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Third face transplant at Brigham

Procedure smooth for Indiana man

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By Liz Kowalczyk
Globe Staff / April 27, 2011

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Only a week or so ago, Mitch Hunter received a new face at Brigham and Women’s Hospital in a 14-hour operation requiring a 30-person team. The Indiana man is just the fourth face transplant recipient in the United States, but he is already out of the hospital, recovering in a nearby apartment.

While the delicate procedure is hardly routine, Hunter’s relatively quick discharge is a testament to the Brigham face transplant team’s growing comfort with an operation that not long ago was as groundbreaking as it was controversial.

“He’s done very well; he’s had no problems,’’ Dr. Bohdan Pomahac, the lead surgeon, said in an interview yesterday after the hospital announced the face transplant — its third in two years.

Like Dallas Wiens, a 25-year-old from Texas who had a full face transplant at the Brigham last month, Hunter will live in the Boston area for two to three months so doctors can monitor his body’s reaction to the donor tissue. Wiens was also in the hospital for less than two weeks.

Hunter, 30, lost much of his face after a car accident in North Carolina in 2001. When the car he was riding in hit a telephone pole, Hunter bolted from the vehicle and either stepped on or grabbed a fallen power line — he doesn’t remember exactly what happened, his family said — sending thousands of volts of electricity surging through his body to his face. He suffered horrible burns and lost his nose, lips, and skin on his face, as well as his left leg below the knee.

Since then, he has undergone more than 40 reconstructive surgeries with limited success, said Morgan Hunter, a younger sister. Doctors hadn’t been able to replace his nose, so he wore a prosthesis. He drooled because he lacked lips. And the skin grafted onto his face looked out of place.

While an aunt in Texas often mailed Mitch Hunter newspaper articles about a new operation that was first done in France six years ago and then in China, the United States, and Spain, he did not become seriously interested in face transplant surgery until last spring, shortly after his girlfriend gave birth to their son.

“Children would look at him, not knowing what to make of it — that was the hardest part for him,’’ his sister said in an interview. “He wanted to have the surgery before his son knew that he looks different from other people.’’

Hunter traveled to the Brigham last October and then again in December for an evaluation to be placed on the waiting list for a transplant, his sister said. Sometime in the past week or so, the family of a young man who died agreed to donate his face, after discussions about the procedure with Esther Charves, family services coordinator for the New England Organ Bank.

Brigham officials would not disclose the exact date of Hunter’s surgery, which they said would help protect the identity of the donor, whose family wants to remain anonymous.

“We are very proud that our beloved son’s wishes were to donate his organs and tissue, helping as many people as possible,’’ the family said in a statement. “We are honored to respect his wishes. When we heard that there was a match for his facial tissue, we were overwhelmed and did not hesitate to say yes. We are so very happy that the transplant is progressing well. It is a gift to us to know that another young man’s life could be so positively changed because of our son’s giving spirit.’’

The Brigham team used the donation to replace Hunter’s “full facial area,’’ including his “nose, eyelids, lips, muscles of facial animation and the nerves that power them and provide sensation,’’ the hospital said in a statement.

“He is a young guy. He felt very, very deformed, which he was,’’ Pomahac said.

Pomahac said that he wants Wiens and Hunter to remain in the area for two to three months in case their immune systems start to attack the donor tissue. Transplant patients take antirejection drugs to prevent it, but episodes of rejection often occur in the first three months.

Wiens also suffered an electrical burn; he was painting a church when the cherry picker he was in touched a power line.

The hospital’s first face transplant patient, James Maki, received a partial transplant two years ago, four years after he fell onto an electrified third rail in the Boston subway. He was in the hospital for about two weeks, was discharged for a day, and then returned for another two to three weeks, in part because his body was starting to reject the donor tissue. Doctors successfully treated the problem.

Registering as an organ and tissue donor on a driver’s license is not accepted as consent for face donation; family consent is required.

Charves said organ bank staff underwent special training to talk to families about donating facial tissue, which can be more difficult emotionally than donating other organs because “when you think about someone you lost who you love, you see their face. You remember their smile and how they looked when they said certain things.’’

One family said no, because they wanted to have a traditional open-casket funeral. Another family was concerned that the recipient would look like their loved one, Charves said. She said she explained that “everyone has different bone structure. [The recipient] will look like a better version of themselves.’’

She said staffers learn to be “very, very sensitive. . . . This is a human being who has lost their life and they have a family who is grieving.’’

While confidentiality rules prohibit her from discussing details of the family’s decision in the most recent face transplant, she said they authorized the donation because “they knew their son was a good, kind human being and helped everyone. This was just another way to do it.’’

Liz Kowalczyk can be reached at kowalczyk@globe.com.

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