THE risks of a face transplant are still far too high to justify the operation, says a panel of experts in the UK.
The report, by the Royal College of Surgeons of England, has been prompted by media speculation that the first face transplant is imminent. At least five surgical teams across the world have expressed interest in performing the procedure.
One of the front runners, Peter Butler at the Royal Free Hospital in London, last week issued a statement saying that he had 10 patients wanting a transplant, although none has yet been assessed for surgery. Despite this waiting list, he thinks that more public debate is needed before a face transplant is done. 鈥淭he team are confident they have overcome the technical hurdles to this procedure,鈥� says the statement. But it adds: 鈥淭here are many moral, ethical and psychological issues which need to be debated before anyone has surgery.鈥�
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For instance, critics say coping with a new visage will be far more difficult than adjusting to a new hand or kidney. After the operation, the report says, the patient鈥檚 face is unlikely to resemble either the donor鈥檚, or their own before whatever injury disfigured them, though the effect of bone structure means that the final result could be closer to their original face.
But the report focuses mainly on practical issues rather than the ethical or psychological questions. 鈥淭he procedure appears to be physically very hazardous,鈥� it says. 鈥淭he work should take a much more incremental approach than some of the current hype surrounding it has suggested.鈥� In particular, the panel argues that the drugs needed to prevent rejection are not yet reliable enough. Around 1 in 10 grafts are likely to be rejected in the first year, they say,while half of all face transplants could eventually fail.
Nadey Hakim at St Mary鈥檚 Hospital in London, a member of the team that performed the first hand transplant in 1998, agrees with the recommendations. Although both hand and face transplants have practical issues in common, he says the failure would have more profound consequences with a face, as the patient would need to have the donor face removed and replaced with numerous skin grafts. 鈥淭he poor patient will end up in a worse situation than they were before the operation,鈥� he says.
The report also points out that immunosuppressive drugs can cause high blood pressure, diabetes, infections and cancer. High doses would be necessary following a face transplant because of the large quantity of skin in the graft, a tissue that provokes a stronger immune reaction than any other organ.
John Barker, a plastic surgeon at the University of Louisville in Kentucky, who wants to carry out the operation, believes that all these questions can only be answered by going ahead with face transplants. 鈥淭hey said there should be a moratorium on hand transplants five years ago,鈥� he says. 鈥淣ow more than 16 people have had the surgery and it鈥檚 considered a success.鈥�