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Pioneering Technique Readies Patients for First Face Transplant

Modern surgical techniques have made most of our bodies replaceable. Doctors can transplant eyes, hearts, kidneys and livers. They can replace hip joints and blood vessels with artificial ones. And now, this medical frontier is putting on a new face.

In the 1997 film Face Off John Travolta plays an undercover agent who takes an unusual step to break up a terrorist plot. He has his face surgically removed and replaced with that of the ringleader who is presumed dead.

By the end of the movie John Travolta gets the bad guy and his original face back.

While that may seem like Hollywood magic, in the real world - at the University of Louisville in Kentucky - it's about to happen. It's not for undercover agents, but for people whose faces have been severely burned or badly deformed.

Dr. John Barker is working on face transplants by applying the microsurgical techniques he developed for the first-ever hand transplant, which he performed in 1998.

He warns that the procedure isn't for everyone. "An ideal patient is someone who is severely disfigured and for whom current methods of treatment are not satisfactory," he says. "Immunologically, there are certain blood types and matching and then of course, it would have to be somebody that could live with the transplanted face and who can withstand intense media attention."

The transplant -- using the face from a donor cadaver -- would be matched for tissue type, age, sex and skin color. The cadaver's face -- from hairline to jaw line -- would be cut away with all the fat, nerves and blood vessels beneath it.

"We're modeling the whole program based on organ donors," he says. "In other words, the person who is donating is also donating his or her organs. And, to dissect away, to take the tissue from the donor, you are talking about three, four hours. The tissue you take depends largely on what the defect (in the patient's face) that you are going to reconstruct is."

But with a reconstructed face, would the patient look more like the patient or the donor?

"We've actually done cadaver studies where we have taken the soft tissue from one cadaver and put it on the bony structure of others to address exactly that question," Mr. Barker says. "While we haven't completed that study yet, the preliminary results look like it is a combination between the donor and the recipient."

This is risky business. As with any transplant, the patient's body could reject the donor tissue. Infections and complications from anti-rejection drugs could lead to liver problems or cancer. But, despite those possibilities, Doctor Barker expects no shortage of willing candidates.

"We are currently running a study in which we ask people what risks (they would) accept to get one of these procedures," he says. "After interviewing over 300 people, the results are that people would take the most amount of risk for a face transplant. (That is) even more than a kidney transplant, which is widely accepted as standard treatment."

Dr. Barker and his team at the University of Louisville is seeking approval from the institution for the go-ahead to perform the procedure. The Cleveland Clinic in Ohio has already received approval to attempt the first ever face transplant. Twelve candidates are now under consideration.