Brits all set to do full-face transplant

Dec 21 2005

A British team has been given the green light to perform the world’s first full-face transplant.

The transplant may be carried out within months after surgeons at the Royal Free Hospital, in London, were cleared by the ethics committee to evaluate candidates for the operation, and determine physical and psychological suitability.

Consultant plastic surgeon Peter Butler, says when an appropriate patient comes forward, he or she could become the first in the world to receive an entire new face.

A French team successfully conducted the first partial face transplant last month, but Mr Butler’s team is proposing to perform a full graft from neck to scalp.

Butler says this is a critical step forward that moves them a lot closer to their ultimate goal, as they can now can look for patients and put them through the psychiatric, psychological and surgical assessments devised to ensure the right candidate is selected.

He says it is very important that they choose wisely or it could be a disaster not just for the patient but for the whole field.

Apparently the Royal Free team has already been approached by as many as 20 patients interested in having a transplant, most of them burns victims, but could not consider any of them for treatment because the hospital had not given ethical clearance.

Mr Butler expects many to now request a formal assessment.

A good candidate would have extensive injuries such as pan-facial burns and need to be psychologically capable of coping with a new facial identity.

It seems that Mr Butler has spent the past four years compiling an array of evaluation tests and has now been given permission to use them with patients.

If an appropriate patient is found, a transplant could take place within a year, but Mr Butler will first have to apply to the Royal Free’s ethics committee for permission to carry out the surgery.

It is believed that decision will be controversial, as the Royal College of Surgeons has not changed its position since advising in 2003 that it is too soon to attempt the procedure.

Mr Butler, however, says that much of his recent work addresses the Royal College’s concerns about the likely psychological impact of the operation.

He also says that many skeptical surgeons have changed their views since the success of the French transplant.

The French operation, says Butler, has shown that this is technically possible, and the results are much better than could have been achieved with any existing reconstructive process.

American surgeons are also planning to conduct a full-face transplant while a group in Louisville, Kentucky, has had ethical approval to choose patients for more than a year.

Mr Butler and the Royal Free are not concerned about being beaten by the Americans and will continue to proceed cautiously.