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Stanford Medicine

Surgery

Face It

In the 1997 Academy Award-nominated movie Face/Off, terrorist Nicholas Cage had his face surgically replaced with that of FBI agent and sworn enemy John Travolta. Today, surgeons at Stanford Hospital & Clinics are debating the merits of real-life face transplants.

On Oct. 29 Stanford will host “Face and Hand Transplantation: Its Beginning, Current and Future Status,” the fourth annual Oscar Salvatierra, Jr., MD, Lectureship in Transplantation. The lecture by University of Lyon professor Jean-Michel Dubernard, who performed the world’s first face transplant, first hand transplant and first double-hand transplant, will be followed by a discussion with two Stanford surgeons, a transplant physicist, ethicist and immunologist.

I spoke about this recently with Stanford surgeon Gordon Lee, who is going to be one of the panelists. I was a bit surprised to learn that it’s not the mechanics of the surgery that make these procedures difficult, but the immunology and the ethics. “Transplant surgeons and immunologists here are saying, ‘We have the ability and technology to be the leader in this field, and we can be pioneers in developing new immunological regimens,” Lee told me. “But there’s also the question: ‘Just because we can do it, should we do it?’”

For patients who have complex defects–say, a gunshot shot wound to the face–Lee says composite tissue allotransplantation, or CTA, has great potential. It’s a relatively new surgical practice that combines the techniques of microsurgical reconstruction, connecting tiny blood vessels, and organ transplantation. It also can combine many kinds of transplanted tissue, including skin, bone, muscle, nerve and tendon.

“CTA sounds complicated, but the technical aspects have never been a barrier–it’s really nothing more than connecting cables, plumbing and wires,” Lee says. “It’s the immunology and the ethical issues that are challenging.”

The side effects of immunosuppressive drugs, which transplanted patients must take forever, include diabetes, kidney problems, increased blood pressure, and a tendency to develop infections–and cancer. “What are the quality-of-life issues, versus the costs of expensive drugs and side effects?” Lee asks. “These surgeries involve a lot of money and a lot of resources, and is the risk of immunosuppression justified by the benefit?”

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