Catherine Pepinster: The futuristic face-off that is best left to Hollywood and John Travolta

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It's more than 30 years since Dr Christiaan Barnard made history by carrying out the world's first heart transplant. It was certainly a medical achievement, but at first there was also something disturbing about such an operation. Was the recipient of the heart in some way, a little less themselves, and instead, did a shadow of the dead donor fall upon them? The heart of someone can obviously be described in biological terms as an organ of the body, but doesn't it have a metaphysical quality, symbolising the essence of a person? It might be an illogical and irrational notion, but the sentiments of people whose children's hearts were used in transplants, prove how important it is to use a symbol of love and what is at the core of us. How often we've heard a parent say after sanctioning such a procedure: "I feel as if my child lives on" or "I feel a special part of them is still here".

Today heart transplants seem almost commonplace, the success rate for the operation is remarkably high, and we don't shudder quite so much.

But now comes the news of something even more disturbing: that face transplants may soon be possible. A report published by the Royal College of Surgeons last week suggests that in as little as five years, a face transplant could be carried out. The skin and underlying fat from a donor face would take the place of the recipient's; nerves and blood vessels would then be reconnected and skin attached around the edges to the patient's own remaining skin.

Only six years ago, when John Travolta starred in Face Off - the story of a man who took another's face in order to solve a murder - the idea of a face transplant seemed incredible. Now it is closer to reality, could it really be as acceptable as a heart transplant? Would you really want the face of a dead person that you had loved, removed and given to someone else, even if the recipient had been horribly maimed? The face after all is what we know of a person. Think of the smiles, grimaces, grins and sneers; the look of love; the expression of pain, the stare of horror. It's not just skin and muscle; it's a window into someone's soul. That becomes quickly apparent if you look at a replica face, like those of the waxworks at Madame Tussauds. There are highly competent images of people such as J-Lo and Pierce Brosnan. But the extra spark, that inexplicable something is missing. It's the real thing, the person that we want, and it's their face that makes you feel you've got it. It's is what we fall in love with. No wonder, then, that even those who first meet in faceless encounters on the internet want to meet face to face.

Some doctors, knowing the ghastliness of disfigurement, can't wait to carry out the latest innovative treatment. Plastic surgeon Michael Earley, who was part of the Royal College's study panel, describes the treatment as the "most exciting possibility for a long time".

There can, of course, be no comparison between the life-saving merits of a heart transplant and the ghoulish desire for a face transplant in order to achieve "Hollywood looks". To take another person's face for vanity would be disturbing and bizarre.

While the desire to help people who have been maimed is more tempting, the very people you might expect to want this kind of treatment aren't so keen. People whose faces have been disfigured by cancer, or shot away or burnt beyond recognition don't think this is the solution. Simon Weston had 70 operations to rebuild his face after being injured during the Falklands War. He doesn't want a transplant. Nor does James Partridge, who lost his face in a car fire and set up the Changing Faces charity to help those with disfigurement. Despite all the skin grafts, the painful operations and the scars, they want the face that is still theirs. What really need to change, though, are the whispers, the curiosity and the ridicule of other people who cannot abide anybody to look any different to them.

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