Brad Spurgeon

Less than a week after French doctors carried out the world’s first partial face transplant on 27 November, the patient - a 38 year old woman – ate, drank, and spoke normally. Professor Jean-Michel Dubernard, who led the transplant team, said that it would be at least six months before they knew how much feeling or motor control the patient would have eventually.

Doctors have been technically ready to do such surgery for some time but have held back for ethical reasons. Carine Camby, the director general of the agency of biomedicine, part of the health ministry that oversees organ donations, said that the patient passed the appropriate psychiatric examinations.

Professor Dubernard, who is a transplant surgeon at the Edouard-Herriott Hospital in Lyon, said that his reservations about doing the transplant evaporated when he saw the extent of the woman’s disfigurement, caused by her own dog biting her while she was unconscious. Tissue around the wound had contracted, making it difficult to eat, talk, and breathe, and reconstructive surgery would have required four or five operations with uncertain results.

"She even prefers her face now than before," Professor Dubernard told Agence France-Presse in an interview on 4 December, "Now that should put to rest all the ethical controversy."

In June a team at the Amiens University Hospital led by Bernard Devauchelle contacted France’s Biomedicine Agency about doing a partial face transplant. They also contacted Professor Dubernard in Lyon, who had done the first hand transplant in 1998 and the first double forearm transplant in 2000.

The French national consultative bioethics committee refused a request last year for a full face transplant for another patient but did not rule out the idea of a partial transplant as a last resort after conventional methods failed. It did not give permission for the latest operation because the surgeons did not seek it.

The Biomedicine Agency agreed to Professor Devauchelle’s request and in July the doctors also received the support of the Health Products Safety Agency. Although the donor, also a woman, had agreed to be a multiorgan donor, the doctors nevertheless contacted her family for permission for the face transplant.

The donor’s nose, lips and chin, including muscles, cartilage, skin, arteries, veins, and nerves, were removed in Lille and taken to Amiens, where eight surgeons and a team of nearly 50 people did the transplant. Two days later the patient was moved to Lyon to receive immunosuppressant treatment and an injection of stem cells from the donor’s bone marrow to help prevent tissue rejection.

Doctors said that visually the face was a hybrid of the donor’s and the patient’s, because the patient’s bone structure alters the appearance of the donor’s facial parts. "We had a very good surprise in terms of the colour of the skin," said Professor Devauchelle.

Last March, an ethical committee in Spain refused to approve a face transplant, citing concerns about the patient’s subsequent psychological identity. Finland is working on an official charter for such transplants.

Although the Royal College of Surgeons in England discouraged face transplants in a report in November 2003, the college said the French transplant did not raise issues related to the similarity of the face of the donor and recipient because only part of the face was transplanted.

Iain Hutchison, chief executive of Facial Surgery Research Foundation, however, voiced concerns about possible failure of the graft, stating "She could be back to square one without a face, needing further reconstruction operations".

Professor Dubernard said that his team planned at least five more face transplants and had applied to the French health ministry for research funding.

Details of the operation are available at www.chu-lyon.fr .