New questions were raised on Sunday over France's pioneering face transplant operation when a leading medical ethics professor said the surgery had been conducted with undue haste, as it emerged that both the donor and the recipient of the skin graft had attempted suicide.
The medical team that carried out the 15-hour operation was accused of ignoring ethical questions in the bid to be first -- and of using a rival doctor's technique. The saga took a further twist when it became clear that both the donor and the 38-year-old transplant patient had been involved in suicide bids.
Transplant patient Isabelle Dinoire, from Valenciennes, north of Amiens, was reported to have overdosed on pills last May following a row with one of her two daughters. As she lay unconscious, part of her nose, her mouth and chin were bitten off by her Labrador-cross dog, Tania.
The donor, whose name has not been released, was said to have been of a similar age and from the same area as Dinoire. She had hanged herself. Permission for the transplant was given by her family after she was declared brain dead.
On Sunday a row broke out after Emmanuel Hirsch, a professor of medical ethics and a member of the Biomedicine Agency -- one of the organi-zations whose approval was sought for the transplant -- said his particular committee had not been informed of the surgery. "I have the impression that everything was done in a hurry and that not all the questions involved were taken into account when there was no real urgency," he told the Le Journal du Dimanche. "We are talking about a pure experiment. Personally I would have expressed serious reservations about this transplant. I'd like to know why we weren't even informed about this operation."
Carine Camby, the agency's director, said Professor Hirsch's committee had not been set up when approval for the transplant was sought. "We received the request in May. The committee was set up in September. It was too late and there was a certain urgency because if we'd waited longer the problems of scarring would have made the transplant impossible," she told the newspaper. She added that the national ethics committee had published advice last year opposing full face transplants but approving of partial transplants "in certain conditions."
Doctors have played down speculation over Dinoire's suicide attempt, mindful of questions about the ethics of such surgery for a patient who is not psychologically robust. Yesterday, surgeon Jean-Michel Dubernard said Dinoire was in "very good general state" and added that "psychologically she is doing very well".
But Hirsch said that many worrying questions remained unanswered.
"How was the patient told about this, was it explained to her that she would be undergoing two experiments: the transplant but also a new immuno-suppressing treatment which involves the injection of stem cells from the bone marrow of the donor? The transplant, even partial, of a face is not just a medical but a psychological test because the identity of a person is involved. Was she well prepared for this?"
The Sunday newspaper also reported that another French plastic surgeon, Laurent Lantieri, claimed the transplant team stole his technique, after his own request to carry out a face transplant last year was turned down. He said one of the doctors who carried out Dinoire's transplant had called him in May "to ask for my protocol -- yes, I gave it to him," he told the newspaper. "Afterwards? I didn't hear anything more."
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