Talk about "saving face"

Bad pun aside, this woman must feel pretty grateful. Apparently, the anti-rejection drugs she is on will shorten her life significantly, but she feels it’s worth it. I think the doctors did an amazing job. Much better than the alternative.

news.bbc.co.uk/2/hi/health/6058696.stm

I would too. discuss?

What are the ethical objections? I don’t know exactly.

I remember reading about her, however. She continues to smoke cigarettes - an absolutely ludicrous thing to do. Nicotine causes blood vessels to constrict, thereby limiting blood flow. Something I imagine, the surgeons would not want to see happen as it could’ve compromised the transplant. I guess it didn’t.

On the surface, I see it as a win - win prospect. The woman has her life back, and the medical community has the benefit of knowledge gained from doing this procedure.

Bodo

I think you’re being too harsh. I know I like a cig or twenty when I’m off my face.

HG

[quote]Last November, Isabelle Dinoire was rushed to hospital after her dog had mauled her and torn off her nose, lips and chin.

She herself has no memory of what happened. After taking sleeping pills, all she can remember is waking up with blood on the ground.

When she tried to light up a cigarette, she realised her nose, lips and chin were missing.
[/quote]

If you think about it this makes sense. She’d be putting the cig in her mouth and it would keep dropping out because there were no lips to hold it.

some people were bitching about the ethical stuff because they accused her of trying to kill herself, and I guess they thought she didn’t deserve to have a new lease on life. Shit, they give alcoholics and smokers new livers, hearts, and lungs all the time, don’t they?

Also, the donor face came from a patient on life support that was not expected to recover. The donor patient was apparently a suicide attempt (by hanging), and the surgeon says he did not know this. He says he wouldn’t have used that face because of the previous constriction of blood vessels due to hanging.

She’s pretty stupid to be smoking, but I guess it’s her life. It’s still possible that her immune system can reject the transplant, and the immunosuppressants that she is on also open her up to other infections.

I just think it’s impressive that they can do that.

[quote=“canucktyuktuk”]some people were bitching about the ethical stuff because they accused her of trying to kill herself, and I guess they thought she didn’t deserve to have a new lease on life. Shit, they give alcoholics and smokers new livers, hearts, and lungs all the time, don’t they?

Also, the donor face came from a patient on life support that was not expected to recover. The donor patient was apparently a suicide attempt (by hanging), and the surgeon says he did not know this. He says he wouldn’t have used that face because of the previous constriction of blood vessels due to hanging.

She’s pretty stupid to be smoking, but I guess it’s her life. It’s still possible that her immune system can reject the transplant, and the immunosuppressants that she is on also open her up to other infections.

I just think it’s impressive that they can do that.[/quote]

[quote]Organ allocation is decided by a complex set of guidelines that continuously evolve. UNOS maintains the lists of potential recipients divided by organ and ABO blood type. Potential recipients can be listed under multiple blood group lists as well as in multiple regions. Priority on each organ list is based upon several factors, including proximity to the donor, severity of illness, length of time on the waiting list, and special circumstances related to particular medical conditions. Objective scoring systems have been set up for the liver (MELD/PELD) and the lung (LAS). These objective scoring systems are based upon defined physiologic and laboratory parameters. A point scale system determines the recipient’s rank on each list. Organ allocation is then decided by the recipient’s points and the following additional factors:

Location (local, regional, national)

Severity of illness (except kidneys)

ABO blood type compatibility

Length of time on waiting list

Histocompatibility leukocyte antigen (HLA) match (kidneys only)

Degree of preformed antigen sensitivity (panel reactive antibody score, kidneys only)

Other special factors (eg, pediatric patients in specific age categories, reciprocal sharing arrangements or pay back agreements, dual organ recipient, liver transplant for hepatic malignancy, acute failure of recent transplanted organ)

Regional transplant centers have different sets of absolute and relative criteria for excluding potential organ donors. Early criteria were fairly strict, limiting evaluation to ideal donors aged 10-50 years with no comorbid conditions. With the increasing demand for organs, donation from an expanded donor pool has loosened restrictions considerably. Organs are harvested routinely from patients younger than 10 years and older than 50 years. Previously, such factors, as hepatitis C or active bacterial infection, were absolute contraindications. Now, such donors are often used for specific recipients. Relatively few absolute contraindications exist, and most potential donors are reviewed on a case-by-case basis. Additional absolute and relative contraindications are assessed for donation of specific organs.

Adaptations of the New England Organ Bank (NEOB) and the California Transplant Donor Network (CTDN) criteria are as follows:

Absolute contraindications

Age older than 80 years

HIV infection

Active metastatic cancer

Prolonged hypotension or hypothermia

Disseminated intravascular coagulation

Sickle cell anemia or other hemoglobinopathy

Relative contraindications

Malignancy other than in the central nervous system (CNS) or skin that is in remission (>5 y)

Hypertension

Diabetes mellitus (DM)

Physiologic age older than 70 years

Hepatitis B or C

History of smoking[/quote]

It is impressive that they can do transplants of all sorts these days. It is also important to realize that it’s not EXACTLY a new lease on life. As you have pointed out, these folks now are on immunosuppressant medications for life. I have taken care of folks pre-heart and post-heart transplant. It’s cool to see them doing better after surgery, but damn! They have to take a little pharmacy worth of meds on a daily basis. They have to come back to the hospital every 6 months for biopsies of their new organs to check for failure. They essentially have to live near a facility that is capable of handling their medical needs. Going on trips out of country, very very tricky. And these new organs don’t last as long as the ones you’re born with (a lifetime). Pullin this out of my bunghole here, but I think a kidney is good for 10 years.

As far as I know about giving alcoholics new livers, or smokers new lungs . . . well . . . the prospective patients have to give up their habits before they can get their new organs. I know . . . it’s easy to play the system, but in theory, no one is giving substance abusers “new” organs.

Transplant Living - This is an interesting site about living with transplanted organs. Lots and lots of info, if you’re interested.

Bodo

That’s right, we’re buying them from China’s condemned. It actually works out cheaper than health insurance over a 10 year chart. If you broke the right deal you get the pituitary ground and dried for wickedly cool Friday night nose candy.

HG

A couple of concerns that were raised by this case were:

  1. To give the transplant the best chances of success, the transplant tissue had to be taken off a living donor. This is common for many transplant procedures, but unlike in the case of say a heart or liver, there was the slight risk of the donor living after the life-support machines were turned off. How do you explain to someone waking from a coma that “we thought you were dead, so we cut off your face and gave it to someone else, sorry.”

  2. Also unlike cases where a heart or liver transplant is needed to extend the life of the recipient, having your face eaten by a dog doesn’t pose any immediate or long-term risk to someone’s health. Immunosuppressant drugs on the other had do, so looking at things on strictly medical terms this treatment actually does damage to the patient, which is contrary to the part of the Hippocratic oath which reads:

Thanks for the info on the ethical concerns related to this case.

Bodo