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transplantation, to identify and match potential
donors and patients. It would be a very important
part of accelerating the pace of these procedures.
That said, the donor’s tissue must match that of
the recipient in terms of blood group, sex, age,
skin color and size. Potential donor families are
approached with sensitivity to the emotional
and ethical issues of donation. Our program
also works with James Kelly, DDS, an expert in
maxillofacial prosthetics to provide the donor
family a facial reconstructive mask to recreate
the donor’s visage and allow for an open-casket
funeral if that is desired.
Identifying the right candidate for the surgery
also is a significant challenge. Because this is a
life-altering procedure rather than a life-saving
one, an appropriate candidate must not only
meet the medical criteria, but must also be
psychologically ready for this surgery, and for
what it means afterward. While there might
be some resemblance, recipients will neither
look like themselves nor like the donor. It
can be a lot for someone to grasp, even for a
patient who up to this point has been living
with a badly disfigured face. That is why
candidates are screened for psychological
issues, including depression and post-traumatic-
stress disorder, which would interfere with their
ability to accept and recover from the transplant.
The program also provides psychiatric care
around the time of the procedure as well as
long-term follow-up with psychiatric therapy.
How is the surgery performed?
to the donor hospital and procures the tissue to
be transplanted, taking only the tissue that the
recipient will need. A second team prepares the
patient, removing damaged tissue and scar tissue
down to the healthy, underlying structures. The
reconstruction begins by anchoring bone in place
and attaching muscle to the facial skeleton. Blood
vessels, nerves, ducts and glands are attached to
corresponding structures, and then skin is closed.
It is a laborious, lengthy procedure than can take
more than 20 hours, depending on the case.
Patients will remain in the hospital for the first
month following surgery, and will start speech
and occupational therapy, which will continue
for a year to 18 months. After they are discharged
from the hospital, they will spend another two
months at nearby UCLA housing, and then they
will be seen monthly for the next year, and then
with decreasing frequency.
The surgery is very complex and involves many
different specialties. How is it being funded?
As one might imagine, this kind of procedure is
very expensive — around $600,000. Right now our
funding is coming from UCLA Health and private
sources. But we are hopeful that the U.S. military
may become involved in supporting our program
as we move forward. The Pentagon has been very
interested in research into such programs as facial
transplantation and regenerative medicine to
treat wounded veterans, and it has given several
million dollars to Brigham and Women’s Hospital
in Boston, which has done the majority of face
transplants in the U.S.
In March 2012, Richard Lee Norris, who was
injured in a gun accident, received a full
face transplant at the University of Maryland
Medical Center. He is pictured in the second
photograph seven months after the procedure.
Once an appropriate donor is identified, two
teams begin work in concert. One team travels
Photos: Courtesy of University of Maryland Medical Center
Kodi Azari, MD, FACS
7 UCLA Physicians Update