Hand, face transplants regulated like other organs

Sure your liver or kidney could save someone’s life. But would you donate your hands, or your face? Signing up to become an organ donor may get more complicated than just checking a box on your driver’s license.

The government is preparing to regulate the new field of hand and face transplants like it does standard organ transplants, giving more Americans who are disabled or disfigured by injury, illness or combat a chance at this radical kind of reconstruction.

Among the first challenges is deciding how people should consent to donate these very visible body parts that could improve someone’s quality of life — without deterring them from traditional donation of hearts, lungs and other internal organs needed to save lives.

”Joe Blow is not going to know that now an organ is defined as also including a hand or a face,” said Dr. Suzanne McDiarmid, who chairs the committee of the United Network for Organ Sharing, or UNOS, that will develop the new policies over the next few months.

Making that clear to potential donors and their families is critical — ”otherwise we could undermine public trust,” said McDiarmid, a transplant specialist at the University of California, Los Angeles.

”The consent process for the life-saving organs should not, must not, be derailed by a consent process for a different kind of organ, that the public might think of as being very different from donating a kidney or a heart or a liver,” she added.

These so-called ”reconstructive transplants” are experimental, and rare. The best estimates are that 27 hand transplants have been performed in the U.S. since 1999, and about seven partial or full face transplants since 2008, said Dr. Vijay Gorantla, of the University of Pittsburgh reconstructive transplant program.

But they’re gradually increasing as more U.S. hospitals offer the complex surgeries, the Defense Department funds research into the approach for wounded veterans — and as transplant recipients go public to say how the surgeries have improved their lives.

”These hands are blessed hands to me,” said Lindsay Aronson Ess, 30, of Richmond, Va., who received a double hand transplant in 2011. She had lost her hands and feet to a life-threatening infection in 2007.

Until now, deciding who qualifies for a hand or face transplant, and how to find a match and approach a potential donor’s family all have been done on an informal, case-by-case basis.

There has been no way to tell which hospitals’ techniques work best and how patients ultimately fare.

There have been reports of two deaths related to face transplants in other countries, and some transplanted hands have had to be amputated.

Source: Teleram news


First full face transplant recipient in U.S.

A December 2010 photo shows Dallas Wiens prior to receiving a full face transplant. Wiens was injured in an electrical accident in Texas in 2008. Before his face transplant, he had surgeries to graft smooth skin over much of his face.

Dallas Wiens, first full face transplant recipient in U.S., grows comfortable in his new skin

‘My entire life is a miracle,’ said Wiens, 28, speaking at a conference of the Radiological Society of North America. Doctors are learning more from Wiens and other facial transplant patients about how the body evolves and adapts following the experimental surgeries.

The nation’s first full face transplant patient Dallas Wiens looks on during a news conference about new research into full facial transplants. Wiens was the first person in the U.S. to receive the surgery, in 2011.
The nation’s first full face transplant patients are growing into their new appearances—literally.

The nation's first full face transplant patient Dallas Wiens looks on during a news conference at McCormick Place in Chicago, Wednesday, Dec. 4, 2013. Despite still visible facial scars from the March 2011 surgery, Wiens looks and sounds like a recovered man. Medical imaging shows new blood vessel networks have formed, connecting transplanted skin with the patients' facial tissue, a finding that may help improve future face transplant surgeries, doctors announced Wednesday. (AP Photo/Paul Beaty)

Medical imaging shows new blood vessel networks have formed, connecting transplanted skin with the patients’ facial tissue, a finding that may help improve future face transplant surgeries, doctors announced Wednesday.

Dallas Wiens, the first U.S. man to get a full face transplant, is a remarkable example of that success. The 28-year-old Fort Worth man attended Wednesday’s annual meeting of the Radiological Society of North America with his new wife and golden retriever guide dog. Despite still visible facial scars from the March 2011 surgery, he looks and sounds like a recovered man.
A 2008 family photo shows Dallas Wiens with his daughter Scarlette prior to an electrical accident that disfigured his face.

“My entire life is a miracle,” Wiens said at a news conference.
His face was burned off in a 2008 painting accident at his church. He was on a cherry-picker lift when his head hit a high voltage wire.
After surgery, Wiens lived for two years with no facial features and just a two-inch slit for a mouth, until his transplant at Boston’s Brigham and Women’s Hospital.

A December 2010 photo shows Dallas Wiens prior to receiving a full face transplant. Wiens was injured in an electrical accident in Texas in 2008. Before his face transplant, he had surgeries to graft smooth skin over much of his face.

Dallas Wiens (r.) poses for a photo with his wife Jamie Nash and his guide dog Charlie. Despite still-visible facial scars from the March 2011 surgery, Wiens looks and sounds like a recovered man.Imaging studies on Wiens and two other full face transplants done at Brigham in 2011 show that a network of new blood vessels had formed just a year after the operations. A fourth full face transplant was performed at Brigham earlier this year.
The same thing typically happens with other transplants and it helps ensure their success by boosting blood flow to the donor tissue. But Brigham doctors say this is the first time it has happened with full face transplants.
The finding could eventually shorten the operating time for future face transplants, Brigham radiologist Dr. Frank Rybicki said. The operations can take up to 30 hours and include attaching spaghetti-thin arteries in the patients’ existing tissue to the donor face, but the findings suggest attaching only two facial or neck arteries instead of several is sufficient, he said.

Dr. Samir Mardini, a Mayo Clinic expert in reconstructive transplant surgery, said blood vessel reorganization occurs with other types of tissue transplants — doctors call it “neovascularization” and it helps ensure the tissue’s survival by improving blood flow.

“It’s interesting that they’ve shown it” with face transplants, but it’s not a surprise, Mardini said.
Face transplants, using cadaver donors, are still experimental. Fewer than 30 have been done since the first in 2005, said Dr. Branko Bojovich, a surgeon involved in a 2012 face transplant at the University of Maryland Medical Center.

He called the Boston team’s findings “very reassuring” for surgeons and for future patients.
“We’re assuming that these patients will hopefully go on to live productive and long lives,” Bojovich said.
Wiens’ life before the accident was troubled, and he says he misses nothing about it except possibly his eyesight.

Source: Daily news