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Maddy Larson
11 July 2015
Cluster Seven Cameo
Derek Dockter
The Process of Face Transplants
In the last century surgeons have discovered new techniques to ensure that their patients
are provided with the best treatment available. In the last decades, for example, surgery
has evolved from transplanting organs to transplanting faces. The journey from
preoperative preparation to postoperative monitoring is a very long journey for both the
patient and the staff involved and unfortunately this process will end up taking a toll on
the patient’s bank account However regardless of the cost and risks, facial transplants
ultimately gives patients exceptional results and allows them to live life normally
Facial transplantations are a complex operation that takes many doctors as well as a lot of
planning. The entire process can take approximately two years because of the extensive planning
which includes finding a suitable donor, preoperative work, the 36 hour operation, and the
postoperative monitoring. There are only a few doctors in the world who can successfully execute
this operation but with each operation these doctors are able to give patients not only their
confidence back but their lives back as well.
Finding a Donor
The first, and most important, step of the entire face transplant operation is finding a suitable
donor. It is important that the donor is alive, on life support, so that there is a continual amount
of oxygen rich blood being circulated so that the tissue will stay viable. Because the donor is on
life support doctors need to make sure that there is no chance that the organ donor could ever be
revived (Watson 5). They need to be brain dead in order to donate the face. Family members of
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the organ donor are often the ones who give consent to donate the face to a patient. However,
even if the family does consent, doctors run into another obstacle. Is the donor a match? In order
to answer this question doctors do an HLA test where they match up the antigen patterns. The
closer the antigen patterns, the less likely there will be a rejection (Fyle 479). A rejection occurs
when white blood cells attack the foreign tissue, it’s often a major problem as a patient could
possibly end up in the same position they started with (Watson 5).
Pre-operative Preparation
Once a suitable donor is found the recipient receives an infusion of “bone marrow stem cells
to prepare the immune system” (Watson 3). Infection and rejection can be common in organ
donation patients and so it is important to infuse marrow stem cells so that they can “lodge and
start to grow in the marrow cavity” (Flye 481). The increased bone marrow allows a stronger
immune system to fight off an infection that could possibly disrupt or ruin the transplantation
process. Meanwhile the donor is getting their face surgically removed. Depending on how much
damage the recipients face has, the surgeons are able to do either a partial or full facial
transplant. Surgeons are also able to remove skin, fat, muscle, cartilage, bones, nerves, arteries
and veins based upon how serious the injury of the recipient is (Watson 5). After the donor’s face
removal, surgeons put the face in an ice cooler and transport it to the designated hospital. There
are “three ways of preserving organs” but for facial transplants they use the hypothermic method
because “skin and muscle can be preserved simply by cold storage and can last up to 14 days”
(Flye 211). “Skin is prepared for cold storage and is immersed in the cryoprotectant agent at four
degrees Celsius” (Flye 211). When it arrives at the hospital doctors are able to prep the operating
room and begin the 36 hour operation.
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Doctors Needed
The 36 hour operation is exhausting for each surgeon, nurse, and staff who is working on this
case. It takes approximately 150 nurses, surgeons, and staff members in order to successfully do
the operation. It takes a neurosurgeons to reattached nerves. It takes a vascular surgeon to suture
veins and arteries back together. It could even take an orthopedic surgeons if there are bones to
be transplanted. Face transplants are a team effort and they would not work if a doctor was
working alone.
The Operation
During the operation, doctors start by removing the damaged skin and muscle for the
recipient. It is important to remove damaged or rotting skin and muscle so that they can reduce
the risk of infection, which can be common in transplant recipients. “Surgeons will first connect
arteries and veins to the new tissue to supply it with blood,” however vascular surgeons do not
connect all of the arteries and veins just enough to keep the new tissue viable (Watson 5). Next a
new set of surgeons work on the patient, they connect nerves so that the patient can have
movement and feeling in their new face. With the nerve repair, surgeons are able to give the
patient 95% of their kinesthetic movement back. Some patients lacked the majority of their facial
movement prior to the surgery so the fact that surgeons can provide them with feeling and
movement is a huge medical breakthrough. After all the veins, arteries and nerves are reattached,
“surgeons drape the donors face over the skull of the recipient, adjust it, and then get it sutured
back together” by a plastic surgeon (Watson 5). Plastic surgeons can use specialized suture knots
to reduce the scarring. One of the most common sutures they use for minimal scarring are buried
subcuticular sutures (Lentz 1) Although this process might seem short when explained it is an
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extremely complex operation that takes up to 36 hours and cannot be completed without the help
of the “150 nurses and professional staff” (Curry 1).
Post-operative Healing and Rehabilitation
After the surgery is complete the facial transplantation patient moves along into the
postoperative phase. There are multiple things doctors must monitor to ensure that the patient
will make a complete recovery. Patients will end up staying in the hospital recovering for a
month or longer. Then they must go through a six to twelve month rehabilitation process at their
homes were they will continued to be checked on. Directly after surgery patients are sent to the
surgical intensive care unit (SICU). Upon their stay at the SICU nurses and doctors will check
the patients every hour to make sure that patients are resting. Doctors will monitor and observe
how the body is reacting to the new face, looking for signs of rejection. Meanwhile the patient is
pumped with immunosuppressive drugs. These drugs are often given to transplant patients in
order to stop their immune system from creating a response and attacking the new tissue in the
body. When white blood cells attack the new tissue it is called rejection (Curry 1). The patient
also starts physical therapy in order to give them the maximum amount of muscle movement and
facial expressions. A week later patients are moved to the normal hospital rooms. In the rooms
they continued to be monitored but not quite as much. The immune system will still be weak so
visitors are limited, but it is very important that a patient has a family member or friend for
his/her emotional support. In the hospital room physical therapy is still crucial and doctors make
it more challenging by showing patients a facial expression and then testing the patient’s ability
when they attempt to match the expression. Without movement in the new face early on it would
be even more difficult for the patient to relearn movements when they are further in the recovery
process. Patients will stay in the hospital rooms for about four weeks and then they are sent
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home. The time patients are sent home will vary “depending on the type of facial injury, the
patient’s health, how well the patient heals, consideration of any complications or unexpected
problems while recovering” (Hopkins medicine 1). Although the patient was discharged it is
important to note that the patient will have a very long journey to recover completely.
When a patient is discharged home it means that they have recovered enough to function
normally without as much monitoring. However, patients still have to do a rehabilitation process
for six hours a day for six to twelve months. This rehabilitation process included physical
therapy, psychological therapy, nutrition and immunosuppression drugs and although these
things are very beneficial to the patient’s health they are not so beneficial to the patient’s bank
account.
The Cost of the Operation
The entire facial transplant surgery can range anywhere from $346,000-$518,000. Depending
on the type of facial transplant the operation will cost approximately $330,000. After the surgery
patients will have to pay for their stay at the hospital along with physical therapy, therapy,
immunosuppressive drugs, a nutritionist, etc. The rehabilitation process can by itself be
approximately $100,000-$200,000 depending on how long the doctors keep the patient on the
immunosuppressive drugs which can range from $15,000-$20,000. If a patient is lucky then the
insurance should cover the majority of the cost; however if the patient has very little to no
insurance the patient could possibly go into debt because of this operation as it is not only
physically draining but financially draining as well.
Face Transplants are still new to the medical field and doctors are continuing to get a feel
for what works and what does not. This protocol may be change or altered depending on future
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cases or better methods. It may take months or even years to perfect this procedure. Although
there have been some successful stories it is not safe to say that this procedure does not come
with risks. It is important to realize that during medical breakthroughs doctors would rather
highlight what went right rather than what went wrong. So readers will often read about the
successful stories rather than the stories that resulted in rejection, failure, or death. Doctors,
however, should highlight failure, as well as success, because it makes it difficult to learn a
procedure without understanding what goes wrong as well. It’s important to have
acknowledgement about each scenario because unfortunately not everything is in physicians
hands; eventually the surgical team will have done everything they can do and it will be up to
the body on whether to accept or reject the new material.
Regardless of the bumps on the road, facial transplants have come a very long way in a very
short time. Despite the risks, facial transplants have allowed doctors to achieve their ultimate
goal by giving their patients not only a better quality of life but a cure to all of their struggles.
Doctors have pushed boundaries, taken risks, saved lives and made surgery an art, and that is
extraordinary.
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Work Cited
Curry, Ann. “University of Maryland Face Transplant Patient Shares Personal Story for First
Time.” University of Maryland Medical Center. N.p., n.d. Web. 11 July 2015.
“Face Transplants.” Johns Hopkins Medicine. N.p., n.d. Web. 11 July 2015
Fyle, Wayne M. "Organ Preservation." “Matching Antigens”. Principles of Organ Transplants.
St. Louis: Washington University School of Medicine, 1989. 211-419. Print
Lentz, M.D. "Suturing Techniques." Suturing Techniques for Less Scarring. N.p., n.d. Web. 11
July 2015.
Watson, Christine. “Face Transplant Risks and Controversies.” HowStuffWorks. N.p., n.d
Web. 11 July 2015