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A BWH surgical team is ready perform partial facial transplants in selected previous transplant patients, making BWH just the second hospital in the country able to perform this procedure which will boost patients' confidence and help them live normal lives, said Bohdan Pomahac, MD.
"This is a very exciting direction that no one has really explored," said Pomahac, who is working closely with his mentor on this project, Plastic Surgeon Julian Pribaz, MD, Chief of Transplant Surgery Stefan Tullius, MD, PhD, and Tissue Specialist Edgar Milford, MD, along with a team of transplant medicine doctors. "We are broadening the scope of clinical services BWH provides," Pomahac said.
A few years ago, Pomahac saw a patient who refused to undergo resection of cancer because of how severely it would alter her face. "With this transplant, she would at least have hope that someday there could be a donor match," he said.
The hospital will partner with the New England Organ Bank (NEOB) to find potential donors, who must qualify beyond regular organ donor status and match the recipient's tissue and blood properties. Individual considerations will be given to the match of race, gender and age. "NEOB representatives have been incredibly supportive, and, without their positive attitude, this project would not take off," said Pomahac.
During a partial transplant, surgeons remove part of a donor's face, such as the nose or lips, and attach the tissue, blood vessels and nerves to the recipient. After the first partial face transplant was performed in France in 2005, the world was abuzz with the potential this type of surgery holds, but many also debated the ethics of this type of surgery.
The BWH team recognizes the ethical concerns and tailored BWH's programs to address them. One concern is that transplant patients spend the rest of their lives taking immunosuppressant drugs to keep the body from rejecting the organ. BWH will only perform facial transplants on those who already are on these drugs, most likely from a previous transplant. "They know what it's like to live on these drugs, which can have debilitating effects on the body," Pomahac said.
Critics also raise questions about the ethics of changing a person's identity. That's why BWH will perform only partial face transplants, removing just the damaged portions of the face.
BWH has not yet performed the surgery, but all candidates will undergo psychiatric screening in addition to the general screening for all transplant patients. "Changing someone's appearance in any way can have a major impact on that person and also their family," Pomahac said. "We will provide that patient with the psychiatric support needed to make the decision about having the surgery."
Pomahac added, "There is no better place than Brigham for a pioneer operation like this, thanks to all the teams of talented individuals from various specialties."