French surgeons defend ethics of face transplant

French surgeons have dismissed suggestions that they had ridden roughshod over ethical and psychological problems before performing the world's first face transplant last weekend. New controversy erupted over a report that the patient, a 38-year-old woman, had been gravely disfigured by her dog, which had been trying to revive her after a suicide attempt.

Professor Jean-Michel Dubernard told a press conference in Lyons that he had "initial" ethical doubts about grafting the flesh of a donor's nose, lips and chin on to the woman, from Valenciennes. But once he had grasped the scale of the woman's disfigurement and physical incapacities, "I no longer hesitated for a second," he said.

The woman, recovering well in hospital in Amiens, had already seen her new face and said "thank you", the professor said.

The news agency AFP reported yesterday that the woman had been disfigured by her own dog. The woman's 17-year-old daughter said she had collapsed after taking an overdose of pills. Her dog, a Labrador cross, had then tried to revive her and, in doing so, had bitten or clawed her face.

This was denied at yesterday's press conference by Professor Dubernard, who was also the first man to perform a hand transplant seven years ago. He said that the woman had taken a sleeping pill after quarrelling with her daughter. She was attacked by the dog after waking during the night. "There was no [attempt at] suicide," he said. He accused the daughter of "saying what journalists wanted to hear". The conflicting accounts will fuel the doubts of senior doctors in France who have reviewed unpublished details of the case. They have suggested that the world's first face transplant patient has a "depressive profile". They question how well she will cope with the stress of living with a partially transplanted face and the need to take drugs to suppress her immune system for the rest of her life.

Face transplants have been technically possible for several years but have been resisted for ethical reasons: principally concern over the psychological impact on the patient and the physical effect of taking anti-immune drugs for so long.

Professor Dubernard was also criticised for his choice of his first hand transplant patient in 1998 - a New Zealander with convictions for fraud. After failing to take the anti-immune drugs, the patient later asked for the hand to be removed.

The professor said yesterday that there was a "host of ethical questions" in cases of this kind but the operation had been approved by France's official, ethical and medical review bodies. "It was extremely difficult, if not impossible, to repair [her injuries] with classical techniques of surgery," he said. "As doctors, if we have the possibility to improve [the condition of] our patient, that is what we must do."

The woman's first reaction, on waking 24 hours after the operation, was overwhelmingly positive, Professor Dubernard said. "The patient saw her face on Monday morning and said 'thank you'."

The transplanted flesh and skin for nose, lips and chin came from a brain-dead donor, who was also a young woman. The doctors hope the transplanted features will eventually mould themselves to the shape of the patient's skull, restoring something close to her original appearance.

The other surgeon who conducted the operation, Professor Bernard Devauchelle, said: "We had a very pleasant surprise in terms of the colour of the [transplanted] skin. The benefits [of the operation] are obvious. She can eat, drink and talk clearly. Before, she had no lips and without lips, it is difficult to breathe, or drink, or eat."

Professor Dubernard said: "But we will only know in four to six months whether she has recovered all feeling [in the nose, mouth and chin 'triangle']."