Doctor wants to try a face transplant

CLEVELAND — In the next few weeks, five men and seven women will secretly visit the Cleveland Clinic to interview for the chance to have a radical operation that has never been tried anywhere in the world.

They will smile, raise their eyebrows, close their eyes, open their mouths. Dr. Maria Siemionow will study their cheekbones, lips and noses. She will ask what they hope to gain and what they fear.

Then she will ask, "Are you afraid that you will look like another person?"

Because whoever she chooses will endure the ultimate identity crisis.

Siemionow wants to attempt a face transplant.

This is no extreme TV makeover. It is a medical frontier being explored by a doctor who wants the public to understand what she is trying to do.

It is this: to give people horribly disfigured by burns, accidents or other tragedies a chance at a new life. Today's best treatments still leave many of them with scar-tissue masks that don't look or move like natural skin.

These people have lost the sense of identity that is linked to the face; the transplant is merely "taking a skin envelope" and slipping their identity inside, Siemionow contends.

Her supporters note her experience, careful planning, the team of experts assembled to help her and the practice she has done on animals and cadavers to perfect the technique.

But her critics say the operation is too risky for something that is not a matter of life or death, as organ transplants are. They paint the image of a worst-case scenario: a transplanted face being rejected and sloughing away, leaving the patient worse off than before.

Such qualms recently scuttled face-transplant plans in France and England.

Ultimately, it comes to this: a hospital, doctor and patient willing to try it.

The first two are in place. The third is expected to be shortly.

The "consent form" says this surgery is so novel and its risks so unknown that doctors don't think informed consent is possible.

Here is what it tells potential patients:

Your face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last eight to 10 hours; the hospital stay, 10 to 14 days.

Complications could include infections that may require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.

The clinic will cover costs for the first patient; nothing about others has been decided.

Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bones and muscles, which give a face its shape.

A face transplant involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient's scalp and neck, and areas around the eyes, nose and mouth.

"For 10 years now, it could have been done," said Dr. John Barker, director of plastic-surgery research at the University of Louisville. Several years ago, these doctors announced their intent to do face transplants, but no hospital has yet agreed.

Siemionow had been experimenting on animals. She got clinic approval to try on people and insists she is not competing to do the first case. "I hope nobody will be frivolous or do things just for fame. We are almost over-cautious," she said.

Siemionow, 55, went to medical school in Poland, trained in Europe and the United States and has done thousands of surgeries in nearly 30 years. The success of this one depends on picking the right patient.

She wants a clear-cut first case. No children because risks are too great. No cancer patients because anti-rejection drugs raise the risk of recurrence.

"You want to choose patients who are really disfigured," yet with enough healthy skin for traditional grafts if the transplant fails, she said.

Dr. Joseph Locala, a psychiatrist, will decide whether candidates are mentally fit. His chief concern: making sure they realize the risks and are well emotionally.

Matthew Teffeteller, who lives south of Knoxville, Tenn., might seem like an ideal candidate. Three years ago, he was burned in a car crash that killed his pregnant wife. Despite many surgeries, his face still frightens children. Yet he wouldn't try a transplant.

"Having somebody else's face ... that wouldn't be right. I'd be afraid something would go wrong, too. What would you do if you didn't have a face? Could you live?"

Bioethicist Carson Strong at the University of Tennessee wonders, too.

"It would leave the patient with an extensive facial wound with potentially serious physical and psychological consequences," he wrote last summer in the American Journal of Bioethics.