Face transplants can improve quality of life for injured

By on June 12, 2013

Imagine what it is like to live without a face. You have no lips to speak. You cannot close your eyes. Simple tasks like eating and drinking become impossible to do. Even breathing normally becomes a chore. Until recently, patients with these and other devastating injuries had few options of treatment. Advances in immunosuppressive therapies and surgical skills have led to the first successful face and hand transplants. The first face transplant was performed by Dr. Maria Siemionow at the Cleaveland Clinic in 2008.

This is a photo of Connie Culp, after an injury to her face, left, and then as she appears today. Culp underwent the first face transplant surgery in the United States at the Cleveland Clinic in December 2008. today.com

This is a photo of Connie Culp, after an injury to her face, left, and then as she appears today. Culp underwent the first face transplant surgery in the United States at the Cleveland Clinic in December 2008. today.com

Five years later, the United States government contemplates regulating face and hand transplants. Talks are underway to create a nationwide system to match and distribute body parts and donor testing to prevent deadly infections. Regulation of face and hand transplants would be a big step towards expanding people’s access to these radical operations. In particular, wounded soldiers returning home could benefit from these operations. Over 1,000 troops have lost an arm or leg in Afghanistan or Iraq. The government estimates that at least 200 troops might be eligible for face transplants.

Spearheading this initiative is the Health Resources Services Administration, the government agency currently regulating organ transplants such as hearts, kidneys, etc. The agency has proposed new rules that would include transplantations of faces, hands, and other body parts as part of the nationwide matching system, which is currently run by the United Network for Organ Sharing (UNOS). Currently, waitlists for these body parts are informal and local. Many potential candidates are unable to undergo these procedures because of limited access to these medical procedures. The rules would regulate transplants of feet, ankles, legs, fingers, windpipes, voice boxes, the abdominal wall and possibly even a uterus or a penis. These rules should take effect later this year or early next year.

The U.S. Department of Defense is also encouraging more medical centers to offer body part transplants. Currently, a dozen U.S. hospitals perform face or arm transplants. In response to the need, University of Pittsburgh, the University of California, Los Angeles, and other medical centers plan to offer face and hand transplants soon.

For patients with severe face, arms, and hands deformities, undergoing a transplant can result in significant benefits in function, appearance, and psychological adjustment. It can significantly improve someone’s quality of life. However, these are still experimental. Patients and physicians must carefully weigh the risks against potential benefits. These surgeries increase the risks of long-term immunosuppression, graft rejection, and psychological harms. The patient will have to take anti-rejection drugs for life which increases his or her risk of developing cancer later on. Often, this medication has severe side effects such as diarrhea and influenza. For many patients, the use of prosthetics is a more viable, safer option. For others, the benefits of a face, arm, or hand transplantations outweigh the harms.

As medical treatments continue to advance, the commonality and risk of this treatment will also reduce. For many, face, hand, or arm transplants would help them regain functionality and improve their quality of life.

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