Faces. for two to four weeks and

Faces. They’re a vital part of everyday life. It’s the first thing one sees when they meet someone; it’s how people are remembered; it’s one’s identity. What would happen if that identity was suddenly shattered, if your face no longer looked like a normal face? Unfortunately, several people are able to answer this question because their face has been damaged in some type of tragic accident. There is a solution, a solution with many risks, but still a solution: face transplants. Several face transplants have previously been performed; however, there is still the question of whether or not they are ethical, which will be explored in this paper.  A face transplant is a surgical procedure in which a part or all of one’s face is replaced with facial tissue from a cadaver (Highfield). This procedure is a very extensive one with many risks and is only meant for those who have had great facial disfigurement, such as burns, diseases, or birth defects, according to Mayo Clinic (Mayo). The first step to getting a face transplant is to pass the immense and detailed tests in place for those who get transplants (Mayo). Unlike most organ transplants; however, this one will be seen by the whole world so getting a similar skin tone is pertinent in addition to finding a donor with the same blood type and similar tissue type (Mayo). Once a donor is found, then the intricate surgery can be performed (Highfield). There are two teams that will perform intricate microsurgery in which they transfer muscle, lips, ear, nose, and skin from the dead donor to the transplant recipient, all while the donor is kept on a heart and lung machine (Highfield). The second team will be preparing the recipient to receive the new tissue by cutting away all of the damaged skin and muscle (Highfield). After this, both teams work together to complete the face transplant. They begin by connecting the veins and arteries to provide blood flow to the tissues (Highfield). The surgeons then continue to use microscopic needles to reconnect the nerves. Lastly, the skin will be “draped over the defect, tailored and sewn (Highfield).”Once the surgery is successfully completed, there is still a long path to recovery and many risks and complications that can still occur. Once completed, the patient is expected to stay in the hospital for two to four weeks and remain nearby for several months (Mayo). In order to try to prevent infections and rejection of the new face, recipients must take immunosuppressive drugs for the rest of their lives (Highfield). These drugs put the patient at a higher risk of getting cancer, heart disease, and several other health problems (Mayo). In addition to physical risks, there are also the psychological risks (Highfield). Patients, as well as their families, have to succumb to the fact that they will never be able to look like they did before their accident (if an accident is the reason they received the transplant) (Highfield). However, if the surgery is successful, the patient will also be able to improve their “ability to smell, eat, drink, talk, smile and make other facial expressions… and regain the ability to feel a light touch on the face (Mayo).” So far, all of the patients have been able to regain some movement and feeling in their face (Kean). Many surgeons hope that families of possible donors, as well as some potential recipients, will overcome the taboos associated with donating one’s facial tissue (Coghlan). A common misconception about face transplants is that the recipient will end up resembling the dead donor (Coghlan). However, Laurent Lantieri, head of the team that performed the third face transplant in France, says that they are not transferring faces but rather “reconstructing patients’ faces with spare tissue (Coghlan).” Surgeons will not replace the parts of the recipient’s face that remain undamaged, but rather only the parts that have been damaged or morphed in some way (Coghlan). The recipient will neither look like his/her old self nor will they look like the donor, but rather a mix of the two, creating a new person, disproving the most common false assumption (Coghlan). The world’s first partial face transplant was performed on Isabelle Dinoire in France in 2005 (Lanchin). Dinoire had taken several sleeping pills before waking up to reveal that her dog had chewed off a massive part of her face (Sviti). She was rushed to the hospital; however, the damage was too extensive for normal surgical repair (Lanchin). Only months later, a transplant team performed the world’s first partial face transplant in which they attached the nose, chin, cheeks, and lips of a 46-year-old donor (See Figure 1) (Bromwich). At the time there was only a 33% success chance (Sviti). Dinoire was able to regain extensive movement in her face and grow her quality of life, which she previously didn’t have (Lanchin). Unfortunately, Dinoire died in 2016, eleven years after her life-changing surgery, as a result of a malignant tumor that recurred which was “scientifically linked to immunosuppressive therapy (Bromwich).”The first full face transplant performed in the United States was performed on Dallas Wiens in 2011 (Warren). In 2008, Wiens’ face came in contact with a high-voltage power line, severely injuring his eyes, nose, upper lip, and most of his hair (Warren). The damage was so extensive that doctors didn’t know if he would survive the accident, and spent 36 hours trying to save his life (The Associated Press). After two days, the doctors then decided to put him into a medically-induced coma for three months (The Associated Press). They said that he would be paralyzed from the neck down, never speak again, and never be able to eat solid food; however, he had a shocking recovery, walking within the year (The Associated Press). He was referred to as a “man without a face (Warren)” for years until he received the first full face transplant (Figure 2). Although he will never regain his eyesight, he is now able to smell and has regained feeling in his face, something that he says is an indescribable feeling (Warren). Since 2005 when the first partial face transplant was performed, there have been many medical advances. From partial face transplant to full transplant and most recently to a double-transplant. In January 2018, just twelve years after they performed the first partial face transplant on Isabelle Dinoire, France has also performed the first ever double-face transplant surgery (Gohd). The Frenchman who received the transplant, rejected the first transplant he had, and has now undergone another surgery, with hopes that he will not reject this one (Gohd). Because it is so recent, it will be weeks more until the surgeons determine if the surgery was a success or not (Gohd). According to a statement by France’s biomedical agency and the National Hospital Service, “This graft shows for the first time…that re-transplantation is possible in the case of chronic rejection (Gohd),” a massive medical discovery. Face transplants, although risky, have proven more beneficial than detrimental. In addition to improving the patient’s quality of life, they also improve the patient’s physical facial abilities, including sense of smell, sight, and talking (Sviti). The patients previously discussed, Isabelle Dinoire and Dallas Wiens, in addition to several others have expressed their gratitude towards the surgeons who performed their face transplants and say that this surgery improved their lives significantly. Dallas Wiens has gone out and given many speeches, most famously saying, “There is life after tragedy (The Associated Press).” Although Isabelle Dinoire said that the most difficult part of the surgery was trying to find herself afterward and learn her identity, she said that she then saw both herself and her donor in the mirror each morning. After her she saw herself in the mirror for the first time after the surgery, she said that “she knew it was a victory…It was fantastic,” and the only thing she could tell the doctors, by writing it down, was “Merci (Lanchin).” Before she died, she also said that before the surgery she was conscious of going out because people would stare at her, but after the surgery, she would go out and not bother about people staring at her because her facial trauma was so minute. Another recipient in the U.S., Andy Sandness (Figure 3), said: “When you look like I looked and you functioned like I functioned, every little bit of hope that you have, you just jump on it (Associated Press).” Many more patients have said similar things to that of Wiens, Dinoire, and Sandness, with only positive things to say about the surgery, opposed to what many critics say.There is much controversy over whether or not face transplants should be allowed. Many falsely believe that the recipient will look like the dead donor; however, the recipient doesn’t receive the full face of the donor, only the part’s in which the recipient’s have been damaged (Coghlan). In addition to taboos, there are also many risks that come along with face transplants, including immunosuppressive drugs that have to be taken for the rest of one’s life, resulting in a higher risk for many possible health conditions (Mayo). There have been many medical breakthroughs when it comes to face transplants. In 2005, the first partial face transplant was performed; several years later, the first full face transplant was performed; now, January 2018, just twelve years after the first face transplant was performed, a double-face transplant has been performed. The consensus from many different face transplant recipients’ testimonies is that although it is hard to find themselves again, the surgery is a very beneficial one that increases their quality of life immensely.


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