A 46-year-old Ohio woman revealed Tuesday that she is the first U.S. recipient of a face transplant, a procedure that embodies both the promise of major medical advances and the ethical and economic challenges they can pose for society.
Connie Culp underwent a 22-hour procedure at the Cleveland Clinic in December to restore function to a face that was ravaged by a shotgun blast in 2004. The wound left her without a nose, lower eyelids, upper jaw, palate and other features, and she had been unable to breathe on her own, eat solid food, smell or smile. Ms. Culp had been unable to leave her home without being shunned by others and teased by children.
At a news briefing Tuesday, the team of eight doctors that performed the operation reported that the surgery will enable her to drink from a cup, eat solid food, smell and breathe through her nose. The surgeons removed most of the face of a deceased donor and placed it onto Ms. Culp like a mask, incorporating portions of her own visage. About 80% of the patient’s face was replaced.
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Doctors Perform Successful Face Transplant
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Surgeons at the Cleveland Clinic performed the first near-total face transplant on a 46-year old woman. The 22-hour procedure will enable her to eat solid food, smell and breathe through her nose again, doctors say.
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“We think this…procedure has changed her life dramatically,” said Maria Siemionow, director of plastic-surgery research at the clinic and the leader of the surgical team. The clinic had disclosed the surgery in December, but not the patient’s name.
Ms. Culp decided to go public because she is about to return to her hometown and clinic officials worried she would be besieged by media inquiries, according to Eileen Sheil, the clinic’s executive director for public and media relations. In addition, Ms. Culp told clinic staff that she wants speak out on behalf of others whose lives are affected by prejudice against the way they look.
The operation reflects how doctors are advancing the frontiers of transplant surgery, devising increasingly complex procedures and using them to improve lives, not just to save them. French surgeons performed the first partial face transplant in 2005. Just Tuesday, the University of Pittsburgh Medical Center said its doctors performed the first double hand transplant in the U.S. Hands have been transplanted for about a decade.
Unlike, say, heart or kidney transplants, which are focused on one specific type of tissue, the face involves skin, muscle, nerves, glands and other structures.
Patients receiving any tissue from a donor need to take antirejection drugs that carry risk of infection, posing an ethical problem when the transplants aren’t done to save or prolong life. Indeed, doctors said that concern has lately been more of an impediment than the technical ability to perform such procedures.
Expense is another issue. While the clinic didn’t provide data on what Ms. Culp’s procedure cost, doctors estimated it would be $300,000 to $400,000 — steep for a procedure that isn’t considered life-saving. And that doesn’t include much of the extended care associated with transplant surgery. (Doctors donated their time in Ms. Culp’s case.)
While it is hard to say how many people in the U.S. might be candidates for such a procedure, clinic officials believe it is in the thousands. Many soldiers in the Iraq war, for example, suffered major facial injuries.
The ethical concerns associated with the procedure help explain why doctors emphasized that Ms. Culp’s face transplant wasn’t done for aesthetic reasons. “The fact that there has been some recovery of function is important,” said Eric Kodish, chairman of bioethics at the clinic. “This is not cosmetic surgery in any sense of the word.”
The circumstances surrounding Ms. Culp’s injury weren’t addressed Tuesday, but news reports prior to her surgery say she was shot by her husband in an apparent murder-suicide attempt in 2004. He also survived and is serving a seven-year prison sentence. In the years before the transplant, Ms. Culp had 30 different reconstructive surgeries, but none effectively restored the lost functionality.
Ms. Culp was chosen for a transplant for both the seriousness of her injury and what doctors described as a positive attitude, making it more likely she would stick to a medication regimen.
The first concern among doctors was whether blood vessels that needed to be attached to vessels in the donated tissue would be too scarred from previous surgeries, said Frank Papay, chairman of the dermatology and plastic-surgery institute at the Cleveland Clinic and a member of Ms. Culp’s surgical team. But it turned out her vessels were OK.
Dr. Papay recalled that when doctors were ready to remove clamps that would enable blood to flow into the donated tissue, “It was a cadaver face, it was pale and white. We released the clamps, it turned rosy pink.” There was a “collective sigh” of relief in the operating room.
Ms. Culp’s appearance is different from before the shooting but, except for excess skin doctors plan to remove in 12 to 18 months, she has a near-normal-looking face.
At the briefing, she thanked the family that allowed facial tissue to be donated and the doctors and nurses who cared for her. Ms. Culp didn’t take questions or describe how her life has changed, but has told people at the clinic that she remembers the first kiss from her grandson that she could feel. Before the surgery, she had so much scar tissue her face had no feeling.
