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CLEVELAND (AP) =97 In the next few =
weeks, five=20
men and seven women will secretly visit the Cleveland Clinic =
to=20
interview for the chance to have a radical operation that's =
never=20
been tried anywhere in the world.
They will smile, raise their = eyebrows, close=20 their eyes, open their mouths. Dr. Maria Siemionow will = study their=20 cheekbones, lips and noses. She will ask what they hope to = gain and=20 what they most fear. Then she will ask, "Are you afraid = that you=20 will look like another person?" Because whoever she chooses will = endure the=20 ultimate identity crisis. Siemionow wants to attempt a face = transplant.=20 This is no extreme TV makeover. It is = a medical=20 frontier being explored by a doctor who wants the public to=20 understand what she is trying to do. It is this: to give people horribly = disfigured=20 by burns, accidents or other tragedies a chance at a new = life.=20 Today's best treatments still leave many of them with = freakish,=20 scar-tissue masks that don't look or move like natural skin. = These people already have lost the = sense of=20 identity that is linked to the face; the transplant is = merely=20 "taking a skin envelope" and slipping their identity inside, = Siemionow contends. Her supporters note her experience, = careful=20 planning, the team of experts assembled to help her, and the = practice she has done on animals and dozens of cadavers to = perfect=20 the technique. But her critics say the operation is = way too=20 risky for something that is not a matter of life or death, = as organ=20 transplants are. They paint the frighteningly surreal image = of a=20 worst-case scenario: a transplanted face being rejected and=20 sloughing away, leaving the patient worse off than before. = Such qualms recently scuttled face = transplant=20 plans in France and England. Ultimately, it comes to this: a = hospital,=20 doctor and patient willing to try it. The first two are now in place. The = third is=20 expected to be shortly. The "consent form" says that this = surgery is so=20 novel and its risks so unknown that doctors don't think = informed=20 consent is even possible. Here is what it tells potential = patients: Your face will be removed and = replaced with one=20 donated from a cadaver, matched for tissue type, age, sex = and skin=20 color. Surgery should last 8 to 10 hours; the hospital stay, = 10 to=20 14 days. Complications could include = infections that=20 turn your new face black and require a second transplant or=20 reconstruction with skin grafts. Drugs to prevent rejection = will be=20 needed lifelong, and they raise the risk of kidney damage = and=20 cancer. After the transplant you might feel = remorse,=20 disappointment, or grief or guilt toward the donor. The = clinic will=20 try to shield your identity, but the press likely will = discover it.=20 The clinic will cover costs for the = first=20 patient; nothing about others has been decided. Another form tells donor families = that the=20 person receiving the face will not resemble their dead loved = one.=20 The recipient should look similar to how he or she did = before the=20 injury because the new skin goes on existing bone and = muscle, which=20 give a face its shape. All of the little things that make up = facial=20 expression =97 mannerisms like winking when telling a joke = or blushing=20 at a compliment =97 are hard-wired into the brain and = personality, not=20 embedded in the skin. Some research suggests the end result = would be=20 a combination of the two appearances. Surgeons will graft skin to cover the = donor's=20 wound, but a closed casket or cremation will be required. = It took more than a year to win = approval from=20 the 13-member Institutional Review Board, the clinic's = gatekeeper of=20 research. Siemionow assembled surgeons, psychiatrists, = social=20 workers, therapists, nurses and patient advocates, and = worked with=20 LifeBanc, the organ procurement agency she expects will help = obtain=20 a face. At first, not everyone was on her = side,=20 acknowledged the board's vice chairman, Dr. Alan Lichtin. = After=20 months of debate, Siemionow brought in photographs of = potential=20 patients. Looking at the contorted images, = Lichtin said=20 he was struck by "the failure of the present state of the = art to=20 help these people." He decided he didn't want to deprive the = surgeon=20 or patients of the chance. The board's decision didn't have to = be=20 unanimous. In the end, it was. Surgeons wished they could have done = a=20 transplant six years ago, when a 2-year-old boy attacked by = a pit=20 bull dog was brought to the University of Texas in Dallas = where Dr.=20 Karol Gutowski was training. Other doctors had tried to reattach = part of the=20 boy's mauled face but it didn't take. The Texas surgeons did = five=20 skin grafts in a bloody, 28-hour surgery. Muscles from the = boy's=20 thigh were moved to around his mouth. Part of his abdomen = became the=20 lower part of his face. Two forearm sections became lips and = mouth.=20 "He'll never be normal," said = Gutowski, now a=20 reconstructive surgeon at the University of = Wisconsin-Madison. Surviving such wounds can be "life by = 1,000=20 cuts." Patients endure dozens of operations to graft skin = inch by=20 inch from their backs, arms, buttocks and legs. Only small = amounts=20 can be taken at a time because of bleeding. Surgeons often return to the same = areas every=20 few weeks, reopening old wounds and building up skin. Years = later,=20 many patients are still having surgeries. A face transplant = =97=20 applying a sheet of skin in one operation =97 could be a = better=20 solution. Despite its shock factor, it involves = routine=20 microsurgery. One or two pairs of veins and arteries on = either side=20 of the face would be connected from the donor tissue to the=20 recipient. About 20 nerve endings would be stitched together = to try=20 to restore sensation and movement. Tiny sutures would anchor = the new=20 tissue to the recipient's scalp and neck, and areas around = the eyes,=20 nose and mouth. "For 10 years now, it could have been = done,"=20 said Dr. John Barker, director of plastic surgery research = at the=20 University of Louisville, where the first hand transplant in = the=20 United States was performed in 1999. Several years ago, these doctors = announced=20 their intent to do face transplants, but no hospital has yet = agreed.=20 They also are working with doctors in the Netherlands; = nothing is=20 imminent. However, Siemionow had been doing = experimental=20 groundwork. She already had creatures that resembled = raccoons in=20 reverse =97 white rats with masks of dark fur =97 from years = of face=20 transplant experiments. She developed a plan and got clinic = approval=20 before going public, and insists she is not competing to do = the=20 first case. "I hope nobody will be frivolous or = do things=20 just for fame. We are almost over-cautious," she said. Siemionow, 55, went to medical school = in=20 Poland, trained in Europe and the United States, and has = done=20 thousands of surgeries in nearly 30 years. The success of = this one=20 depends on picking the right patient. She wants a clear-cut first case. No = children=20 because risks are too great. No cancer patients because=20 anti--=97rejection drugs raise the risk of recurrence. "You want to choose patients who are = really=20 disfigured, not someone who has a little scar," yet with = enough=20 healthy skin for traditional grafts if the transplant fails, = she=20 said. The person must bond with the = transplant team,=20 especially Siemionow. How much would she want to know about = the=20 person? "Everything possible. It's a = commitment on both=20 sides," she said. Dr. Joseph Locala will decide whether = candidates are mentally fit. His chief concern: making sure = they=20 realize the risks. "They almost need to understand as = much as the=20 surgeon," he said. A psychiatrist who has worked with = transplant=20 patients for 11 years, Locala knows they often have been = coached on=20 what to say to be chosen. He'd veto candidates who had = abused=20 alcohol or drugs, because they may not comply with = medications. Likewise someone who had attempted or = seriously=20 threatened suicide, or with little family or friends for = support.=20 "I'm looking for a psychologically = strong=20 person. We want people who are going to make it through," he = explained. Dr. James Zins, chairman of plastic = surgery,=20 expects to be among the 10 to 12 doctors involved in the = transplant=20 and has been screening patients. "We get some pretty strange calls = from people=20 who are really not candidates," he said. For someone to be = chosen,=20 "they're going to have to get a pass from every member of = the team."=20 Matthew Teffeteller might seem an = ideal=20 candidate. Hair is driving him crazy. What used = to be a=20 beard can't grow through the skin-graft quilt that = Vanderbilt=20 University doctors stitched over parts of his face that were = seared=20 off in a car crash. Trapped under this crust, hair festers, = leading=20 to staph infections, pain and more surgeries. "It's a nightmare and it never ends," = he said.=20 "Being burned is the worst thing that can happen to you. I'm = about=20 sure of it." Teffeteller, 26, lives south of = Knoxville, in=20 the foothills of Great Smoky Mountains National Park where = he=20 worked, ironically, as a fire fighter. The day after = Valentine's Day=20 in 2002, he was taking his pregnant wife to buy a cowboy hat = and go=20 country line dancing to celebrate their first anniversary. = "The next thing I remember, = everything just=20 went all to pieces...there was a big explosion. I remember = seeing=20 gas splash off of the windshield," he said. Rear-ended by a truck, his car = flipped and=20 caught on fire. His wife died. He was burned trying to free = her.=20 "They said my face was charcoal = black," he=20 said. He didn't see it for two months, = until he=20 glimpsed a mirror on his way to therapy. "Oh, my God," he thought. "I remember = seeing my=20 eyes pulled open. I remember my ears were burned off, and I = remember=20 my bottom lip being pulled down." Three years later, his face still = frightens=20 children. Yet he wouldn't try a transplant. "Having somebody else's face ... that = wouldn't=20 be right. When I look in the mirror, I might be scarred but = I can=20 still tell that it's me," he said. "I'd be afraid something would go = wrong, too.=20 What would you do if you didn't have a face? Could you = live?" Bioethicist Carson Strong at the = University of=20 Tennessee wonders, too. "It would leave the patient with an = extensive=20 facial wound with potentially serious physical and = psychological=20 consequences," he wrote last summer in the American Journal = of=20 Bioethics. Such worries led the Royal College of = Surgeons=20 in England and the French National Ethics Advisory Committee = to=20 decide it shouldn't be tried. Any doctor considering it = should=20 examine soul and conscience, Strong wrote. Ironically, people most emotionally = devastated=20 by disfigurement are those most likely to seek a transplant = and=20 least able to cope with uncertain results, media attention = and loss=20 of privacy, ethicists from England wrote in the same = journal. One worried that a donor family might = have=20 unhealthy expectations of seeing a loved-one "live on" in = another=20 person's body, or that recipients might want to see and = approve a=20 potential face. No way, said Siemionow. "It's not a shopping mall. They need = to rely on=20 our judgment. If they are starting to shop, they are not = good=20 candidates," she said. Siemionow said critics should admit = that risks=20 and need for the transplant are debatable. "Really, who has the right to decide = about the=20 patient's quality of life?" she asked. "It's very important = not to=20 kind of scare society.... We will do our best to help the = patient."=20 If all of the candidates back out, = "that's OK.=20 It means that we are not ready yet," she said. But if a transplant succeeds, many = people who=20 live in misery could benefit, said Gutowski, the Wisconsin = surgeon.=20 "Someone's got to push the envelope," = he said.=20 "In retrospect, we'll know whether it should be done." Copyright 2005 The Associated Press. All rights reserved. = This=20 material may not be published, broadcast, rewritten or=20 redistributed. |
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