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    Thursday, December 15, 2005

    Much Ado II: The media - and a few plastic surgeons who were beaten to the glory - continue to see ethical controversy in the French face transplant:

    Among the most disturbing aspects of the debate are conflicting reports from doctors about whether the transplant was the result of two suicide attempts, one successful by the donor, and one failed by the recipient.

    If Ms. Dinoire's disfigurement resulted from an attempted suicide, it would raise questions about her emotional stability and her ability to consent to such a risky operation.

    How, exactly, does having a history of depression disqualify a person from receiving a transplant? It's not as if we're talking about a depressed alcoholic who's going to ruin his new donated liver by continuing to drink, or a depressed diabetic who's going to blow out his donated kidneys by neglecting his diabetes. And we aren't talking about a procedure or organ that's in high demand. There are not waiting lists for new faces. As long as the patient is not psychotically depressed, he or she should be competent to make the decision about a face transplant.

    The mode of death of the donor is even less relevant - in fact it's not relevant at all unless it left the face so damage that the skin and muscles and vasculature would not be suitable for transplant.

    And let's be clear. The woman will not be seeing the face of a dead person in the mirror. The procedure she had is more akin to a skin graft . The only difference is that it included underlying muscles of the face. She did not have a head transplant. The skin and muscles were attached to her own bone structure and will take the shape of her face, not the donor's. Not to mention the fact that she didn't receive an entire face - just a portion of it.

    This whole "ethical dilemma" seems forced and manufactured, except for one aspect that only receives a passing mention:

    "Clinically, she's excellent," Dr. Bernard Devauchelle, the surgeon who performed the transplant, said in his office in Amiens late Monday. But psychologically, he added, she is only "good enough," because of the intense media pressure she is under.

    In other words, all this chatter about her mental health is getting to her. As it would anyone. And it sounds like the reporters have been as relentless as the volume of stories would suggest:

    Ms. Dinoire's mother, returning to her third-floor walk-up with a plastic bag of groceries, waved off a reporter last week.

    "No!" she shouted. "I've had enough."

    As would anyone.

    P.S. This may be the most ethically questionable aspect of the case:

    Critics have already questioned the ethics of a commercial arrangements brokered by Dr. Dubernard in which exclusive rights for photographs and video of the operation were given to Microsoft's Corbis photo agency under an agreement that allows Ms. Dinoire to share in the proceeds from the materials' sale.

    But at least the patient gets to share in the profits - something you never see in medicine.


    posted by Sydney on 12/15/2005 09:30:00 AM 2 comments


    I'm not getting the controversy. This wasn't someone who wanted enhanced body parts for vanity. She was seriously disfigured, which is a genuine medical problem, and the physicians helped her. This is bad?

    By Anonymous Bruce Small, at 5:48 PM  

    I think the questions about this are those that can only be answered with time, such as whether we really know enough about how to do this successfully and what is the long term result.

    One of the particular things I would wonder about is in regard to the neurologic function of this perioral area. If we look at the "successful" hand transplants that have been done, these people are still left with a largely anesthetic hand, which works at best like a marionette, with the action in the hand coming from the forearm muscles.
    So, for the face, what will be the movement in perioral muscles? I'm not sure I understand how the obicularis oris can operate to move the lips for speaking, puckering, etc. And the lips will be quite numb.

    This may come out looking much like the perioral action one saw in the original Planet of the Apes characters. (Not trying to be funny or derogatory, just pointing out how false nonmoving lips can appear)

    It would seem that at best a rather severe labial dysarthria must be expected.

    By Blogger Greg P, at 9:18 AM  

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