Public squeamishness over the limits of modern surgery are to be tested next week when specialists propose the transplant of a whole human face from a dead to a living person.
At least five teams around the world are making preparations for the transplant, which would cross ethical and technical frontiers. But before such an operation, doctors have to convince a sceptical public that its potential benefits outweigh the psychological, emotional and ethical challenges the surgery presents.
In Britain, 10 people with faces disfigured by disease or an accident have approached the consultant plastic surgeon Peter Butler, after he published preliminary research last year on face transplants. Mr Butler, who divides his time between the Royal Free Hospital, London, and the Massachusetts General Hospital, Boston, said advances in understanding rejection and perfection of the skills necessary made the surgery technically possible, if ethical and psychological objections could be overcome. "These need to be ironed out before we can go ahead," he said yesterday.
A report by a working party of the Royal College of Surgeons, to be published next week, will examine the key issues raised by the proposed surgery. Its publication on 19 November is timed to coincide with an inaugural debate at the Science Museum's new Dana Centre on face transplants.
The debate will be addressed by John Barker, leader of plastic surgery research at the University of Louisville, who is expected to claim that transplanting a whole face would be simpler, and give better cosmetic results, than the current method of using tissue from other parts of a person's body, which can involve up to 100 separate operations.
Mr Butler acknowledged that the issue of individual facial identity was the main reason for opposition to face transplants, but saidit was unlikely to be a problem for the most basic kind of transplant, which involved taking the skin, fatty tissue and blood supply. Most of a person's facial appearance is determined by the cranio-facial skull - the underlying bone structure - which would not be transplanted. The transplant would involve attaching a different "skin envelope" over the bone and muscle.
A bigger issue is whether taking lifelong anti-rejection drugs could be justified. The skin provokes a stronger immunological reaction than any other organ in the body and thus requires heavier doses of immunosuppressant drugs. But they have side-effects including an increased risk of diabetes, cancer and high blood pressure, as well as a continuing threat of rejection.
The American team led by John Barker is likely to be the first to transplant a face if approval is granted, but other teams are also working on the challenge. In France, a team led by Francois Petit, a plastic surgeon who operates near Paris, applied for ethical approval a year ago.
The Royal College of Surgeons said it had set up its working party, chaired by Sir Peter Morris, the college's president, after protests from the charity Changing Faces, led by Dr James Partridge, which campaigns for an end to discrimination against people with disfigurements.
Dr Partridge, whose face was destroyed in a car fire when he was 18, called on the college to impose a moratorium on the research while a debate on the ethics was held.Reuse content