Registered: Mar 2004
Location: USA
Posts: 24747

Doctors prepared to do face transplant
Team includes UofL researchers By Laura Ungar
lThe Courier-Journal

Even as ethicists and others raise concerns, a team of doctors from Louisville and the Netherlands says it is ready to perform a face transplant.

"There arrives a point in time when the procedure should simply be done. We submit that that time is now," the researchers wrote in an article scheduled for publication today in The American Journal of Bioethics.

The article, by the team from the University of Louisville and the University of Utrecht in the Netherlands, explores the ethical and psychological issues, and physical risks, involved in a transplant that would attach the face of a dead donor to someone with a severely disfigured face, such as the victim of a serious burn or accident.

Although researchers will not say when such a transplant would be done, they are taking steps toward the first operation, which would be considered clinical research.

In addition to seeking comments from peers, they have submitted an application to an institutional review board in the Netherlands and are almost ready to submit one to an independent board in the United States. The Louisville doctors said they would not perform the transplant without approval from one of the boards, which are designed to protect medical research subjects' rights.

The team has also evaluated several potential candidates for the transplant — in both the United States and the Netherlands — but has not yet found an "optimal" candidate, said Dr. John H. Barker, one of the article's authors and a member of the UofL/Utrecht team. They are not actively screening potential patients, he said, but do consider those who call.

"The people we're considering are people who have no other options," said Barker, director of plastic surgery research at UofL.

Not everyone believes the world is ready for such a transplant, however.

Members of another local team, a partnership of UofL, Jewish Hospital and Kleinert, Kutz Hand Care Center, do not think a transplant should be performed yet. Dr. Gordon Tobin, a member of that team, said ethical and other issues have not been fully explored, and there needs to be a more thorough understanding of the procedure by the public.

Nichola Rumsey of the University of the West of England, an expert in psychosocial issues in medicine, expressed similar sentiments in one of 14 essays written in reaction to the UofL/Utrecht article and published in the bioethics journal.

"Previous research and current understanding indicate that the psychological risks are more complex and extensive than the Louisville team suggest," she wrote. "I have no wish to minimize the distress experienced by many people with severe disfigurements, but to my mind, the current risk/benefit ratio ... is dubious at best."

But Osborne P. Wiggins, chairman of the UofL philosophy department and one of the authors of today's article, said researchers have gotten as far as they can without actually performing the procedure.

"Do we let the uncertainties and unknowns stop us and decide not to do it at all? Or do we go ahead and perform the procedure and learn the answers? We're willing to take the second option," Wiggins said.

Problems and benefits

Face transplants differ from other transplants because the face is an integral part of someone's identity, said the researchers, who helped write the article. "What is at stake," the researchers wrote, "is a person's self-image, social acceptability and a sense of normalcy as he or she subjectively experiences them."

The procedure involves removing a donor's skin and other tissue, putting it over the recipient's bone and cartilage and reconnecting it.

Researchers outlined some potential problems, such as misuse of the procedure. Aging rich people, for example, might seek a transplant for cosmetic improvements and criminals might want to conceal their identity, researchers said.

People getting such transplants would also face the same risks as other transplant recipients, such as the increased incidence of infection and cancer associated with immunosuppressive drugs.

Given such issues, Tobin said, doctors need to move forward carefully and methodically.

But the benefits are many, researchers said in the bioethics article. For example, transplants could restore facial expressions and sensory functions and improve people's psychological outlook. Besides Louisville, such transplants are being considered by teams in Cleveland, England and France.

"In a large number of cases facial disfigurement leads to depression, social isolation and even the risk of suicide," the UofL researchers wrote. "Restoring the abilities to make facial expressions, enjoy an aesthetically acceptable appearance and interact comfortably with others lends significant weight to the benefit side of the risk/benefit equation."

Experts disagree

But the other side of the equation weighs heavy too, some experts said.

Rumsey, the English researcher, wrote that potential recipients might have to wait a long time for suitable donors and might be tempted to put their lives on hold in the interim. They might also have to endure lots of media coverage, she said. Socially, she wrote, such a procedure might convey the notion that people can't live well with disfiguring conditions.

Carson Strong, of the University of Tennessee College of Medicine, wrote that two prominent professional committees — the Royal College of Surgeons of England and the French National Ethics Advisory Committee — have said that a face transplant should not be carried out now.

Strong said recipients would face the risk that their grafts could fail, making things worse.

But other experts agreed with UofL researchers that the time for a transplant is now.

"Our position is that face transplantation could now be performed," wrote three surgeons from Henri-Mondor Hospital in Paris. "The switch from `could' to `should' depends on the ethical conditions surrounding the procedure."

UofL researchers said they are considering all of the critiques as they move forward. They also have to take several additional steps, such as developing a program with Kentucky's organ procurement agency, developing a funding strategy and finding a full clinical team. The team also needs to find a hospital in which to perform the procedure.

Linda McGinity Jackson, vice president for public relations at Jewish Hospital, said there are no plans to let the UofL team do the procedure there. And Tobin said there are no plans to merge the two teams because of the differences in philosophy.

Tobin said he does believe that a face transplant is on the horizon. "It will be a positive contribution to the frontiers of medicine when the time is right," he said.

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Hmmm.

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Registered: Feb 2004
Location: south afrika
Posts: 16791

How do you get a gay man to shag your girlfriend?

Shit in her cunt.

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Registered: Sep 2004
Location: Canada
Posts: 107

quote:

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Originally posted by Trenchant_Troll
"Socially, she wrote, such a procedure might convey the notion that people can't live well with disfiguring conditions."

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Sure, the elephant man had it easy....

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