Human facial transplant ok’d by review board

CLEVELAND – The Cleveland Clinic says it is the first institution to receive review board approval of human facial transplant for someone severely disfigured by burns or disease.

Several independent medical teams around the world also are pursuing the procedure. The Cleveland Clinic said its approval on Oct. 15 followed 10 months of debate on medical, ethical and psychological issues.

It has no current patients or donors for the procedure.

“We are at this point ready to begin screening patients,” said Dr. Maria Siemionow, the hospital’s director of plastic surgery research and training in microscopic surgery, who advocated the procedure.

Doctors at the clinic said finding an appropriate donor cadaver for the facial skin and underlying tissue might be more difficult than choosing a patient, which could take up to two years.

“It may not happen in our life, or it may happen sooner than you expect,” Siemionow said.

She said she will tell patients there is as much as a 50 percent chance of failure because of tissue rejection or other complications.

A central question in debate over the procedure has been whether patients should be subjected to risks of transplant failure and life-threatening complications from anti-rejection drugs for an operation that is not lifesaving.

Siemionow said she wants to start with a relatively simple procedure that would involve transplanting only the skin and underlying fat. The patient’s own muscles shape the face, so the patient would not take on the appearance of the donor, she said.

Current facial reconstructive surgery uses skin grafts and flaps — tissue containing blood vessels — from other parts of a patient’s body. The result “following major trauma, burns and tumor resections has been, at best, mediocre,” Dr. Graham Lister, a retired professor of plastic surgery and a mentor of Siemionow’s, wrote on her behalf to the clinic review board.