Lyon, France — A partial face transplant performed recently in France has generated a swirl of ethical and technical concerns, including questions about patient and donor privacy, doctors and ethicists tell Cosmetic Surgery Times.
In late November, a team of surgeons led by Dr. Bernard Devauchelle, M.D., Ph.D., F.R.C.S., head of maxillofacial surgery, CHU Amiens, transplanted the lips, chin and nose of a cadaver donor to a female patient. The woman had been mauled by her dog in May, according to Benoit Lengele, M.D., Ph.D, a member of the surgical team and professor of anatomy and reconstructive microsurgery at the Catholic University of Louvain in Brussels, Belgium.
According to reports, the French experiment one month post-surgery seemed successful, and elsewhere, teams in several countries were continuing preparations to move ahead with full face transplants. Surgeons in China and Britain had announced plans at press time to perform the procedure within one year if they find appropriate patients and donors, and U.S. surgeons in Cleveland and in Louisville, Ky., also were selecting candidates.
But despite the movement toward the more radical, full-face procedure, troubling issues remain, including the question of patient privacy, doctors and ethicists say.
At press time, France's National Council of the Order of Physicians had issued a statement criticizing what it called a "premature, uncontrolled release of information" about the Frenchwoman's case, adding that it put the "technical exploit ahead of respect for the patient (and) the donor" and that it broke the group's ethical codes, according to news reports.
Table 1: Portions of face are surgically transplanted
The Associated Press also reported that Carine Camby, director general of the French Biomedicine Agency, France's organ donation agency, said anonymity is critical in transplant cases and that she finds it "extremely shocking" and "absolutely scandalous" that the donor's name was published by some media outlets outside of France. Under French law, the donor and recipient cannot be fully identified by name.
However, some contend that the recipient herself sought publicity. Laurent Lantieri, M.D., head of plastic surgery and the face transplant project at CHU Henri Mondor Hospital, APHP, Creteil, France, says he is upset and disappointed, in part, because he says the patient has been paid for photos and has sold movie rights to her experience.
He says the procedure was premature, and because doctors didn't try conventional reconstruction first, the patient was treated as an emergency case "when there was no emergency."
Dr. Lengele disputes those claims. He says the patient was assessed by several experts in plastic, reconstructive and maxillofacial surgery, and her file was examined by national ethics authorities. He says all experts agreed that doctors could have tried conventional reconstruction, but it would have required at least four to five operations stretching over more than a year, and probably would have produced poor aesthetic and functional results.
"The patient is not making money from the photos," Dr. Lengele says. "Photos were given only to protect the patient because people were saying that we had put a male face on a female patient." He adds that doctors cautioned the patient about the likelihood of intense media scrutiny during the informed consent process.
Dr. Lantieri says he believes the procedure was imprudent because the patient reportedly attempted suicide through a sleeping pill overdose.
However, Dr. Lengele says the woman did not attempt suicide.