Surgeons at Harvard-affiliated Brigham and Women’s Hospital toiled in twin operating rooms Thursday (April 9), becoming just the second U.S. team to perform facial transplant surgery.
The 17-hour operation, conducted on a patient who wishes to remain anonymous, involved replacing the entire mid-face area, including the skin, the muscles and nerves that allow it to move and feel, the nose, hard palate, and upper lip.
Surgeons declined to reveal details that might identify either the recipient or donor, but said the patient had suffered an injury that resulted in the loss of the bony structures in the mid-face, including the nose and hard palate.
Though the patient’s condition was not life-threatening, Bohdan Pomahac, the Brigham plastic surgeon who led the surgical team and an assistant professor of surgery at Harvard Medical School, said the patient’s injury had affected his ability to eat and drink and the quality of his social interactions.
“It is really difficult to live without a major part of your face,” Pomahac said during a news conference at the hospital Friday afternoon. “This is not lifesaving, but it is a life-giving procedure.”
The operation was just the second of its kind to be conducted in the United States and among just a handful worldwide. The first partial face transplant was conducted by French surgeons in 2005 on a woman who had been mauled by a dog. Since then, similar procedures have been performed in France, China and — in December 2008 — at the Cleveland Clinic in Ohio.
Leaders of the Brigham team traveled to France in preparation for the surgery and interviewed the recipient from that first 2005 case, Isabelle Dinoire. Pomahac said Dinoire told them she at first referred to the transplant as “the face,” but as it healed and she began to feel sensations, she started to think of it as her own. Even with that initial feeling of alienation, Dinoire said she never regretted the operation.
The Brigham has had a pioneering role in the history of transplantation. The first-ever organ transplant was performed there in 1954 when Joseph Murray, today a professor of surgery emeritus at Harvard Medical School, transplanted a kidney from one brother to another. Murray won the 1990 Nobel Prize in medicine for his work on organ transplantation. In 2006 alone, more than 100 kidney transplants and 30 lung transplants were performed at the hospital.
“Today we have taken another step in improving the lives of our patients with this partial face transplant,” said Elof Eriksson, chief of the hospital’s Division of Plastic Surgery and Joseph E. Murray Professor of Plastic and Reconstructive Surgery at Harvard Medical School.
The operation was conducted by a team of seven plastic surgeons and one ear, nose, and throat surgeon, as well as nurses, anesthesiologists, and residents. The first six hours of the operation were conducted in two operating rooms as doctors simultaneously removed the donor’s tissue and prepared the recipient to accept the transplant. From there, surgeons performed the painstaking process of connecting nerves, blood vessels, muscles, and other tissues to attach the donated tissue to the recipient. Because the underlying bone structure of individuals is different, recipients of such transplants do not look like the donor and about 60 percent look like their prior selves, Pomahac said.
During the Friday afternoon news conference, physicians involved with the operation thanked both the donor’s family and the recipient for being part of a pioneering procedure that can improve the lives of others in the future.
The donor’s family released a statement that indicated that the donor had been waiting to be an organ transplant recipient. Kevin O’Connor, senior vice president of the New England Organ Bank, declined to elaborate further on the family’s brief statement.
“To go from being a recipient family to a donor family so suddenly has given us the opportunity to fully understand the power of organ transplantation to give and transform lives,” the statement said. “The fact that we were able to give this gift was a tremendous comfort in our time of grief. Our greatest hope is that this encourages others to become donors and also have the opportunity to give this remarkable gift of life.”
By the time of the news conference, the recipient was still recovering from the surgery and hadn’t yet seen the transplant. Pomahac said the surgery obligates the recipient to a lifetime on anti-rejection drugs to keep his body from rejecting the grafted tissue as foreign. He will undergo both physical and psychological therapy as he heals. With the first such surgery only in 2005, questions about the long-term prognosis for the transplant remain unanswered.