1st near-total face transplant performed

CLEVELAND — A woman so horribly disfigured she was willing to risk her life to do something about it has undergone the nation's first near-total face transplant, the Cleveland Clinic announced Tuesday.

Reconstructive surgeon Dr. Maria Siemionow and a team of other specialists replaced 80 percent of the woman's face with that of a female cadaver a couple of weeks ago in an operation certain to stoke the debate over the ethics of such surgery.

The patient's name and age were not released, and the hospital said her family wanted the reason for her transplant to remain confidential. The hospital plans a news conference today.

The transplant was the fourth worldwide; two have been done in France, and one was performed in China.

Details of the Cleveland surgery were not disclosed, but surgeons generally transplant skin, facial nerves and muscle and often other deep tissue. That is done so the new face will function and not just be a mask.

Surgeons not connected to the case reacted cautiously but generally praised the operation.

"There are patients who can benefit tremendously from this. It's great that it happened," said Dr. Bohdan Pomahac, a surgeon at Harvard-affiliated Brigham and Women's Hospital in Boston who plans to offer face transplants, too.

Unlike operations involving vital organs such as hearts and livers, transplants of faces or hands are done to improve quality of life, not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and many other problems.

Arthur Caplan, a leading bioethicist who has expressed grave concerns about such surgery, withheld judgment on the Cleveland case but said the woman's doctors should give her the option of assisted suicide if they make her life worse.

"The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell," said Caplan, bioethics chief at the University of Pennsylvania. "If your face is falling off and you can't eat and you can't breathe and you're suffering in a terrible manner that can't be reversed, you need to put on the table assistance in dying."

Siemionow, (SIM-en-now), 58, a noted hand microsurgeon, has been testing the surgical approach and ways to temper the immune system's response in experiments for more than a decade.

She considered dozens of burn victims and other potential candidates over the past four years, ever since the clinic's internal-review board gave her permission to attempt the operation.

"She's a leader in this field. She's been investigating this for a long time," said Dr. Warren Breidenbach, a surgeon at Jewish Hospital in Louisville, Ky., who did the nation's first hand transplant, in 1999. Siemionow trained with him in Louisville.

Her task now is to prevent organ rejection while managing the risk of infection from taking strong immune-suppressing drugs.

Rejection is a possibility whenever someone receives an organ or cells from someone else because the body regards this as foreign tissue. Two types of problems can result.

The first is graft-versus-host disease, which could happen if the new facial tissue were to attack the recipient's body. The second is if the patient's body were to attack the transplanted face, causing inflammation and other problems at the site of the new tissue. Either can be life-threatening.