UK’s first larynx transplant

By Dr. Ananya Mandal, MDJun 19 2011

In a first, UK will get its voicebox or larynx transplant in less than a year after the Royal College of Surgeons gave its seal of approval for trials to take place. A report by the college said the pioneering procedure could help people who had cancer of the larynx to speak and breathe normally again.

The team was led by Martin Birchall, professor of laryngology at the University College London Ear Institute, who was the lead scientist involved in the ground-breaking 18-hour operation on a woman in the US last October. Brenda Charett Jensen had been able to communicate only with a handheld electronic device for 11 years and breathed through a tracheotomy tube. Two weeks after the operation, she was able to speak her first words and can now talk normally.

Birchall has two British patients lined up and says that now he has the backing of the college, he can apply for funding to begin the complex operations in the UK early next year. “It has given us the green light to apply to launch a programme. There is a difference between doing a one-off, as we did in California, and having a properly established programme,” he said, adding that he believed there would be a growing need for the operation. “Patients are few and far between but when you start doing something highly innovative, firstly there are more patients than you realize. Then the threshold drops as your experience grows. From liver transplants to advanced eye surgery, we have seen that happen.”

The surgery is not life-saving but an improvement to people's quality of life. That means the risks involved in the highly complex procedure and in the lifetime's course of drugs to suppress the immune system have to be taken into account. The report says that as many as 1,000 patients a year whose larynx has been destroyed in accidents or through cancer could benefit from the procedure. Some patients, such as those with recurrent or advanced cancers, would be unsuitable, however. Further research is needed on nerve regeneration and care must be taken, involving psychological experts, in selection and aftercare of patients, the report warns.

New surgical techniques and understanding of organ rejection have opened up exciting possibilities in transplantation, said Prof Tony Narula, chairman of the group that produced the report. “But just because something is possible, it doesn't necessarily mean it is in the best interests of patients. When trialing this procedure the medical team must meet the highest ethical standards and submit their plans to independent open scrutiny.”

Birchall said that the loss of the larynx “removes many things that make us quintessentially human, through loss of speech, swallowing and altered appearance”. He believes that embarking on highly innovative procedures brings benefits for medicine and society generally. A patient who receives a donated larynx will not have the voice of the dead donor, but may not have exactly their own original voice either. “It is unclear how the patient with a transplanted larynx will sound in comparison with his or her original voice quality,” says the RCS report.

Professor Tony Narula, said, “This presents exciting opportunities for treating conditions and improving quality of life in ways that simply were not possible in the past.”