The Sunday Times - Britain

The Sunday Times                         June 18, 2006

British doctor plans first full face transplant

Siobhan Maquire and Jon Ungoed-Thomas

A SURGEON is preparing to conduct the world’s first full face transplant at a hospital in Britain. Peter Butler, a consultant plastic surgeon at the Royal Free hospital in Hampstead, north London, has already been contacted by 29 disfigured volunteers willing to undergo the operation.

He is understood to have identified a 22-year-old man, whose face was badly scarred in a house fire when he was 10, as a potential candidate. Butler is awaiting the final go-ahead from his hospital’s ethics committee to conduct the pioneering operation. He will present his submission to the committee this week.

In 2003 Butler planned to perform a face transplant on a 14-year-old Irish girl, but the Royal College of Surgeons of England warned it was too early to attempt the procedure and he cancelled his plan. Some critics believed the risks were too great, while others pointed to the questions of identity involved in transferring a face from one person to another. However, last year’s successful partial face transplant on Isabelle Dinoire, a French woman, has underlined the potential benefits of the operation. Dinoire, 38, had her nose, lips and chin replaced after her face was mauled by a dog. In a television interview last month Dinoire said she was trying to return to a normal life and that she now had “a face like everybody else. I hope this operation will help other people too”.

Butler believes Britain is ready for a face transplant that would relieve the suffering of someone with such a serious disfigurement that he or she feels unable to lead a normal life. “People have seen a woman with severe facial deformity change to what looks like a perfectly normal face,” said Butler. “It’s now not a case of how, in this country, but when.”

The research ethics committee at the Royal Free hospital will consider on Wednesday whether to give Butler’s team final approval. If he receives permission, he will begin to make his final selection. His team has raised about £40,000 to fund operations on two patients.

Dr Michael Pegg, the chairman of the ethics committee, said: “We are considering an application to do a face transplant and want to make sure that the procedures are followed perfectly. We will look at the application very carefully before making a decision.”  The committee has 60 days to consider the request, but this period can be extended if further information is required. Pegg said yesterday that a Royal College of Surgeons working party was also reviewing the issue, but any advice it gave would not be binding.  Butler and his 30-strong team at the Royal Free have spent 10 years studying the clinical and psychological aspects of face transplants. The ethics committee has given him authority to seek patients for the operation.
“Selecting the right patient is very important,” said Butler. “It has to be someone who can handle the psychological impact and has the coping mechanisms to deal with the procedure.”  Butler indicated that one potential candidate was the 22-year-old, who was extensively burned as a child. He said: “He has a mask-like effect on his face and is missing his eyebrows. His muscles are working underneath but not very well because the scar and the skin grafts are tethering. He also has problems closing his eyelids and opening his mouth properly. So he has the type of injury we are looking for.”

Other hospitals are also hoping to perform the world’s first full facial transplant. A medical team in Ohio was given the go-ahead last year, but is still looking for a volunteer.  Butler said yesterday: “My aim is not to be first, but to do it on the right patient. It would be very dangerous to look at it as a race because it could harm the patient and (the reputation of) the procedure.”

Two teams of surgeons are involved during a face transplant operation. One team removes the facial tissue of the donor from the hairline to the jawline. The donor’s blood must be kept flowing artificially after death to stop the face decaying. In a nearby theatre, the skin of the transplant patient is detached. The blood vessels are clamped while muscles and nerves are left in place.

The donor’s face is stretched over the patient’s bone structure and face, then sewn into place. The recipient must take immuno-suppressant drugs for the rest of his or her life to stop the donor face being rejected. If the patient’s immune system rejects the face, he or she will lose their own face and that of the donor.