The world's most extensive facial transplant

Each year at Fieldfisher we nominate a 'charity of the year'. This year we are proudly sponsoring 'Changing Faces'. They are a charity that aims to transform public attitudes towards people with unusual appearances. Their goal is to 'face equality'.

Since they formed in 1992, they have achieved a number of advances for people with facial disfigurements. They have achieved legal protection for people with disfigurements in the Equality Act 2010. They continue to work with NHS England's Clinical Reference Groups to shape the best practice for the psycho-social care of people with burns, skin conditions and head and neck cancer.

Living with a facial disfigurement evokes a wide range of day to day barriers for an individual to overcome, these include both psychological and social problems. For many years, Changing Faces has been involved in the public debate regarding facial transplants. As a charity, the support research in medical science. When interviewed about facial transplantation research, James Partridge, the charities Chief Executive, states that their stance is:

• We will support unconditionally any patient (and family) who chooses to undergo a face transplant, and any UK face transplant team that meets the Royal College of Surgeons’ 15 preconditions.

• We retain an independent position from which to judge the balance of risk-benefit in face transplant research and remain cautious about psychological issues.

• We strongly support the privacy clauses imposed and respected by the media and hope that all patients will be afforded the same – if they wish it.

• We consider that face transplantation research is still in its relatively early stages and think there is a continuing need to assess the learning internationally and evolve best practice.

Facial transplants are unlike any other type of organ donation surgery. The operations require several teams of specialists, and many considerations before confirmation the procedure can go ahead. The patient must be matched with a donor's tissue type, age, sex, blood type and skin colour but to name a few of the requirements. Effectively, the patients face will be removed and replaced with the donor's. The recovery of the donor's face for the facial transplant had to take place in a room adjoining the one where the transplant is performed, and surgery can take anything from 8 – 36 hours depending on the extent of the transplant. In 2005, the first partial facial transplant was completed. A 38 year old Frenchwoman, Isabelle Dinoire who was mauled by her dog. She underwent surgery of a nose and mouth graft. Some five years later, in 2010, the first full facial transplant was successful; the recipient was a 31 year old Spanish farmer who had accidently shot himself in the face. This year, the most remarkable transplant has been completed, and I have outlined the story below.

In September 2001, a volunteer fire fighter Patrick Hardison suffered life changing injuries when his entire face, head, neck and upper torso was burnt after entering a fire. Patrick entered the fire with three other firefighters, when the ceiling collapsed around him. He recalls how his hose had 'already melted' and then he felt his mask begin to melt to his face. Incredibly, instinct kicked in and when Patrick removed his mask, he closed his eyes and held his breath. Doctors believe that this saved his sight and prevented his lungs and throat being damaged by the smoke. He lost his ears, lips, most of his nose and the vast majority of his eye tissue. He was completely unrecognisable and tragically comments how his children were scared of his appearance. He spent 63 days in hospital. During his time in hospital, flesh was taken from his thighs to rebuild his face. Patrick subsequently underwent 71 operations to try to rebuild his facial features, including his mouth, nose and eye lids using skin grafts.

However, fourteen years later, in August this year Patrick underwent a surgical procedure lasting 26 hours. He had the first full face transplant and the results are extraordinary.

Before he could have the surgery, Patrick required a donor who matched his skin and hair colour, along with his blood type and skeletal structure. In 2014, a friend of his contacted Dr Rodriguez who agreed to help and Patrick was placed on a waiting list. Sadly, Patrick was waiting for somebody to die.  A year later, in July 2015, a young man named David Rodebaugh, was in a fatal motorbike accident, while riding his bike, he suffered a head injury and a few weeks later was tragically declared brain-dead. David's family made the courageous decision to donate David's organs. His heart, liver, corneas, bone and skin tissue were all donated, along with his face.

The surgery consisted of the removal of the David's face, scalp, tissue, nerves and muscle, while another medical team removed the tissue from Patricks. The donor's face was then placed on Patricks and the blood vessels were connected.

Although only three months since surgery, the results of the operation are truly incredible, this series of pictures documents Patrick's recovery.

While he needs to undergo more surgery, due to his new eyelids Patrick is expected to regain a normal field of vision. He will be on life-long medication to prevent his body from rejecting the transplant. The full story can be read on:

• http://www.medicalnewstoday.com/articles/302696.php
• http://www.dailymail.co.uk/news/article-3320663/My-mask-melting-face-Firefighter-severely-injured-blaze-extensive-face-transplant-performed.html, and
• http://www.bbc.co.uk/news/health-34831206

There are many ethical issues that this type of procedure gives rise to  such as submitting physically healthy people to lifelong immunosuppressant therapy. To date, it has been recorded that four people have died due to complications arising from the procedure. There is also no guarantee that the recipient will not reject their new face.

Dr James Partridge, Chief Executive of the UK charity Changing Faces, said an altered appearance can be psychologically difficult to adjust to.

"There are myriad ethical issues too, and we mustn't lose sight of the complexities by just celebrating a successful transplant operation. In many ways, Mr Hardison's journey is only just beginning."

While there are risks (as there are with all types of surgery, no matter how big or small) and it is obviously incredibly sad that the only way a patient will receive this treatment is because another person has passed away, setting this aside, Patrick is proof that it really does change someone's life. Having read Patrick's story, I think it is truly inspiring that medicine has advanced so rapidly over the last ten years that surgeon are now able to complete this kind of procedure. His children no longer run away scared, they embrace their daddy. Patrick himself states 'they have given me more than a new face. They have given me a new life'.  For me, this is all the evidence I need to believe that this journey, is a journey worth taking.