Doctors set to transplant faces from dead to the living

Surgeons are preparing to cross a new medical frontier with the transplant of a whole human face from a dead to a living person.

Advances in understanding of the processes of biological rejection and perfection of the skills necessary to carry out the surgery would make the operation technically possible within the next year, specialists said yesterday. The first candidates for the surgery could be children under six, disfigured by disease or accident, who are too young to have become familiar with their own appearance. Doctors said an adult acquiring a new face would have to cope with a major psychological and emotional challenge.

But the main barrier was likely to be public squeamishness about an operation that people associate with science fiction rather than surgical fact, specialists said. Peter Butler, a consultant plastic surgeon at the Royal Free Hospital, London and the Massachusetts General Hospital in Boston, US, said a public debate was needed to determine society's views in advance of the surgery becoming possible.

Speaking before a conference organised by the British Association of Plastic Surgeons, at which latest research on face transplants was to be presented, Mr Butler said he expected to complete a study of the anatomical and technical difficulties involved in the next six months. Transplant of a whole face with underlying muscle would have advantages over current treatment methods that rely on skin grafts taken from other parts of the body. They do not allow movement – essential to convey feeling and expression – and create a mask-like appearance.

Mr Butler, who has researched new techniques of transplantation and tissue engineering for eight years and was part of the American research team that grew a "human ear" on the back of a mouse, said there were three options for the surgery. The first, the subcutaneous option, involved taking the skin, fatty tissue and blood supply. The second, the sub-periosteal option, would include facial muscle and nerves while the third option would take bone as well and involve partial reconstruction of the skull.

For the first transplant, if approved, surgeons would take the simplest and safest sub-cutaneous option, to minimise the risks. "On that basis we should be able to carry out a face transplant in the next six to nine months," he said.

A bigger challenge was to overcome rejection of the transplanted tissue. The skin is the most antigenic organ in the body triggering a powerful immune response which requires high doses of anti-rejection drugs be taken for life.

The anti-rejection drugs, such as cyclosporin, have nasty side-effects and increase the incidence of cancer but this is considered an acceptable risk for a life-saving transplant involving a kidney, heart or liver.

Where the transplant is about improving the quality of life, as with face transplants, the risks and benefits are more finely balanced.

Mr Butler said research to be presented to the conference opened up the prospect of drug-free immunosuppression, meaning transplants of faces and limbs could be done without the need for lifelong prescription of medicines.

The technique of immunosuppression, called a tolerance induction regime, had been successfully achieved in pigs by the Transplant Research Biology Centre in Massachusetts and trials on humans will start next year,

"If this comes to clinical reality in the next year or so it is going to open widely our ability to transplant the face," Mr Butler said. "I am told that the age at which children first recognise themselves is between five and six. Children might be the first group to use this technique on."

However, public squeamishness is a factor. A study of attitudes to "face donation" among 120 people, including doctors, nurses and lay people, found widespread resistance.