First Full Face Transplant in the US: Years in the Making
The first successful full face transplant in the United States was an incredibly important step for reconstructive surgery in this country. Performed on Dallas Wiens, a young construction worker critically burned in a power line accident, underwent this procedure to restore his nose, skin, lips, facial muscles and nerves from an unidentified donor at a Boston hospital. Since 2005, there have been 6 partial face transplants and 3 full facial transplants around the world, with Mr. Wiens being the most recent.
What has received little attention during this event is the careful preparation that was required in order to make this a reality. The techniques involved are actually not new. Microvascular and nerve surgery procedures are routinely used by plastic surgeons nearly everyday. The fact that the grafted tissue was provided by an unrelated deceased donor (not the patient’s own tissues) thus requiring lifelong anti-rejection drugs also was not new, as it is done in organ transplant every day. The trouble encountered when this procedure was first contemplated was mostly ethical. Is it acceptable to perform a face transplant? The face, it was argued, was not essential for life in the same sense as a heart, liver or kidney. Wouldn’t these patients be risking their lives for something that came down to simple human vanity?
These questions were not difficult to answer by any plastic surgeon that has treated these poor souls who suffered a catastrophic loss of the facial tissues. Although these tissues together form our external appearance and provide our unique social identities, they also perform vital functions such as protection of our eyesight, oral competence, and airway protection. It is difficult to understand the impact on someone’s life when all of these functions are lost. Despite our best reconstructive efforts, these massive defects are not satisfactorily repaired since the specialized tissues needed do not exist on other parts of the body. The only options for these people involve looking to human donors for these special tissues.
It is not hard to imagine the reluctance of the general public to a procedure of this type. There was real concern that the pool of organ donors may shrink, as someone may be afraid that they would be signing up for something more personal than donating just an organ after death. This could impact our already short supply of needed organ donations. Certainly an individual may take pause at the prospect of someone else living with their face. Would the recipient look like the donor? Images of Hollywood movies such as “Face/off” come to mind. As our appearance is due to many more factors than just the soft tissues of our faces, at this point it seems likely that there is little to no chance of the recipient looking like the donor.
It was very generous of Mr. Wiens to share his experience with the world. We were all able to see his result and hear the story in his own words. Although the face transplant procedure is still in its early stages and still in many ways experimental, the experiences of individual patients such as Mr. Wiens are essential in evaluating its impact on the treatment of the catastrophic loss of the face and its functions.