Partial face transplant at Brigham is second in US

Surgeons on Thursday transplanted the donor's nose, hard palate, upper lip, facial skin, muscles of facial animation, and the nerves that provide power and sensation, to the recipient. The surgery took 17 hours. The tissue graft from the face used in the surgery was obtained through the New England Organ Bank after conversations with the donor's family.

"Advances in transplantation only happen when there are individuals and families who can see past their own tragic circumstances and agree to donation," said Kevin O'Connor, a senior vice president of the organ bank, in an earlier press release. "A gift such as this holds the promise of health and hope for a patient in need and it was New England Organ Bank's honor to work with such a remarkable donor family.”

The hospital had announced plans to perform the procedure in 2007. But the first face transplant in the US was performed in December at the Cleveland Clinic, where surgeons replaced 80 percent of a woman's face in a 22-hour operation.

Five other face transplants have been reported worldwide, four in France and one in China. A French woman who had been mauled by her dog was the first recipient, in 2005.

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 originally planned to offer face transplants only to people who were already taking 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 anti-rejection drugs that make them more vulnerable to infections and cancer.

But last 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 in an interview with the Globe in December: The first transplant recipient's function and sensation have been encouraging; and immune-suppressing drugs have been less problematic than thought. 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.