French surgeons have performed the world’s first face transplant, a development which has provoked mixed reactions amongst their colleagues and bioethicists. The patient is a 38-year-old woman, Isabelle Dinoire, who lost her lips, chin and part of her nose when she was savaged by her own dog.

Because of the dangers of transplant failure and psychological damage, doctors have been reluctant to perform this sort of operation, although a number of medical centres around the world have plans to do so. Unlike the heroes of Hollywood’s saga of face transplant surgery, Face/Off, patients will probably end up with faces which are unlike their own or their donor’s.

American surgeons were upset on several counts. First, the operation involved not one but two novel procedures: transplanting facial tissue and transplanting bone marrow stem cells from the donor to prevent rejection. Now, they say, if the experiment fails, it will be difficult to determine which technique was responsible. Second, the French doctors made no attempt to reconstruct the patient’s face using conventional techniques — although the French team said that this was impossible in this woman’s case.

Third, the woman may not be emotionally stable. The London Times claimed that she had been unconscious after a suicide attempt when the dog attacked her, a detail denied by her doctors. Another factor is that the donor had committed suicide. American surgeons say that they would only perform such an operation on a person who is psychologically very resilient. Finally, the woman’s name has been leaked to the media, which has already published before and after photos. Psychologically, this could be quite destabilising for the patient.

"We want for this to go well," Dr Maria Siemionow, of the Cleveland Clinic, told the New York Times. "But if it does, then I am afraid everyone will forget that the ethics were not proper here. And if it does not, then they will be blaming the transplant procedure, but not the ethics behind it."

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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