Miracle Transplant Wearing the Face of a Dead Man
Part 2: A Chance Born of Optimism
Jeffrey Janis, the doctor treating Wiens in Texas, recognized the possibility that he could be only the second or third patient in medical history -- and the first in the United States -- to receive a completely new face. Janis, a respected plastic surgeon, helped save Wiens' life immediately after the accident. Like any ambitious doctor in the United States, he attends every medical conference he can. At one symposium, Janis listened to a presentation by Bohdan Pomahac, the director of the Burn Center at Brigham and Women's Hospital, in Boston.
Pomahac, a native of the Czech Republic, reported on the initial experiences with partial face transplants. But, more importantly, Pomahac had access to a generous research budget that would enable him to fund at least half a dozen transplants. The US Department of Defense has awarded him a $3.5 million (2.5 million) grant to conduct further research on facial surgery, which could also benefit wounded soldiers.
Janis first told Pomahac the unfortunate story of Dallas Wiens at the conference. When Pomahac saw Wiens for the first time, he almost rejected him as a candidate. Pomahac had seen few faces in his career as badly damaged as Wiens'.
Nevertheless, Pomahac had his team take a closer look at Wiens, analyzing his tissue, his blood vessels and his nerves. They made 3-D images of his head, a model of his damaged skull and models of the missing bone segments that would have to be taken from a donor at a later date.
They also spoke with Wiens who -- contrary to his doctors' predictions -- had learned how to speak again. Indeed, it is quite possible that Wiens' positive attitude, his characteristically Texan optimism and his unbroken faith in all kinds of things ultimately convinced the team in Boston to accept him as a candidate. Wiens was fearless.
He wanted his chance, and he would get it.
15 Hours of Surgery
Boston is sacred ground for doctors the world over. Harvard Medical School is surrounded by several major hospitals and famous research centers that together cover the area of a small city. In one of the buildings, the "Ether Dome," the first operation performed with ether anesthesia took place in 1846, and on Dec. 23, 1954 Joseph Murray, who would later receive the Nobel Prize in physiology or medicine, performed the first successful human kidney transplant between identical twin brothers.
In the early days, organ transplantation was a grim guessing game. Few patients survived the procedures, or they died because overdoses of X-ray radiation had overly weakened their immune defenses. The equipment, the computers and the analytical technology with which humans can now be dissected down to the cell level simply didn't exist at that time.
By comparison, when it was lying on the operating table at Brigham in March 2011, Wiens' body was like an open book. Only two people before him, one in Spain and one in France, had received complete donor faces, and now it was his turn.
The video of the 15-hour operation, edited down to a few minutes, makes the procedure seem much less complex than it actually was. It shows a group of doctors standing quietly around the table, wearing extremely powerful loupe systems on their heads. There is also a blue refrigerated box with a white lid. It presumably held the donor face preserved in a sterile plastic bag placed inside another bag filled with water that was, in turn, surrounded by ice.
The Complexities of a Transplant
The basic goal of the operation was to remove the face from the dead person along with all underlying tissue, nerves and blood vessels, to tie off all their ends or seal them with an electric scalpel, and to connect this mask to the recipient's jugular vein and carotid artery. "Once blood circulation has been established," says Stefan Tullius, head of the transplant surgery division at Brigham, "you have a little time."
Tullius flips open anatomy textbooks to explain the whole thing. A native of the western German town of Bad Kreuznach, Tullius received his medical degree in Frankfurt. He worked at Berlin's Virchow Hospital for 12 years, and he has transplanted thousands of organs over the years, including kidneys, livers and pancreases. Tullius has been working in Boston since 2005. He runs his own research laboratory, performs surgeries at Brigham and teaches at Harvard Medical School. When Wiens was wheeled into the operating room, Tullius was also standing at the operating table as part of the pack surrounding Pomahac, the chief surgeon.
Hundreds of tiny blood vessels and nerves in a face have to be connected, Tullius explains, "which is why everything takes so long." The larger nerve fibers, barely as thick as a hair, are sewn together with tiny needles and thread, "which isn't really a problem nowadays." The fact that the donor face lies firmly attached to the recipient's head is partly the result of many muscle strands having been connected, says Tullius, "and the recipient's blood vessels and nerves sprout in."
They sprout in?
"They branch out into the new tissue," Tullius explains. "And the skin is also sewn together. At any rate, nothing falls off."
Medically Pioneering, Philosophically Challenging
Tullius talks about the pressure doctors face when they venture into new territory in the operating room. He is aware that such radical interventions into the human face are pushing the boundaries of medicine.
Tullius has two children. His son was six when a program about a partial face transplant he had a hand in was shown on television. Before that, Tullius says his son had not been particularly interested in his work -- the kidneys and the pancreases and all that.
But when Tullius's son heard that this operation had to do with the face, he asked his father: "And what about the person who donated the face?" Tullius suddenly found himself having to talk to his son about death. "When it comes to the face," he says, "questions about recipients and donors, and about life and death, are different, more urgent. It's just the way it is."
Indeed, astonishing, incomprehensible things happen in the human body when body parts and organs are transplanted. Tullius describes one patient who received a transplant of the lower face in Boston. After the surgery, the patient's skin would turn bright red every four weeks. Doctors initially interpreted this as the first sign of a rejection reaction. But then they learned that the donor had had a skin disease known as rosacea that the transplant recipient "inherited" from the donor. "There are many things we still don't understand," says Tullius.
He does a lot of research with laboratory mice, and he often encounters philosophical questions in the process. What is age? What is youth? And what defines life?