Transplant surgeries move beyond body's vital organs

Recent successes of hand, nerve, muscle operations raise prospects, questions


Transplant surgeons who once concentrated on vital organs such as hearts, livers and kidneys are branching out, transplanting an array of body parts with surprising success and possibly heralding a day when tissues not essential to life are routinely given to others.

To the astonishment of many experts, two men recently given new hands in Lyon, France, and Louisville, Ky., are progressing well, without rejection crises. With less publicity, surgeons elsewhere have successfully performed experimental knee, larynx, trachea, femur, nerve and muscle transplants.

Possibilities grow

The newer transplants are believed to be few -- no central organization keeps a tally, and there is no way to know how many people would benefit from them if they proved successful in the long run.

Still, as word of the early successes spreads, doctors are beginning to stretch their imaginations. Leading transplant surgeons envision a future in which they can put new faces on burn patients; give a woman new breasts or a uterus; transplant penises; and reconstruct jaws and neck tissue for patients with cancer, gunshot wounds, dog bites or accident injuries.

But the new, nonvital transplants raise disturbing ethical questions. With rare exceptions, transplant recipients must, for the rest of their lives, take powerful anti-rejection drugs whose side effects include increased risks of infection, diabetes, cancer and other conditions. Who should decide whether the risk is worth the reward? Who should pay for the procedures? If they proved effective, would people be willing to donate their tissues for nonessential operations?

Ethical issues

"This is second only to cloning as an ethical issue," said Dr. Rollin K. Daniel of Newport Beach, Calif., a member of a team that performed experimental hand transplants on baboons in the 1980s at McGill University in Montreal.

The new transplant operations are generally experimental and must be approved by an ethics committee before they are carried out. Many of the newer procedures failed when they were tried years ago.

Improvements in surgical techniques, drug therapies and tests to monitor rejection crises have paved the way for the revival. But until scientists learn more about the new procedures, no one can be sure whether they will revolutionize medicine or end up as footnotes in medical history.

Meanwhile, a few doctors in such fields as orthopedics and transplantation who were not aware of each other's work have begun sharing information, learning about advances in other specialties and trying to apply them to their own fields.

Some surgeons are expressing tempered excitement at the explosion of possibilities. Success with the hand transplants, for example, could even lead to radical procedures such as a face transplant for a burned child, said Dr. John H. Barker, head of the Louisville team's research program.

Pub Date: 5/02/99

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