10 years’ research by Dr Butler’s team.

After the first transplant — which is likely to take 10 to 12 hours and involve about four to six surgeons — there will be a six-month gap before the second operation to assess the procedure.

The British Association of Aesthetic Plastic Surgeons said it hoped full face transplants, long seen as the “Holy Grail” of surgery, would become routine given the right safeguards.

Changing Faces, a British charity for people with facial disfigurement, said it would have preferred if the ethics committee had waited until the RCS recommendations on minimum requirements was published next month.

Patients needed to be fully aware of the risks linked to immuno-suppressant drugs, including the possibility of rejecting the new tissue, and the need for a “plan B” if the operation is unsuccessful, it added.