http://news.bbc.co.uk/2/hi/uk_news/magazine/4263508.stm Last Updated: Tuesday, 20 September 2005, 11:09 GMT 12:09 UK E-mail this to a friend Printable version Trading faces By Jonathan Duffy BBC News Magazine Not for the first time surgeons are planning to perform the world's first face transplant. The expertise already exists but in the past doctors have shied away, fearing the emotional consequences of this medical taboo. It took about four years for Denis Chatelier, the world's first double hand transplant patient, to accept the foreign appendages that had been grafted on to the stumps where his hands used to be. The defining moment, he explained in a newspaper interview in the spring, came about a year ago when, "without realising it, I stopped calling them 'the hands' and started calling them 'my hands'." The Frenchman's anecdote alludes to the psychological cliff face the recipient of the world's first face transplant would have to scale. For, as James Partridge, whose face was severely disfigured by burns from a car accident, says "when you look at your hand, you say 'that's mine', whereas the thing about the face is that when you look in the mirror you say 'that's me'." Previous efforts From the moment primitive man fashioned his first mask, the issues of taking on someone else's identity have been a source of fascination. And while doctors have grappled with the technicalities of face transplants, crime writers have toyed with its fanciful implications. The period of adjustment can be long and hard - it took four to five years in my case Dr James Partridge The advent of the face transplant has loomed ever closer. In the 1990s doctors in India replanted the skin of a nine-year-old girl who had lost her face and scalp in a threshing machine accident. There have been partial "face transplants", which actually amount to elaborate skin grafts, and last year doctors in Kentucky signalled their intention to perform such an operation - but are still awaiting permission from an ethics panel. Doctors in Cleveland, Ohio, have already overcome that hurdle and are about to start screening 12 severely disfigured patients for the first face transplant. Although the medical world is divided about whether such a procedure is technically possible, rarely has a surgical procedure thrown up such a welter of psychological issues for potential patients and their loved ones. Traumas magnified Doctors already know patients who receive a transplanted organ, such as a kidney, face all sorts of possible emotional traumas, such as: * fears about whether the organ will work * fear for the effects if it doesn't * doubts about the effects of the strong drugs that help the body accept the new organ * worries about being personally responsible if the organ fails * anxieties about how the new organ melds with the existing body image * feelings of gratitude and guilt towards the donor and the donor's family A report by Britain's top surgeons two years ago suggested that these issues "may be magnified" in the case of a face transplant. Clint Hallam eventually asked for his new hand to be removed The case of Clint Hallam, who received the world's first hand transplant, looms large. Mr Hallam eventually asked for the hand to be removed. Doctors said he had skimped on his anti-rejection drugs - a charge Mr Hallam denied. The experience highlights the need for careful patient selection. But with the face so deeply integral to one's personality, experts see an inherent paradox - those most unhappy with their disfigured features, and therefore most likely to want a new face, will be most emotionally delicate. What then, if the transplant starts to go wrong? How will a psychologically vulnerable person cope with their new face sloughing off, especially if more surgery is then required to patch up the old, disfigured face? All of which raises the question of whether a patient is mentally fit to put themselves forward for such an operation. "If the people seeking this type of procedure are possibly the most vulnerable, how can they give informed consent?" wonders Dr Diana Harcourt, deputy director of the Centre for Appearance Research. Supporters of face transplants say patients will get post-operative counselling, which has proved fruitful when helping people accept their disfigured face after an accident. SOCIETY'S REACTION Society's reaction could further traumatise a transplant patient There will be invasive media interest Despite anonymity, the press will likely track down the first face transplant patient Another issue is the belief a patient would take on the appearance of the dead face donor. "Because of the patient's underlying bone structure and eyes what you will really create is a third face," says Dr Alex Clarke, a clinical psychologist in London, and a supporter of face transplants. Dr Clarke says the term "face transplant" perhaps over-eggs the procedure, which actually is "moving just a little bit further than the plastic reconstructive surgery" that is common for many burns victims. Nevertheless, she agrees the "identity issue is the big one" and favours the more cautious pace of British medics compared to Americans. 'Face race' To emphasise the point Dr James Partridge cites the case of Donald "Dax" Cowart, an American who changed his name after suffering severe facial disfigurement in an explosion. Dr Partridge, who runs the Changing Faces charity which helps facially disfigured people, thinks another 10 years' research is needed into transplants to iron out the emotional issues. He is scornful of the "face race" to be the first to perform a transplant, and believes strongly that counselling can be "massively effective" in helping people accept a disfigurement, as it was to him. "The period of adjustment can be long and hard. It took four to five years in my case to come to terms with my new face, but now I like it and I wouldn't change it." ********** Face transplants yes, the secret of eternal youth. Then brain transplants starting with george bush,and all the retards who voted him in, it takes 4 or 5 years for the recipient to get used to the transplant, thats about the time, for one presedential term, go for it george, but my guess he has already had one, hence the reason the last 5 years, of his office, have been a disaster.
