Ohio doctor seeks to perform world's first face transplant

CLEVELAND -- In the next few weeks, five men and seven women will secretly visit The Cleveland Clinic to interview for the chance to have a radical operation that has never been tried anywhere in the world.

They will smile, raise their eyebrows, close their eyes, open their mouths. Dr. Maria Siemionow will study their cheekbones, lips, and noses. She will ask what they hope to gain and what they most fear.

Then she will ask, ''Are you afraid that you will look like another person?"

Because whoever she chooses will endure the ultimate identity crisis.

Siemionow wants to attempt a face transplant.

This is no extreme TV makeover; it is a medical frontier being explored by a doctor who wants the public to understand what she is trying to do.

It is this: to give people horribly disfigured by burns, accidents, or other tragedies a chance at a new life. Today's best treatments still leave many of them with freakish, scar-tissue masks that do not look or move like natural skin.

These people have lost the sense of identity that is linked to the face; the transplant is merely ''taking a skin envelope" and slipping their identity inside, Siemionow contends.

Her supporters tout her experience, her careful planning, the team of specialists assembled to help her, and the practice she has done on animals and dozens of cadavers to perfect the technique.

But her critics say the operation is way too risky for something that is not a matter of life or death, as organ transplants are. They paint the frighteningly surreal image of a worst-case scenario: a transplanted face being rejected and sloughing away, leaving the patient worse off than before.

Such qualms recently scuttled face transplant plans in France and England.

Ultimately, it comes to this: a hospital, a doctor, and a patient willing to try it.

The first two are in place. The third is expected to be shortly.

The ''consent form" says that this surgery is so novel and its risks so unknown that doctors do not think informed consent is possible. Here is what it tells potential patients:

''Your face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex, and skin color. Surgery could last up to 10 hours; the hospital stay, 10 to 14 days.

Complications could include infections that turn your new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.

After the transplant you might feel remorse, disappointment, or grief or guilt toward the donor. The clinic will try to shield your identity, but the news media probably will discover it.

The clinic will cover costs for the first patient; nothing about the others has been decided."

Another form tells donor families that the people receiving the faces will not resemble their dead loved ones. The recipients should look similar to how they did before the injury because the new skin goes on existing bone and muscle, which give a face its shape.

All of the little things that make up facial expressions are hard-wired into the brain and personality, not embedded in the skin.

Some research suggests the end result would be a combination of the two appearances. Surgeons will graft skin to cover the donor's wound, but a closed casket or cremation will be required.

It took more than a year to win approval from the 13-member Institutional Review Board, the clinic's gatekeeper of research. Siemionow assembled surgeons, psychiatrists, social workers, therapists, nurses, and patient advocates, and worked with LifeBanc, the organ procurement agency she expects will help obtain a face.

Surgeons wished they could have done a transplant six years ago, when a 2-year-old boy attacked by a pit bull was brought to the University of Texas in Dallas where Dr. Karol Gutowski was training. Other doctors had tried to reattach part of the boy's mauled face, but it did not take. The Texas surgeons did five skin grafts in a bloody, 28-hour surgery. Muscles from the boy's thigh were moved to around his mouth. Part of his abdomen became the lower part of his face. Two forearm sections became lips and mouth.

''He'll never be normal," said Gutowski, now a reconstructive surgeon at the University of Wisconsin-Madison.

Surviving such wounds can be ''life by 1,000 cuts." Surgeons often return to the same areas every few weeks, reopening old wounds and building up skin. Years later, many patients are still having surgeries. A face transplant -- applying a sheet of skin in one operation -- could be a better solution.

Siemionow said critics should admit that the risks and the need for the transplant are debatable.

''Really, who has the right to decide about the patient's quality of life?" she asked. ''It's very important not to kind of scare society. . . . We will do our best to help the patient."

If all of the candidates back out, ''that's OK. It means that we are not ready yet," she said.

But if a transplant succeeds, many people who live in misery could benefit, said Gutowski.

''Someone's got to push the envelope," he said. ''In retrospect, we'll know whether it should be done."