01:00 AM EST on Monday, March 22, 2004

BY SHARI ROAN
Los Angeles Times

Society may not be quite ready for the day when a dead person's face is recycled for the living -- but that day is coming nonetheless.

Such an operation would give new life to someone severely disfigured by burns, cancer or an accident, allowing the person to exist free of the stares and shock their appearances often evoke.

Already, doctors at the University of Louisville in Kentucky say they hope to soon select a candidate for the operation, possibly within the year. The same team performed the first U.S. hand transplant in 1999.

Surgeons in other countries are pursuing the possibility of a face transplant as well. All agree it's just a matter of time until the world's first face transplant.

The technical skills needed for the surgery are well-established. Organs are routinely transplanted from one person to another, and even some limb transplants have been successful. Those operations, once remarkable, have become almost commonplace.

But an internal organ, or even a hand, is dramatically different from the wholesale appearance change that surgeons are now considering, the Louisville surgeons acknowledge.

Faces are the most visible portion of human identities. They're how we think of ourselves, how others recognize us. The possibility of altering that identity so radically -- a science fiction plot device made real -- could make people recoil.

In Britain, reservations from the medical community have indefinitely stalled plans there for a facial transplant.

Aware of the sensitive nature of such surgery, the doctors in Kentucky are treading carefully. The team is exploring ethical arguments for and against the procedure, using studies and surveys to gauge likely public reaction.

"As for surgical technique, a face transplant could have been done 10 years ago," said Dr. John Barker, director of research for the surgeons' group. "And now with the preliminary results we have in our ethics studies, we think it's time."

The group is evaluating potential transplant recipients, as is a group of collaborating physicians in the Netherlands, he said.

A face transplant would not be an easy fix, even for severely burned patients. They would still have some scarring and would require extensive psychological adjustment.

The first candidate for a face transplant would be someone who has been disfigured for some time and has the emotional wherewithal to deal with the transplant, Barker said. There is no way to predict how the recipient might feel with a new face, he added.

Psychological hurdles exist on the other end of the transplant as well, experts noted. Who would donate their loved one's face?

"Would parents, for example, be willing to have their brain-dead child's face excised?" said Trump. "Would anyone want a loved one's face removed after death? I think this is a major obstacle to the procedure becoming routine."

Public acceptance is not the only roadblock, however. Many doctors remain unconvinced of the medical need for the operation, questioning whether the risks of the surgery outweigh its potential value.

A face transplant would rely on microsurgery -- the connection of very small nerves and blood vessels.

In the first such surgeries, doctors probably would remove a layer of donor skin containing muscle, nerves, tendons and blood vessels. The recipient's disfigured face would be removed down to the bone and cartilage, and the donor face draped across it, fitted and reattached.

The result would be a hybrid face, with features from donor and recipient, Barker said. The team has tried to anticipate the cosmetic result by experimenting on cadavers. The result is a face that resembles both donor and recipient, perhaps similar to a relative of one or the other.

Like people who receive new hearts or other organs, face transplant recipients would have to take medications for the remainder of their lives to prevent the body from recognizing the donor tissue as foreign and rejecting it.

The long-term risks of these drugs -- and the unforeseeable psychological effect of wearing someone else's face -- were cited by the Royal College of Surgeons of England as a reason to delay such surgeries.

In the United States, no such official decree is in the works. The Louisville surgeons need only receive consent from their hospital's institutional review board to proceed with the surgery.

However, American reconstructive surgeons echo some of the same concerns as the British.

"While we can sometimes do wonderful things technically, can we follow up with the other things? The tissue matching. The rejection phenomenon. The social issues. Can we overcome all the other issues?" said Dr. James Wells, a Long Beach, Calif., plastic surgeon and immediate past president of the American Society of Plastic Surgeons. Although donor and recipient would share several tissue-typing characteristics, anti-rejection drugs would still be needed to suppress the recipient's immune system so it wouldn't attack the donor tissue. The drugs carry long-term risks, such as hypertension, diabetes, kidney toxicity and infection.

"The problem still is with the drugs. If we could solve that, we'd have face transplants all the time," said Dr. Rod Rohrich, president of the American Society of Plastic Surgeons.. "But, long-term, these drugs themselves can cause problems. The risk may not be worth the benefit."

It's also possible that the drugs could fail and a recipient's body would reject its new face. Barker said a second transplant would be attempted in such cases.

Although some people with devastating facial injuries adjust and thrive, others' lives are ruined, said Amy Acton, executive director of the Phoenix Society, the nation's largest burn survivor organization.

"I think there are many people who live with a facial difference successfully," said Acton, a burn survivor whose injuries were to the neck, torso and limbs. "But there are still people who never get to this place, and maybe this option would make a difference for them. In our culture there is a tremendous amount of pressure to look 'normal.' As a group, we would not want to deny the possibilities that are out there."

A face transplant, even with its risks, might be more appealing than the alternatives, said burn survivor Barbara Kammerer Quayle.

After surviving a rear-end car crash in 1977, Quayle underwent approximately 20 operations over four years to reconstruct her face.

Reconstruction strategies include skin and muscle grafts and prosthetic implants; someone with a severe injury could need a dozen or more surgeries over the course of many years.

"While there are many possibilities for people with reconstructive surgery, sometimes people have to come to the conclusion that there is just so much that can be done," said Quayle, who works at the University of California, Irvine, Medical Center in nearby Orange, counseling other burn patients on recovery and image enhancement

"If it's a serious burn, and face transplantation is an option, I say hallelujah."

identity so radically -- a science fiction plot device made real -- could make people recoil.

In Britain, reservations from the medical community have indefinitely stalled plans there for a facial transplant.

Aware of the sensitive nature of such surgery, the doctors in Kentucky are treading carefully. The team is exploring ethical arguments for and against the procedure, using studies and surveys to gauge likely public reaction.

"As for surgical technique, a face transplant could have been done 10 years ago," said Dr. John Barker, director of research for the surgeons' group. "And now with the preliminary results we have in our ethics studies, we think it's time."

The group is evaluating potential transplant recipients, as is a group of collaborating physicians in the Netherlands, he said.

A face transplant would not be an easy fix, even for severely burned patients. They would still have some scarring and would require extensive psychological adjustment.

The first candidate for a face transplant would be someone who has been disfigured for some time and has the emotional wherewithal to deal with the transplant, Barker said. There is no way to predict how the recipient might feel with a new face, he added.

Psychological hurdles exist on the other end of the transplant as well, experts noted. Who would donate their loved one's face?

"Would parents, for example, be willing to have their brain-dead child's face excised?" said Trump. "Would anyone want a loved one's face removed after death? I think this is a major obstacle to the procedure becoming routine."

Public acceptance is not the only roadblock, however. Many doctors remain unconvinced of the medical need for the operation, questioning whether the risks of the surgery outweigh its potential value.

A face transplant would rely on microsurgery -- the connection of very small nerves and blood vessels.

In the first such surgeries, doctors probably would remove a layer of donor skin containing muscle, nerves, tendons and blood vessels. The recipient's disfigured face would be removed down to the bone and cartilage, and the donor face draped across it, fitted and reattached.

The result would be a hybrid face, with features from donor and recipient, Barker said. The team has tried to anticipate the cosmetic result by experimenting on cadavers. The result is a face that resembles both donor and recipient, perhaps similar to a relative of one or the other.

Like people who receive new hearts or other organs, face transplant recipients would have to take medications for the remainder of their lives to prevent the body from recognizing the donor tissue as foreign and rejecting it.

The long-term risks of these drugs -- and the unforeseeable psychological effect of wearing someone else's face -- were cited by the Royal College of Surgeons of England as a reason to delay such surgeries.

In the United States, no such official decree is in the works. The Louisville surgeons need only receive consent from their hospital's institutional review board to proceed with the surgery.

However, American reconstructive surgeons echo some of the same concerns as the British.

"While we can sometimes do wonderful things technically, can we follow up with the other things? The tissue matching. The rejection phenomenon. The social issues. Can we overcome all the other issues?" said Dr. James Wells, a Long Beach, Calif., plastic surgeon and immediate past president of the American Society of Plastic Surgeons. Although donor and recipient would share several tissue-typing characteristics, anti-rejection drugs would still be needed to suppress the recipient's immune system so it wouldn't attack the donor tissue. The drugs carry long-term risks, such as hypertension, diabetes, kidney toxicity and infection.

"The problem still is with the drugs. If we could solve that, we'd have face transplants all the time," said Dr. Rod Rohrich, president of the American Society of Plastic Surgeons. "But, long-term, these drugs themselves can cause problems. The risk may not be worth the benefit."

It's also possible that the drugs could fail and a recipient's body would reject its new face. Barker said a second transplant would be attempted in such cases.

Although some people with devastating facial injuries adjust and thrive, others' lives are ruined, said Amy Acton, executive director of the Phoenix Society, the nation's largest burn survivor organization.

"I think there are many people who live with a facial difference successfully," said Acton, a burn survivor whose injuries were to the neck, torso and limbs. "But there are still people who never get to this place, and maybe this option would make a difference for them. In our culture there is a tremendous amount of pressure to look 'normal.' As a group, we would not want to deny the possibilities that are out there."

A face transplant, even with its risks, might be more appealing than the alternatives, said burn survivor Barbara Kammerer Quayle.

After surviving a rear-end car crash in 1977, Quayle underwent approximately 20 operations over four years to reconstruct her face.

Reconstruction strategies include skin and muscle grafts and prosthetic implants; someone with a severe injury could need a dozen or more surgeries over the course of many years.

"While there are many possibilities for people with reconstructive surgery, sometimes people have to come to the conclusion that there is just so much that can be done," said Quayle, who works at the University of California, Irvine, Medical Center in nearby Orange, counseling other burn patients on recovery and image enhancement

"If it's a serious burn, and face transplantation is an option, I say hallelujah."

identity so radically -- a science fiction plot device made real -- could make people recoil.

In Britain, reservations from the medical community have indefinitely stalled plans there for a facial transplant.

Aware of the sensitive nature of such surgery, the doctors in Kentucky are treading carefully. The team is exploring ethical arguments for and against the procedure, using studies and surveys to gauge likely public reaction.

"As for surgical technique, a face transplant could have been done 10 years ago," said Dr. John Barker, director of research for the surgeons' group. "And now with the preliminary results we have in our ethics studies, we think it's time."

The group is evaluating potential transplant recipients, as is a group of collaborating physicians in the Netherlands, he said.

A face transplant would not be an easy fix, even for severely burned patients. They would still have some scarring and would require extensive psychological adjustment.

The first candidate for a face transplant would be someone who has been disfigured for some time and has the emotional wherewithal to deal with the transplant, Barker said. There is no way to predict how the recipient might feel with a new face, he added.

Psychological hurdles exist on the other end of the transplant as well, experts noted. Who would donate their loved one's face?

"Would parents, for example, be willing to have their brain-dead child's face excised?" said Trump. "Would anyone want a loved one's face removed after death? I think this is a major obstacle to the procedure becoming routine."

Public acceptance is not the only roadblock, however. Many doctors remain unconvinced of the medical need for the operation, questioning whether the risks of the surgery outweigh its potential value.

A face transplant would rely on microsurgery -- the connection of very small nerves and blood vessels.

In the first such surgeries, doctors probably would remove a layer of donor skin containing muscle, nerves, tendons and blood vessels. The recipient's disfigured face would be removed down to the bone and cartilage, and the donor face draped across it, fitted and reattached.

The result would be a hybrid face, with features from donor and recipient, Barker said. The team has tried to anticipate the cosmetic result by experimenting on cadavers. The result is a face that resembles both donor and recipient, perhaps similar to a relative of one or the other.

Like people who receive new hearts or other organs, face transplant recipients would have to take medications for the remainder of their lives to prevent the body from recognizing the donor tissue as foreign and rejecting it.

The long-term risks of these drugs -- and the unforeseeable psychological effect of wearing someone else's face -- were cited by the Royal College of Surgeons of England as a reason to delay such surgeries.

In the United States, no such official decree is in the works. The Louisville surgeons need only receive consent from their hospital's institutional review board to proceed with the surgery.

However, American reconstructive surgeons echo some of the same concerns as the British.

"While we can sometimes do wonderful things technically, can we follow up with the other things? The tissue matching. The rejection phenomenon. The social issues. Can we overcome all the other issues?" said Dr. James Wells, a Long Beach, Calif., plastic surgeon and immediate past president of the American Society of Plastic Surgeons. Although donor and recipient would share several tissue-typing characteristics, anti-rejection drugs would still be needed to suppress the recipient's immune system so it wouldn't attack the donor tissue. The drugs carry long-term risks, such as hypertension, diabetes, kidney toxicity and infection.

"The problem still is with the drugs. If we could solve that, we'd have face transplants all the time," said Dr. Rod Rohrich, president of the American Society of Plastic Surgeons. "But, long-term, these drugs themselves can cause problems. The risk may not be worth the benefit."

It's also possible that the drugs could fail and a recipient's body would reject its new face. Barker said a second transplant would be attempted in such cases.

Although some people with devastating facial injuries adjust and thrive, others' lives are ruined, said Amy Acton, executive director of the Phoenix Society, the nation's largest burn survivor organization.

"I think there are many people who live with a facial difference successfully," said Acton, a burn survivor whose injuries were to the neck, torso and limbs. "But there are still people who never get to this place, and maybe this option would make a difference for them. In our culture there is a tremendous amount of pressure to look 'normal.' As a group, we would not want to deny the possibilities that are out there."

A face transplant, even with its risks, might be more appealing than the alternatives, said burn survivor Barbara Kammerer Quayle.

After surviving a rear-end car crash in 1977, Quayle underwent approximately 20 operations over four years to reconstruct her face.

Reconstruction strategies include skin and muscle grafts and prosthetic implants; someone with a severe injury could need a dozen or more surgeries over the course of many years.

"While there are many possibilities for people with reconstructive surgery, sometimes people have to come to the conclusion that there is just so much that can be done," said Quayle, who works at the University of California, Irvine, Medical Center in nearby Orange, counseling other burn patients on recovery and image enhancement

"If it's a serious burn, and face transplantation is an option, I say hallelujah."