British surgeons were on Wednesday given the final go-ahead to perform the world’s first full face transplant, a radical procedure that has raised concerns about its physical and psychological risks.
The U.K. Face Transplantation team at the Royal Free Hospital in London received permission for four transplants from the hospital’s Research Ethics Committee.
“We can now begin to evaluate patients and draw up a shortlist of four people who want to undergo this procedure,” said Peter Butler, the plastic and reconstruction surgeon who will head the team.
“We will continue to take a cautious and careful approach and we will not be rushed. It may be many months before we are ready to carry out an operation,” he added in a statement.
The ethics committee said it reached its decision after carefully reviewing a decade of research results by Butler and his team.
“Groundbreaking research is always difficult and there will always be doubters and detractors,” said Andrew Way, the chief executive of the hospital.
But he added that many people with severe injuries desperately need help and the transplantation team at the hospital has an international reputation.
“Face transplantation has been shown to be a successful treatment elsewhere and our team will now be able to begin the latest and most difficult phase of their work,” said Way.
Risks and benefits
Surgeons in France performed the world first partial face transplant in a 15-hour operation last year on Isabelle Dinoire, who received a new nose, lips and chin after being mauled by her dog.
The pioneering surgery by Professor Bernard Devauchelle and his team at the Centre Hospitalier Universitaire Amiens in northern France sparked an ethical debate and raised questions about the psychological impact of the procedure on both the recipient and the donor’s family.
Although the microsurgery techniques needed for a full transplant are well established, little is known about the psychological impact and the long-term risk of the drugs the patient will need to take to avoid rejection of the new face.
Changing Faces, a charity that represents people with disfigurements, said it would have preferred the decision to have been delayed until Britain’s Royal College of Surgeons updated their recommendations on face transplants.
“Our main concern is to ensure that any patient who is being considered for this procedure has a full understanding of the risks and benefits, especially the risks associated with the immunosuppressant drug regime,” the charity said in a statement.
But other experts welcomed the decision.
“It marks another step forward in facial reconstructive surgery,” said Michael Earley, a plastic surgeon and former president of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS).
Andrew George, a professor of molecular immunology at Imperial College London, said the surgery will enhance the quality of life for a small number of patients.
“However, this will not be without risks, both physical and psychological, and it would be important that the patients are fully informed of these risks before surgery — as the ethics committee would insist on,” he said.
The Face Trust, a charity which has been set up to fund research for surgical reconstruction and facial transplantation, launched an appeal for money to fund the transplants, which are expected to cost at least 25,000 pounds ($50,000) for each procedure.
