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1st U.S. face transplant is reported

Seriously disfigured woman has world's 4th such surgery, in Ohio.

A woman so horribly disfigured she was willing to risk her life to do something about it has undergone the nation's first near-total face transplant, the Cleveland Clinic announced yesterday.

Reconstructive surgeon Maria Siemionow and a team of other specialists replaced 80 percent of the woman's face with that of a female cadaver a few weeks ago in an operation certain to stoke debate over the ethics of such surgery.

The patient's name and age were not released, and the hospital said her family wanted the reason for her transplant to remain confidential. The hospital plans a news conference today and would not give details until then.

The transplant was the fourth worldwide; two have been done in France, and one was performed in China.

Details of the Cleveland surgery were not disclosed, but surgeons generally transplant skin, facial nerves and muscle, and often other deep tissue. That is done so that the new face will actually function and not just be a mask.

Surgeons not connected to the case reacted cautiously since little was known about the circumstances, but they generally praised the operation.

"There are patients who can benefit tremendously from this. It's great that it happened," said Bohdan Pomahac, a surgeon at Harvard-affiliated Brigham and Women's Hospital in Boston who plans to offer face transplants, too.

Unlike operations involving vital organs like hearts and livers, transplants of faces or hands are done to improve quality of life - not extend it. Recipients run the risk of deadly complications and must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer and other problems.

Arthur Caplan, a leading bioethicist who has expressed grave concerns in the past about such surgery, withheld judgment on the Cleveland case but said the woman's doctors should give her the option of assisted suicide if they make her life worse.

"The biggest ethical problem is dealing with failure - if your face rejects. It would be a living hell," said Caplan, bioethics chief at the University of Pennsylvania. "If your face is falling off and you can't eat and you can't breathe and you're suffering in a terrible manner that can't be reversed, you need to put on the table assistance in dying."

Siemionow's long and careful preparation should help prevent such a horrific outcome, those familiar with her said. Siemionow (pronounced SIM-en-now), 58, a noted hand microsurgeon, has been testing the surgical approach and ways to temper the immune system's response in experiments for more than a decade.

She considered dozens of burn victims and other potential candidates over the last four years, ever since the clinic's internal review board gave her permission to attempt the operation. She said she would choose someone severely disfigured as her first case.