The donors would be brain-dead people on life support systems, of the same age as the recipient, who would be given the facial skin, muscles, nerves, bones and even lips, Dr John Barker of the University of Louisville, Kentucky, suggests.
Having a face transplant would not automatically make the recipient look like the donor, because the underlying bone structure determines the face's shape. But in situations where the bones have been destroyed, such as mouth cancer or attempted suicides, the donor's bones could also be changed to create a new base for the transplanted skin.
Dr Barker, who told New Scientist he plans to begin a programme of "at least 10" hand transplants in 1999, and to transplant pieces of face by 2003, believes that face transplants will be in demand from people whose faces have been irreparably damaged.
"I had a case described to me a week ago where a three-year-old child had his face ripped off by a pit bull dog, leaving just the bone underneath," he said yesterday. "The plastic surgeon was wondering whether the technique used for transplanting hands could be used. If we had a donor, we would take the skin and put it over the existing bone."
At present, damaged faces are rebuilt using flaps of skin and muscle from other parts of the patient's body. That avoids the body's natural rejection of foreign tissue. But, Dr Barker says, "cosmetically it looks terrible".
Nadey Hakim, one of the international team of doctors who last week transplanted a hand on to Clint Hallam, a New Zealander, said that face transplants would be "much more complicated than what we have done". The ethics "would depend on whether you're looking at it from the donor's side or the recipient's".
Mr Hakim, of St Mary's Hospital in London, said Mr Hallam was doing well. "Just looking at it on the surface, the hospital told me it looks perfect," he said yesterday. "They have done a biopsy to test for immune rejection but it will take 24 hours to get the results."
The hand transplant is an ambitious step and could provide a means of testing the techniques needed for face swaps. Most transplants involve only a single organ or tissue; but a hand incorporates skin, muscle, nerve and bone, making the operation in some ways more demanding than a face transplant, where bone would not be involved.
But New Scientist warns: "The idea of a market for young faces emerging among the ageing rich is too awful to contemplate" and adds: "Besides, cosmetic surgeons can already transform the faces of the living. Ask Michael Jackson."Reuse content