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Face Transplants: Scots Surgeons' Struggle for NHS Backing

Doctors trained in the controversial surgery say NHS bosses are refusing to back the plan.

 

Face Transplants: Scots Surgeons' Struggle for NHS Backing. Picture: Face transplant procedure taking place in US. NYU Langone

It was once the stuff of science fiction but now the procedure of face transplanting is a reality.

A number of people have benefited from the operation and a team of Scottish scientists who are trained to perform such transplants say they are ready to begin with the UK's first procedure.

But they have hit a roadblock as NHS bosses are refusing to back the plan.

Face transplanting has been done less than 50 times, with successful operations in countries including the US, Spain and France.

There has yet to be such an operation in the UK despite much of the research being done here.

The specialists in Scotland are based mainly in the Queen Elizabeth University Hospital in Glasgow, with a team who intend to treat the most severe facial disfigurements from across the UK.

"In Scotland some years ago I thought it would be a good idea here," said lead surgeon Dr David Koppel.

"We had the skill, we had the microvascular skills within the department, so we set about trying to build a team and a programme that would be both able to do the surgery and do this in a sustainable way."

They organised training for staff by specialists in Paris from the world's leading face transplant programme, with one of Dr Koppel's colleagues spending a year learning techniques at the centre.

"We have the technical skills to do it and we also have the experience now of performing transplants in France with the busiest transplant unit in the world," he said.

"I think we have the infrastructure here at the Queen Elizabeth Hospital in Glasgow to be able to provide this service, and all aspects of this service."

Dr Koppel led the team behind the face transplant service.

How does a face transplant work?

The process involves removing all or part of the face of a deceased donor and grafting it on to the face of the patient.

It requires complex surgery to make sure skin, blood vessels, nerves, bone, muscle and other supportive structures are correctly transplanted.

The recipient of the procedure is required to take drugs which stop the body from rejecting the new face but there is no guarantee that it will be successful.

Surgery is long and dangerous, with huge teams of surgeons, anaesthetists, nurses and other medical experts involved.

While there have been ethical concerns over the use of a donor face, the bone structure of the recipient often means there is little resemblance between the two.

Dr Koppel told STV News what happens inside the operating theatre for such a complex procedure.

"A team of surgeons remove the tissue from the donor, in the same way that a kidney or a liver is removed," he explains.

"In a sequential way to preserve it and maintain the key structures so we are able to then inset it into the recipient.

"Then we would to prepare the recipient, and that would involve probably removing existing tissue from the recipients face and then preparing the blood vessels and the nerves to receive the donor face."

He adds: "The key part of the procedure would reconnect the arterial blood supply carrying blood into the tissue and veins taking the blood back out of the tissue so we can reestablish a blood supply.

"The next stage is the preparing and joining of all the bones if we are using a bone transplant to fit in to the existing skeleton of the face and then the joining of the nerves to give the sensation of feeling and to move the face."

Despite the development of a coordinated plan to provide a national face transplant service in Glasgow, the NHS body in charge of funding these procedures has decided the service was not required in 2014.

STV News understands the national specialist service committee pointed to the small number of cases in the UK, a prohibitive overall cost and the availability of facial transplant surgery in the special unit in Paris when it rejected the plans.

Patients who require such treatment will be likely sent to the French facility despite a trained medical staff in Scotland saying they are ready to perform it.

Dr Koppel said the team "struggled to understand" why the decision was made.

A detailed cost and budgeting from the group behind the new service plan found each case would cost just over £163,000, which Dr Koppel said was comparable to a kidney transplant or a heart transplant.

He said: "Whilst it is slightly more expensive than a routine operation in our department it's not hugely different to the ballpark and therefore, per patient, I think it is a relatively small amount of money when this procedure can and often does affect someone so dramatically that they change from being an isolated, socially inactive person to being a productive member of society."

French doctors who pioneered the surgery are not thought to be likely to accept new patients from the UK in the near future. They described the NHS plan as "difficult"

Speaking to STV News, surgeon Jean Paul Meningaud said: "I think that my Scottish colleagues are perfectly capable to do this type of surgery because they are trained and we went to Scotland to train them. I think they can do it."

The first partial transplant was done in France in 2005 on Isabelle Dinoire, who had been attacked by her dog.

She received a graft comprising the nose, lips and chin of a donor who had been pronounced brain dead.

A Spanish farmer was the first to receive a full face transplant after being disfigured in a hunting accident. A team of 30 surgeons worked on the operation, which took 24 hours.

Susan Duncan lived with facial disfigurement since she was a young girl. Her face was reconstructed using bone from other parts of her body, but she has a strong sense of what those waiting for such surgery are going through.

She urges caution and says the risks of facial transplants must be taken into account.

"It's such a big risk," she said.

"How long are people able to put up with the drugs and the risk of infection and everything like that. That scares me, and I think it's all or nothing basically."

In a statement, an NHS spokesman said as there were such a small number of cases patients are currently referred to a "high quality service" in France.

There are currently no plans to change the policy and support a national face transplant service in Scotland.

 

Source: STV News

 

 

Face Transplants: Scots Surgeons' Struggle for NHS Backing

 
 
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