Waiting for a new face: The transplants giving people back their lives

Willie Grace | 8/7/2014, noon | Updated on 8/6/2014, 10:49 p.m.
Last month the United Network of Organ Sharing (UNOS), a non-profit organization managing the U.S. organ transplant system, approved the ...
Richard Norris. left, in high school in 1993; center, after suffering a gunshot injury; right, after face transplant surgery.

"These types of patients have such disfigurement beforehand they can't eat, they can't breathe properly. It's about functionality," says Dr. Richard Luskin, CEO of the New England Organ Bank.

Luskin is referring to the small group of people worldwide who are on waiting lists in hope of a new face, and in the United States at least, they may now have one donated to them more readily.

Last month the United Network of Organ Sharing (UNOS), a non-profit organization managing the U.S. organ transplant system, approved the first national policies for the transplantation of limbs, faces and other structures collectively known as "vascularized composite allografts" (VCAs) -- which should make it easier to find donors.

As of April 2014, there had been 28 face transplants across the world. Animal attacks, severe burns and gunshot wounds had left these recipients scarred for life, literally, in the one place their scars cannot be hidden -- their face.

"Anyone with this disfigurement would argue they're not living, they're surviving," says Luskin.

A growing field

The first face transplant was performed in France in 2005 on Isabelle Dinoire, whose mouth, nose and chin had been chewed away by her dog. Since then the field has grown and transplants involving varying combinations of facial parts have been performed in six other countries, including the United States.

As the procedures improve and their safety grows, donor registries and collaborating hospitals will increasingly be asking the question: Would you like to donate your face? Or in the case of the UNOS approval, asking family members of potential donors the sensitive question of whether they will donate the face of their loved one.

The UNOS approval will initially be in place temporarily for 15 months to enable public comment, but families of donors will receive extra guidance when it comes to making the decision. "Face transplants remain unique and require very specific criteria such as hairlines and ethnic components," explains a UNOS spokesperson. "Therefore consent should be distinct and individual."

"(This) will broaden the donor pool for wait-listed patients across a number of regional and national organ procurement organizations," explains Dr. Eduardo Rodriguez, professor of reconstructive plastic surgery at NYU Langone Medical Center. "A major component for a successful procedure is patient selection on both the recipient and donor," he adds. "The likeliness of a perfect match can be very challenging."

But this once-experimental procedure is becoming more widespread and accepted. Richard Norris, from Virginia, received a new face in March 2012 and last month his face was featured on the cover of the U.S. edition of men's magazine GQ. Norris lost most of his facial features after a gun blast, and lost abilities such as his sense of smell. But after surgery at the hands of Rodriguez and his team he can live his life once again.

Risk of rejection

However, as this mode of surgery becomes a norm, the side effects and risks that come with the life-changing operation are still a concern and a question of ethics.