Over the next few weeks five men and seven women being evaluated by a US clinic hope to be the one final chosen recipient of a new face after a radical face transplant operation. The Cleveland Clinic's Dr Maria Siemionow is studying the prospects and will determine that who among them best stands to gain by taking a new “skin envelope" for their identity.
Even if the risky prospect of patient's systems rejecting the transplanted face ended similar operation plans in France and the UK, here the hospital, doctor and patient are all willing to give everything they have got to this first-time operation. Dr Siemionow, who prior to this experimented with animals before receiving clinical approval for trying the procedure on humans, is studying cheekbones, lips and noses in a bid to give one of the twelve disfigured people, a chance of a new life. But whomever she does eventually choose will also have to endure for a lifetime a crisis of having two identities.
Meanwhile helping her is a clinical psychiatrist, Dr Joseph Locala, who will identify who is most “psychologically strong…. to make it through". The Cleveland Clinic which is supporting the first-time effort, finds the surgery is so novel that it is unable to clearly name the risks on its consent form for a truly informed consent. Currently the clinic believes that the surgery could last between eight and ten hours and puts the estimated hospital stay to between ten days and a fortnight.
At worst it believes that complications could result in the “new face” turning black, requiring another transplant or graft-based reconstruction, besides lifelong drug therapies to prevent rejection while risking kidney damage and cancer. On the psychological front, the clinic while trying to shield the identity of the final recipient of the new face, believes the worst could be a complex feeling of disappointment, remorse, sadness or guilt to the donor.
The applicants who have already lost touch with their original identities, having suffered extensive facial disfigurement, and are willing to try despite an equal probability of success as failure, despite having no control over their new looks. Though opponents to the procedure suggest that facial disfigurement can be endured unlike organ transplants requiring immuno-suppressants for life, Dr. Siemionow believes that the shame and depression of an unsightly face are just as “life threatening”. She says, “For many patients (who do not leave their houses), being able to go back to their normal lives is worth the risk of taking lifelong immuno suppression”.
On the optimistic side the surgery promises a normal life, eating, drinking and communicating through facial expressions and mannerisms that patients have lost since their disfigurement. Apart from the Cleveland Clinic, the University of Louisville's plastic surgery lab has also sought approval for performing the face transplant procedure on burn victims. In 1999, the University performed the first hand transplant in US, using microsurgery.
Despite mounting criticism to the procedure, technically the recipient expects to look similar to what they originally did, as only new skin is being grafted to their existing structure of bones and muscles that determine a face's shape. Also as the brain determines expressions and facial characteristics, the new facial tissue will do little to change the patient's existing unique expressions. The fallout of this path-breaking surgery would be the possibility of millions whose lives are disfigured by facial damage to regain a vista of their normal life and freedom.
