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