UPMC considers approving face transplant surgery

About a month after performing its second double hand transplant, the University of… About a month after performing its second double hand transplant, the University of Pittsburgh Medical Center is considering using the technology to perform face transplants.

Dr. Joseph E. Losee and other members of the center’s transplant team have asked UPMC’s Institutional Review Board — a group of surgeons, psychologists and other medical experts who work to make sure the center abides by its ethics policies — to consider allowing it to perform face transplants.

Dr. Vijay Gorantla, another member of the transplant team, said he expects the board to make its decision by the end of next month.

Face transplants, he said, use similar techniques to the ones UPMC surgeons used in its hand transplants.

For the hand transplants, UPMC surgeons used a new technique, which some have labeled the “Pittsburgh Protocol.” Before they developed the protocol, doctors would give transplant patients three immunosuppresive drugs, which keep their bodies from fighting off foreign cells, such as bacteria.

Under the “Pittsburgh Protocol,” doctors give transplant patients one immunomodulating drug instead of the three immunosuppressive drugs, Gorantla said. When they use immunomodulation, doctors both harvest a donor’s face and take cells from the spinal cord. They inject the stem cells into the transplant patient before he undergoes surgery. This allows a patient’s body to become used to the foreign cells before the transplant, reducing the chances of the patient’s body rejecting the transplant, Gorantla said.

Dr. Gerald Brandacher, a surgeon at UPMC and the founder of the American Society of Reconstructive Transplantation, said UPMC surgeons waited to perform the transplants until they could develop the protocol. “We were cautious because we wanted to come up with a safe protocol,” he said.

Eight face transplants have been performed throughout the world.

Losee said the immunosuppressive drugs could have several serious side-effects, such as cancer. Because the drugs weaken the immune system, people with chronic conditions, such as the Human Immunodeficiency Virus, aren’t eligible for the transplants, Brandacher said.

Gorantla said people with facial deformities are often willing to take the risks because, “a face is tied into your body fabric.”

Brandacher said the suicide rate for people with facial deformities is above 90 percent.

Face transplants can give people with facial deformities more movement and sensation than even the best prosthetics could, Brandacher said.

Losee said the procedure is often cheaper than reconstructive surgeries. The costs of the transplants vary depending upon the person. A doctor who performed a face transplant in Cleveland last spring told the Associated Press that she estimated that the cost was between $250,000 and $300,000.

The donor’s faces will look different on the people who receive them than they did on the donors. Doctors search for faces that won’t look like a mask when they’re transplanted, Losee said.

Unlike traditional organ transplants that simply require the donor’s consent, surgeons ensure they have the approval of living family members before selecting a face transplant donor.

If UPMC decides to perform face transplants, it will be monitored by the Data Safety Monitoring Board, a panel of health care workers. The board works to ensure that UPMC meets the IRB requirements and makes any changes necessary.