Face Transplant Waits for the Future

Some day, somewhere, some surgeon is going to perform the first face transplant. It might even be Dr. Maria Siemionow of the Cleveland Clinic. But despite news reports this past weekend that she is interviewing potential candidates for this pioneering operation, don't expect that it will be happening any time soon. It will take months to find the right person with the right combination of physical disfigurement and psychological adaptability to be a recipient. And — if past experience with hand transplants is any guide — possibly more than a year to find a donor for the procedure.

It's also entirely possible that no operation will take place. Over the past two years, at least two other medical teams — one in England, one in Kentucky — have announced they were taking the necessary steps to perform a face transplant, only to back down after strong ethical objections were raised.

After all, a face transplant, unlike a heart or lung transplant, is not a life-saving procedure. Since the benefit is not as great, the risk of complications looms larger. Surgery is just a first step. A person who receives a face transplant will need to take immune-suppressing drugs for the rest of his or her life. Side effects from these medications may lead to diabetes, cancer and even death. Despite all that, the body may still reject the new face, leading to more and more complicated surgery.

The situation could change if researchers develop a less toxic method of tricking the immune system into accepting foreign tissue grafts—something that Dr. Andrew Lee and his colleagues at the University of Pittsburgh School of Medicine are trying to do. Dr. Lee prefers to think of face and hand transplants as "composite tissue transplants" because several kinds of tissue—fat, skin, muscle and possibly even bone—may be involved. (He didn't say this but maybe it's also a way to tone down some of the more ghoulish reporting on the topic.) "Composite tissue transplants have the potential to revolutionize reconstructive surgery," says Dr. Lee, who is chief of the school's division of plastic surgery. "I think it is premature to do this [operation] now."