• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
WellcomeHistory
ISSUE 39
WINTER 2008
Feature article 2
Face transplantatin
MaNcHeSter uNit 4
Intensie care Abdminal illnessNHS rerganisatin Animal testingCnnectie tissue Animal suicide
cONFereNce rePOrt 13reSearcH reSOurceS 16
Italian charlatans database
bOOk reviewS 18caleNdar 24
 
2Manchester unit
Wellcome
History Issue 39
 
Face transplantation
Learning frm the heart
 Above:
Jennier Sutton,a heart transplantrecipient, with herold heart. Recentcontroversy aboutace transplantationhas much incommon with earlierdebates about hearttransplants.
 Adrian Brooks
Cover:
 The ace has longbeen seen as both asite o anatomicalinterest and a ocus o personal identity. ByJaques Fabien Gautierd’Agoty, 1748.
 ayeSHa NatHOO
“Face transplantation – antasy or the uture?”asked a leading London plastic surgeon, PeterButler, in the
Lancet
on 6 July 2002. “[A]lthoughit may be technically and immunologicallypossible, should a ace be transplanted? Theconcept may be shocking. [It]...appears tohave come straight out o science fction”.
Three years later, the world’s rst partial face transplanttook place in Amiens, France, closely followed byanother in France and one in China. Even thoughthe surgical know-how has been in place for years,face transplantation is a controversial act over whichthe medical world is divided and has provoked anintense public debate, facilitated and fuelled bythe media. The very idea has unsettled deeply heldnotions of self and of the sanctity of the humanbody, and has called into question the aims andboundaries of biomedical science and technology.This article brings attention to some of the strikingparallels between the controversy surrounding facetransplantation and that of the rst heart transplantsin the late 1960s. The comparison also draws outdistinctions between the two procedures in terms of their relationship to personal identity and criteria forsuccess, and highlights the crucial role of the media inshaping the course of high-risk medical innovation.At a conference in 1964, two American pioneersof cardiac transplantation warned their colleaguesthat although human heart transplants weretechnically feasible, “perhaps the cardiac surgeonshould pause while society becomes accustomedto the resurrection of the mythological chimera”.Three years later, the world’s rst human-to-humanheart transplant was performed in Cape Town by arelatively unknown surgeon, Christiaan Barnard.The awe-inspiring news of 3 December 1967 madefront-page headlines around the world, transformingBarnard and his patient, Louis Washkansky, intointernational celebrities. Over 100 similar operationsfollowed worldwide within a year, but owing mainlyto insurmountable immunological challenges, mostof these patients died within months, sometimesdays or hours, and a moratorium was called for thefollowing decade. The unprecedented media coveragethat the operations received contributed directly toundermining public trust in the medical profession andbringing about the moratorium. The late 1960s hearttransplants permanently and radically transformedthe relationship between medicine and the media.
 These surgical eats challengedeeply held conceptions o identity, and hence constituterich human interest stories
Forty years later, doctors are expected to associate withthe media, to be held to account and to promote andparticipate in public debate over new technologies.They work alongside ethics committees, politicians,lawyers, powerful patient organisations and aninterested and demanding public to whom the internetaffords unprecedented access to information. Imagemanagement has never been more important, andhospitals, together with most other medicalorganisations, now routinely employ sophisticatedpublic relations machinery. The heart transplantsmarked the start of this media-conscious era, whenhospitals rst started staging post-operative pressconferences and when professional ethical codes thatgoverned institutional and doctor anonymity were
 
3
Wellcome
History Issue 39
Feature article
broken down. Intimate details about heart-transplantrecipients were printed and broadcast alongside theirnames and photographs, and media regulatory bodiesruled that the public’s ‘right to know’ about newmedical innovation and its subjects took precedenceover patient condentiality.When in 2002 the London plastic surgeon Peter Butlerdeclared his readiness and intention to transplant ahuman face, a Working Party of the Royal College of Surgeons convened to assess its viability. Their 2003report advised against British surgeons proceeding withthe innovation. In addition to potential technical andimmunological drawbacks they identied a plethora of psychological, ethical and social concerns, including“the considerable challenge of media intrusion”;they worried that “recipients, their families, thedonor’s family and the transplant surgeons will bethe subject of invasive press interest and publicity”.Indeed, when in November 2005 French surgeonsconducted the rst partial face transplant, on a womanwhose nose, chin and lip had been torn off by herdog, even though French privacy laws protected therecipient’s identity, intense media speculation andinterest forced her onto centre stage. Following a blazeof publicity, the recipient, Isabelle Dinoire, rst directlyaddressed journalists and photographers alongsidethe medical team in February 2006. As the
 Independent 
 reported: “Isabelle Dinoire showed a new face to theworld…To a storm of ash bulbs and camera shutters,she appeared before a two-hour press conference”.What has constituted ‘medical news’ has changed overtime, indicating that newsworthiness is context-specicrather than inherent in an event. Nonetheless, thereare specic elements to heart and face transplantationthat contribute to their especially high news value. Inparticular, these surgical feats challenge deeply heldconceptions of identity, and hence constitute richhuman interest stories. In the late 1960s, journalistsquestioned Louis Washkansky about how he felt asa Jewish man to have the heart of a gentile woman,and Barnard’s second transplant in January 1968 washighly controversial given the use of a ‘coloured’ man’sheart for a white recipient in apartheid South Africa.Similar sentiments provoked journalists to questionthe psychological implications of Dinoire’s acquiringsomeone else’s face, especially after it transpired thatthe ‘brain-dead’ donor had attempted suicide.Peter Butler responded to the issue optimistically:“Isn’t it great that something good has come outof a tragedy?” He dismissed the possibility thatDinoire could be traumatised by the knowledge asbeing “hocus pocus and black magic”, and assignedmuch of the public disquiet and misconceptions of face transplantation to the ctional content of the1997 blockbuster
 Face/Off 
in which a criminal andan FBI agent exchange faces through surgery. In thelm the recipients’ faces looks exactly as they didon the donors, which would not be the case in a realoperation given different underlying muscle and bonestructures. Moreover, in
 Face/Off 
the criminal and FBIagent switch identities, with the effect of conatingpersonality and appearance. The widespread belief in physiognomy during the 19th century (withremnants of these ideas still found today) in factdemonstrates a far longer-standing cultural associationbetween facial characteristics and personality.Following the transplant, Dinoire herself reportedlyexperienced an “odd taste in her mouth”, her chinsprouting hair for the rst time, and a feeling of detachment from her transplanted nose. Numerouspsychological studies have found that it is notuncommon for transplant recipients to feel theirreceived organs to be endowed with personal qualitiesand characteristics of the donor. The medicalanthropologist Lesley Sharp has demonstrated thatsuch feelings are partly attributable to transplantsurgeons themselves framing organs as bothpersonalised and objectied parts. Organ donationis promoted using a dual rhetoric, whereby the ‘giftof life’ supposedly allows for the deceased to ‘live on’in the recipient. The heart, which literally beats onin the new body, is personalised as the ‘ultimate gift’.Although face transplantation is not life-saving, it islife-changing, and proponents use similar rhetoric.
Doctors are expected to associatewith the media, to be held to accountand to promote and participate inpublic debate over new technologies
Yet in medical discourse the heart is concomitantlymerely a ‘pump’, devoid of meaning, that wouldotherwise be ‘wasted’ upon death. The success of the rst heart transplant was judged exclusively onwhether this objectied heart functioned in thenew body. In the
South African Medical Journal
on 30December 1967, Barnard described his “successfuloperation” (even though Washkansky was dead bythe time the report was published). The editorialclaried: “the claim ‘successful’ can be used even at thisearly stage…no matter how short the further survivalof the patient might be”. The denition of successchanged for subsequent transplants, lacking the statusof ‘rsts’, and ultimately the highly publicised poorsurvival times resulted in
 Life
magazine’s cover storyon 17 September 1971 denouncing “an era of medicalfailure…The Tragic Record of Heart Transplants”.For Dinoire, reacquisition of sensory and motorresponses were critical to deeming her operation asuccess, as without command over actions such aseating and speaking, the face is but a mask. Dinoire’sability to articulate her press statement and sip waterat the press conference were ostensible indicatorsof a successful transplant and a great photographicopportunity for the media; similarly, her abilityto smile made headlines. But unlike the heart,aesthetics, in addition to function, is paramount todening a successful face transplant, and a principalreason that facially disgured people would beprepared to undergo such a radical procedure.
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...