Boston Surgeons Authorized To Perform Face Transplants

A surgical team at Brigham and Women’s Hospital in Boston recently received permission to perform partial face transplants on qualified disfigured patients, the Boston Globe reported late last month.

The procedure has faced ethical complications due to the necessary use of immunosuppressants, or anti-rejection drugs, to prevent the patient’s immune system from rejecting the donor tissue. These toxic drugs expose patients to infection and increase the risk of cancer, prompting many to quesiton whether it is right to subject patients to such risks for a non-lifesaving procedure.

Brigham and Women’s has overcome this obstacle by only permitting the operation to be performed on patients that are already on the immunosuppressant drugs.

John H. Barker, a surgeon at the University of Louisville, said he believes that the approach taken by Brigham and Women’s will be worth the risk to those that are able to receive the transplants.

Barker has been conducting research on non-life saving transplants, such as those for the hand or face, since 1994. He said all of his analysis has led him to believe that the benefits of a face transplant for the facially disfigured outweigh the negative aspects, regardless of whether or not the patient is already on the immunosuppressant drugs.

Surveying over 350 people—ranging from plastic surgeons to facially disfigured patients—Barker said that his research has determined that most people are in favor of the procedures, despite their high-risk nature.

“They feel that the quality of their life is so much less for having terrible facial disfigurement that they would risk a lot,” he said.

Bohdan Pomahac, the associate director of Brigham and Women’s burn unit and the head of the hospital’s face transplant program, told the Globe that he has performed dozens of facial surgeries using skin grafted from elsewhere on the patient’s body, leaving the patient still looking disfigured.

Pomahac did not respond to repeated requests for comment from The Crimson.

Patients looking to qualify for the procedure would undergo extensive medical and psychiatric screening, including an evaluation by a psychiatrist from Massachusetts General Hospital. The psychiatrist would not be affiliated with the Brigham program and who would act on the behalf of the patient. Barker believes that another potential problem with the procedures is finding people who are both on immunosuppressants and are in need of a facial transplant.

Pomahac told the Globe that he has seen four people over the past several years who could potentially qualify and that over the next several months, he will be meeting with doctors from around the state who may have qualified patients.

With clearance from the hospital and the search for patients underway, donors must also be found, since Massachusetts residents who sign up as organ donors on their driver’s license will not be automatically considered face donors. While donor and recipient must have the same blood type, a face transplant requires their race, gender and general age to also match in order to create as natural a look as possible for the patient.

Despite all of the potential complications, however, Barker said he still fully supports the hospital’s plans.

“The concept is good,” he said. “The idea is good.”

—Staff writer Beryl C.D. Lipton can be reached at blipton@fas.harvard.edu.