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Face transplants inch toward reality

University of Louisville doctors to seek ethics review of surgery


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(CNN) -- Doctors in Kentucky have begun preparing a document to be submitted to an ethics panel at the University of Louisville School of Medicine seeking permission to perform a face transplant, the lead researcher in the endeavor told CNN.

"We are in the process of doing that," Dr. John Barker, director of plastic surgery research at the University of Louisville, said Tuesday. "We have a team of about 16 or 17 people."

The radical procedure, intended for patients with severe disfigurement, has not been attempted before, though doctors in the past have successfully reattached faces to patients after accidents.

The development was first reported in the May 29 issue of New Scientist magazine.

The operation could offer new hope for those who suffer severe burns, cancer or gunshot wounds. The surgery will attach facial tissue and blood vessels from a cadaver to a new patient.

The transplant also brings a lifetime dependence on expensive immuno-suppressant drugs to block rejection of the new tissue.

Candidates could include people whose faces have been grossly disfigured, as happened to Jacqueline Saburido, who was a 20-year-old student at the University of Texas at Austin in 1999 when her car was hit by a driver who had been drinking.

Saburido's face -- including her nose, lips and ears -- burned in the resulting fire. Since then, she has undergone more than 40 surgeries, most of them on her face and hands.

"My life completely, completely, completely changed," she told CNN affiliate WAVE, in Louisville.

In addition to reconstructing her face, she hopes to reconstruct her life, fall in love and have children, something a face transplant could facilitate.

"I hope I can do [so] soon, you know, because life is now," she said.

But any attempt at such a procedure is at least a year off, said Kathy Keadle, director of communications and marketing for the school's health sciences center.

The ethics committee -- called an institutional review board -- is charged with approving or turning down requests for experimental procedures.

The novel procedure would require approval not only from the Louisville school's board but also from a sister institution's -- Western Kentucky University -- "to make certain all questions are asked and addressed," said Kathy Keadle, director of communications and marketing for the Louisville school's health sciences center.

Keadle said any such attempt is at least a year off. "That's just one of many, many things that would need to happen. ... There's still quite a lot to do," she said.

Surgical teams in Britain, France and Cleveland, Ohio, are also considering performing such an operation, but Barker said he would not predict when his team would carry out the procedure.

"We'd rather not say," he said in a telephone interview. "The minute you put a date or a time -- then all of a sudden, it's a race."

Recent successes in multiple tissue transplants -- such as hands -- led surgeons to consider attempting the face procedure, Barker said.

The problem of transplanting skin has recently been overcome, paving the way for researchers to attempt a face transplant, Barker said. Unlike the transplant of solid organs -- such as hearts and kidneys, which have been routine for decades -- procedures such as hand transplants require multiple types of tissue, including skin.

Researchers found that a cocktail of drugs used for kidney transplants would also work with skin transplants.

"When we did the initial research that led to the hand transplant -- in animals -- we found a certain cocktail of drugs is effective in stopping rejection of skin," he said. "That was what had held back hand and face [transplants] and anything that includes skin."

Doctors currently are limited to grafting skin and muscles from other parts of the body in patients who have suffered catastrophic damage to their faces, but the result is typically cosmetically unsatisfactory.

Still, some bioethicists have urged caution: The face recipients would need to undergo life-long immunosuppression, which carries increased long-term risks of cancer.

The Louisville team includes three bioethicists, Barker said.

He noted that the underlying skeletal structure of a recipient would differ from that of a donor, meaning that the recipient's face would look much different from that of the donor's.

Because of the lengthy approval process required before any such attempt of the procedure, patient recruitment has not begun, Keadle said.

"The patients who will need this surgery, I'm sure, are desperate for hope, and we wouldn't want to dangle that hope" so far in advance, she said.


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