Read Online Extreme Medicine by M.D. Kevin Fong - Free Book Online Page A

lit rooms on hospital corridors, are among the hardest in all of medical practice. For the team that approached a recently bereaved family somewhere in New England in March 2011 to ask for their consent to donate not only a heart or a liver but also a face, the task must have seemed impossible.
    The doctors took their time, talking over the intricacies of the procedure. They told them that it was among the first of its kind in the world—and in that respect as experimental as much of McIndoe’s early work. There could be no coercion, only openness.
    There were, however, reassurances. The transplant team made clear that the recipient of the donated face would not resemble their loved one. Once transplanted, the face, laid upon a new underlying structure of bone and tissue, would be as unique in appearance as any other. Neither identity nor appearance would be transferred.
    But there were also difficult realities to confront. After the retrieval of a face, efforts are made to reconstruct the appearance of the donor. Casts of the face are taken, and silicon masks are sometimes fashioned. But none of these restores the donor’s appearance enough to allow the body to lie in state in an open casket. All of this had to be understood and accepted. After deliberation and despite the magnitude of the request, the family members gave their consent.
    â€”
    T HAT DAY, PLASTIC SURGEON B OHDAN P OMAHAČ was sitting in the back of a private jet taxiing on the runway at Boston’s Logan Airport, waiting to take off. He was leading a transplant team, making ready to retrieve a donor organ. The plane was one of several regularly chartered by the hospital’s transplant service. Hearts, lungs, livers, kidneys, and other organs were ferried urgently across the United States in this way. But this mission was different. That evening Pomahač was going out to retrieve an organ as a prelude to a procedure that the United States had never before seen: the transplant of a complete face.
    Pomahač had waited a long time for this opportunity and had fought hard just to gain permission to attempt the operation. At the time, only one other full face transplant had ever been carried out—by a team in Spain a year earlier. Pomahač was nevertheless convinced that this procedure offered the only real hope for people who had suffered catastrophic facial injuries. But not everyone was of the same mind. He petitioned the institutional review board (IRB) at Brigham and Women’s Hospital repeatedly. The board, tasked with making sure that both the science and ethics of the proposed procedure were sound, was supportive but took some time to be convinced. The difficulty was that, unlike other transplant surgery, the transfer of a face did not ameliorate life-threatening illness. The review board had to weigh the very real risks of the procedure against its perceived aesthetic benefits.
    It wasn’t just the surgery that might present a threat. To be able to accept a transplant from another individual, the recipient’s immune system must be heavily suppressed to stop the newly grafted organ from coming under attack. For ordinary organ transplants, the tissue type of the donor organ must be matched as closely as possible to that of the recipient. Part of the body’s formidable defense against infection is its ability to distinguish foreign proteins and tissues from its own—a function fulfilled by the white blood cells patrolling in our circulatory system.
    Once recognized as “other,” foreign bodies are attacked by battalions of immune cells. These cells damage, destroy, and later engulf. Without this defense, the simplest of infections would prove lethal. But if you want a patient to receive an organ transplanted from another individual, these defenses work against you. The newly grafted organ is detected, attacked, and eventually rejected by the body.
    During World War II, plastic surgeons were aware that