The first face transplant operation in the United States has been completed and initial results are positive, reports the medical team at the Cleveland Clinic. The patient, who had suffered severe facial disfigurement from trauma, had 80 percent of her face replaced with one taken from a cadaver, leaving only her own upper eyelids, forehead, lower lip, and chin. After the transplant, “I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw,” said the lead surgeon, Dr. Maria Siemionow [AP].
Although the woman’s identity and the nature of her trauma has not been revealed, doctors say her injuries were so severe that she lacked a nose and palate, and could not eat or breathe on her own without a special opening into her windpipe [AP]. The 22-hour-long surgery took place sometime in the last two weeks and is the most radical facial transplant ever attempted. Along with about 500 square centimeters of skin, the transplant also included bones, muscles, blood vessels, nerves, a nose, sinuses, the upper jaw, and even some teeth. The doctors hoped the operation would allow her to regain her sense of smell and ability to smile [AFP].
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In a pioneering new treatment, doctors created a tailor-made new windpipe for a woman out of donor tissue and the woman’s own stem cells, and say the new, transplanted trachea has been accepted by the woman’s immune system as a natural part of her body without the use of powerful immune-suppressing drugs. Martin Birchall, one of the surgeons, said the transplant showed “the very real potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases. We believe this success has proved that we are on the verge of a new age in surgical care” [The New York Times]. Similar treatments could soon be tried on transplants of other hollow organs, like the bowel, bladder, and reproductive tract, he said.
The 30-year-old patient, Claudia Castillo, had failing airways and severe shortness of breath due to a bout with tuberculosis. By March of this year, Castillo’s condition had deteriorated to the point where she was unable to care for her children. Removing a lung was one treatment option, which would have allowed her to live, but seriously impaired her quality of life [Forbes.com]. She opted instead for this experimental treatment, in which doctors took a piece of trachea from an organ donor and transformed it into a structure that now appears native to her body.
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A controversial proposal to switch the U.K.’s current system of voluntary organ donation to a system of “presumed consent” was rejected by the UK Organ Donation Taskforce, which said the change would not increase organ donations and could damage patient-doctor as well as donor-recipient relations. Presumed consent would designate everyone as an organ donor unless the individual or the family of the deceased opted out; the current system is just the opposite, harvesting organs only from people who opt in to organ donation.
The task force advised against the switch supported by Prime Minister Gordon Brown, the British Medical Association (BMA), and several physician groups. Nevertheless, Brown continues to support a presumed consent system. “While they are not recommending the introduction of a presumed consent system, as I have done, I am not ruling out a further change in the law,” he said [The Guardian].
The U.K. has one of Europe’s lowest rates of organ donation. Of an estimated 8,000 people on waiting lists for organ transplants, only about 3,000 receive transplants every year, and 1,000 die while waiting for a transplant. Vivienne Nathanson, the BMA’s Head of Science and Ethics, said presumed consent was not a panacea, but was likely to result in a 10 to 15 per cent increase in donated organs, if sufficient surgeons, intensive care beds and transplant coordinators were put in place. She said it would also encourage families to discuss their views, and make their wishes clear before death: “We know that the majority of the population want to be organ donors, but only 25 per cent are on the register” [Times Online].
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In a remarkable announcement, German researchers have declared that they “functionally cured” a patient of AIDS, eradicating all traces of the virus from his body. The feat was accomplished with a bone marrow transplant from a donor who had a genetic resistance to the virus, and researchers say that 20 months later they can find no trace of the virus in the patient’s blood, bone marrow, or organ tissue.
But the accomplishment shouldn’t be taken as a sign that a cure for the 33 million people living with AIDS is around the corner, researchers are hasty to add. Professor Rodolf Tauber from the [German] clinic said: “This is an interesting case for research. But to promise to millions of people infected with HIV that there is hope of a cure would not be right” [BBC News]. Reasons for this caution include the small number of potential donors with the HIV-resistant mutation, and the difficulty and expense of bone marrow transplants.
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An Israeli biotech company says it has developed a way of freezing and then thawing a pig liver that doesn’t destroy the organ, and says that the thawed out liver appeared to function normally when transplanted into a new pig. The company, Core Dynamics, says the work could lead to advances in human organ transplants, and could eventually allow for “banks” of frozen organs. Organ donation schemes have to work fast to match organs with patients who need them, as, even if kept chilled, they can become unusable within 24 hours. Researchers have been looking for ways to preserve them by freezing, to cope with delays between donation and transplant operation [BBC News].
Lead researcher Amir Arav says the key to limiting cell damage during freezing is to cool the liver very slowly, as this prevents the formation of jagged ice crystals. Some frog species employ a similar technique when they allow parts of their bodies to freeze during hibernation. “We didn’t invent this process, nature did,” says Arav [New Scientist].
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Two years after receiving a dramatic face transplant, a Chinese man who was mauled by bear can eat, drink, and talk normally, doctors reported. Another patient, a Frenchman who suffered from a rare genetic disease that deforms the face, received a similar transplant one year ago and can now smile and blink, proving that the brain is restoring facial nerve connections.
Despite recurrent episodes of tissue rejection in the first year after their transplants, neither man had psychological problems accepting their new faces and have been able to rejoin society [Reuters]. Doctors say that the successes with these two men, who are only the second and third people to ever receive the operation, suggest that the procedure is safe and could one day become routine. “There is no reason to think these face transplants would not be as common as kidney or liver transplants one day,” said Dr. Laurent Lantieri, one of the French doctors [AP].
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In a controversial new procedure, doctors removed the hearts from three severely brain damaged infants soon after the babies were removed from life support and transplanted the organs to three other infants, where the hearts were restarted. The news is raising complicated questions about when a patient can be declared dead, and whether doctors are pushing an already controversial organ-retrieval strategy beyond acceptable legal, moral and ethical bounds [The Washington Post].
The hearts of the three donor babies stopped beating soon after their ventilators were removed. In the first case, the Denver team waited three minutes after what appeared to be the last heartbeat. But because there has never been a case where the heart restarted itself after 60 seconds, they waited only 75 seconds for their next two cases [Reuters]. All three babies who received new hearts would have died without the transplants; six months after the operations, all three were doing fine. Doctors believe the swift organ removals from the donor babies increased the odds of survival for the recipient babies.
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