Excitement buzzes around Seattle Grace. It's a historic moment; Dr.
Sloan is about to perform the fifth face transplant, ever. Interns,
residents and attendings alike want in on the surgery that Mark has
spent years prepping for. He's come up with a surgical plan, pitched it
to the medical community, listened to their questions, revised and
defended his plan. Once they approved him to do the face transplant, he
searched for and found the right patient (David Young). Someone with
severe facial deformity, who could pass the psychiatric testing,
someone who the ethics committee would approve, someone who had a
support system in place to help with the grueling physical and
psychological aftermath of the surgery. Once he had the receipient in
place, he had to find a deceased organ donor who matched the
recipient's blood type, skin type, gender and age. Whew! I'm tired just
thinking about it.
Why are face transplants so complicated?
Because they're complicated. They're risky. They're experimental.
They're dangerous. And the medical community is still trying to decide
if they're ethical.
They're physically complicated because it takes about ten hours to
remove the face from a deceased donor. The surgeon must painstakingly
cut each blood vessel and nerve and preserve it for reconnection, then
peel off the skin and put it in preserving solution to transfer it to
the recipient's OR.
There the recipient is prepped. Using bone and cartilage from the
donor, the surgeon rebuilds facial structure, precisely places the skin
and begins to meticulously connect the nerves and blood vessels. This
also takes about ten hours. Once the blood vessels are connected, if
the skin turns pink, it was a success.
If it doesn't, it's bad. (One of the reasons it's so risky.) In order
to qualify as a recipient for a face transplant, the patient must have
undergone every known procedure for grafting facial skin. The backup
plan is a repeat of one of these methods, something that has already
failed for the patient. Doctors know it won't work. They know it won't
restore functionality, but they can't leave the facial muscles exposed,
they have to do something. So, they harvest remaining skin from the
back and legs and graft it onto the face. This is one reason a patient
must undergo psychiatric evaluation. If this goes badly, it goes really
badly and the patient has to be prepared.
He must also be prepared to wear the skin of a dead man on his face for
the rest of his life. That's just the first thing on the list of things
he's going to have to do for the rest of his life. The other huge thing
is, take immunosuppression drugs. These keep his body from attacking
the skin graft, but they also stop him from being able to stop or fight
infection and make him prone to lymphoma or diabetes. Even with the
immunosupression drugs he will have to live with the knowledge and fear
his body could reject his new face at any moment.
The psychologist is also confirming the patient wants to live. After
all, the family of the facial tissue donor is giving up an open casket
funeral. So, the recipient cannot be suicidal, he has to be willing to
fight for his recovery.
Sheesh. That's a lot. But, living without a face and feeling like a
monster is a lot too. Which is why doctors and ethicists approved the
trial face transplants. See, deformities are horrible and disabling,
but not life threatening. So, doctors really had to think hard if it
was ethical to put a patient through a potentially fatal surgery and
let them live on immunosuppression drugs, which have potentially fatal
side effects, in order to potentially (not absolutely) improve a
condition which is not life threatening. If it were a heart, or another
vital organ, doctors reason the potential benefit (extending a life) is
worth the potential risk (speeding an already imminent death). But, in
the case of a face transplant, is it doing harm? One side argues, the
patient could live a long life with facial deformity. The other side
responds that the quality of life matters and should be taken into
consideration.
See, it's all very complicated and makes me glad I'm the director of
medical research and not a fancy ethicist making life and death
decisions for other people.
But, one thing is definite. We need friends and we need to let our
friends help us. David Young learns this when he turns his friends
away, afraid they will reject him because of his deformity and risks
losing the surgery he is so desperate to have. One of the
qualifications to get the surgery is recipients must have an active
support system to help them through recovery. Izzie learns something
from this patient and is willing to accept help from her friends in her
fight against skin cancer at the end of this episode.
