The worldâs first full-face transplant may be performed within months after a British hospital was given the go-ahead by its ethics committee on Wednesday.
Consultant plastic surgeon Peter Butler said he was âdelightedâ to have been given permission for the pioneering surgery by the committee at the Royal Free Hospital in Hampstead, north London.
âWe can now begin to evaluate patients and draw up a shortlist of four people who want to undergo this procedure,â he said. âWe will continue to take a cautious and careful approach and we will not be rushed. It may be many months before we are ready to carry out an operation.â
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The prospect of a full-face transplant raises hopes for people with severe facial disfigurement â caused by burns or disease, for example â and comes after surgeons in France carried out the worldâs first partial face transplant in November 2005.
Isabelle Dinoire, who had her nose, lips and chin replaced after she was savaged by a dog, is reportedly happy with the result. âI have now a face like everyone else,â she said in February 2006, when she faced the press for the first time.
In April 2006, a hospital in China conducted what is believed to be the second partial face transplant on Li Guoxing, aged 30, who had been attacked by a bear.
Patient selection
Patients selected for the proposed full-face transplant will only be considered if they are from the UK or Ireland, due to concerns about the long-term care of overseas patients in Britainâs publicly-funded National Health Service. Butler said he would not be able to carry out the operation on children, because of issues of consent.
All the patients are likely to have pan-facial disfigurement, where the whole face has been affected by injury, spreading to the scalp or ears.
âThese patients will have already undergone reconstructive surgery. Perhaps they will have had 50 or 70 reconstructive operations,â says Butler, who adds that he has already been approached by 34 patients from across the world.
âThey have reached the end of the reconstructive ladder and thereâs nothing more it can offer them. They have the problem of integration into society, of being able to walk down the street in society without anybody staring at them. Thatâs all these people want â to be normal,â he says.
Detailed scrutiny
Computer modelling has shown that the recipient of a full-face transplant would look different to the donor because of their face shape and bone structure.
Andrew Way, chief executive of the trust that runs the Royal Free Hospital, said the committee gave the green light only after âthe most detailed scrutinyâ of more than 10 yearsâ research by Butlerâs team.
After the first transplant â which is likely to take 10 to 12 hours and involve four to six surgeons â there will be a six-month gap before the second operation to assess the procedure.
Changing Faces, a UK-based organisation for people with facial disfigurements, said that patients considered for the procedure must have a full understanding of the risks and benefits, especially the risks associated with taking immunosuppressant drugs for life, which are needed to prevent rejection of the new facial tissue.
âA viable âPlan Bâ should be developed and explained in the event of a transplant being rejected and every effort must be made to protect the patientâs privacy and that of the donorâs family,â the charity added.
