Doctors now back face transplants

Isabelle Dinoire had a partial face transplant in 2005

Leading doctors have given cautious backing to face transplants.

Three years ago the Royal College of Surgeons (RCS) advised against the procedure, saying the physical and psychological risks were unknown.

Since then, a Frenchwoman has received a partial face transplant and a UK surgeon has been given the go-ahead for full face transplants.

But the RCS has set down 15 conditions which it said had to be met before a transplant took place.

See how the transplant process works

Rejection

The RCS decided to revisit the issue because of these developments, and because of evidence from hand transplants which provide information on both the risks of rejection and the psychological impact of a transplant.

The substantial report by a working party headed by Professor Sir Peter Morris, a former president of the college, examines the medical, psychological and social issues involved in considering whether or not to go ahead with a face transplant.

It says the potential recipient needs to be fully informed about the experimental nature of the procedure, the need to take immunotherapy drugs for life - and the risk the transplant will be rejected.

The report adds that evidence from other types of tissue graft suggests that between 30 to 50% of face transplants might be rejected.

We've always said the bar should be set high Peter Butler, UK face surgeon

The RCS also calls for the recipient, their family and that of the donor to be fully counselled about the psychological impact of the procedure, and about the media attention which will come with their involvement.

The report concludes: "Rather than continue to maintain that there should be a prohibition on facial transplantation without more research, we now accept its inevitability."

But it does set out 15 minimum recommendations, also covering the technical skills required and the medical support needed, which should be met before hospital ethics committees gave the go-ahead.

It adds: "If it can be demonstrated to the satisfaction of an appropriately constituted independent review committee that these minimum requirements can be met then, in our opinion, a committee might reasonably take the view that individual patients may proceed with facial transplantation in an appropriately regulated research setting."

'Way forward'

Last November Isabelle Dinoire from France became the first person to receive a partial face transplant.

Rather than continue to maintain that there should be a prohibition on facial transplantation without more research, we now accept its inevitability Royal College of Surgeons report

She had her nose, lips and chin torn off after being mauled by the family dog.

Her operation has been deemed a success, and she has appeared in public stating that she is happy with the results.

In October, surgeon Peter Butler who is based at London's Royal Free Hospital was given permission by the hospital's ethics committee to carry out a series of full face transplants.

No patients have yet been selected for the operation, although 30 people have approached the team.

He said: "We very much welcome this report. We suggested to the Royal College of Surgeons that guidelines were the way forward - and we're pleased they've taken our recommendations on board.

"We've always said the bar should be set high - and especially for the initial transplant because if it's not done in the right way, the undertaking would damage not only the patient but also the whole process.

"Since we were given permission by the ethics committee, we have been setting up the infrastructure to assess the patients - but we are going to progress extremely slowly."

James Partridge, chief executive of the Changing Faces charity, welcomed the RCS report: "By recommending 15 minimum requirements to protect patients throughout the procedure and in the long-term, whether it is successful or fails, the Royal College has rightly made the well-being of the patient its primary concern."

FACE TRANSPLANT

Step 1: Skin and muscle tissue, eight different blood vessels, four arteries and four veins cut away from donor's face
Step 2: Blood vessels and nerves from face section connected to recipient using microvascular surgery

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