Brigham and Women's expands patients eligible for face transplant

A Boston hospital poised to offer face transplants has enlarged the pool of patients it would consider for the life-changing surgery, the doctor leading the program said today after the first face transplant in the nation was reported.

Dr. Bohdan Pomahac, a plastic surgeon at Brigham and Women's Hospital, welcomed today's announcement by the Cleveland Clinic that its surgeons had replaced 80 percent of a woman's face with the face of a deceased female donor, making it the fourth face transplant in the world.

"I think it's very exciting," Pomahac said in an interview. "I hope it's going to open the door for many more patients and allow us to help them."

Three years ago the world's first face transplant gave a new face to a French woman who had been mauled by her dog. Since then a Chinese man who had been attacked by a bear and a French man with a disfiguring genetic condition have had face transplants. Like other transplant recipients, they have to take drugs to suppress their immune systems in order to prevent rejection of donor tissue. But because face transplants aren't life-saving surgeries, debate has arisen on whether it is ethically acceptable to put these patients on such powerful drugs for the rest of their lives.

The Brigham said last year it would offer face transplants only to people who were already taking the anti-rejection drugs. That limited the candidates to people who had already received transplants, such as a kidney or pancreas. Some of those patients develop cancers of the face that can be disfiguring, a possible side effect of the drugs that makes them more vulnerable to infections and cancer.

But in May the hospital expanded its protocol to anyone whose deformity involves 25 percent of the face or all of a major facial part such as the entire lip or entire nose. Burns, trauma, or benign tumors are common causes of this kind of disfiguring problem.

There are two reasons for the change, Pomohac said. Three years after the first transplant, the patient's function and sensation have been encouraging. At the same time, immune-suppressing drugs have been less problematic. In more than 100 patients who had limb transplants, which are similar to face transplants because they also involve a combination of skin, fat, muscle, and bone, no cases of skin cancer or kidney failure have been reported, Pomohac said.

"I still believe that a previously immune-suppressed organ transplant patient would be the ideal candidate, but there are just too few of them," he said.

Potential face transplant patients are being interviewed, he said. The New England Organ Bank, the region's organ-procurement organization, approved the Brigham's program earlier this year.

"It is an entirely new hope for these patients," Pomahac said. "We don't quite understand how bad life is for them."