Isabelle Dinoire, who recieved the world’s first partial face transplant, provoked lively debate
about the ethics of the operation, but was
more concerned about media harassment of her and her family. (Includes some of the latest photos of Isabelle Dinoire)

The news of Isabelle Dinoire’s pioneer operation in France last
November got doctors and ethicists asking whether she could live with a
dead person’s face or suffer psychological damage from losing something
so essential to her self-image.

Isabelle Dinoire

With medical ethics panels in
France, Britain and the United States advising caution before
undertaking the risky operation, transplant surgeon Dr Jean-Michel
Dubernard was accused of "jumping the gun" to be the first to perform
the feat.

But Dinoire, 38, showed no sign of doubt about the
rights or wrongs of her operation during her first meeting with
reporters at the Amiens hospital in north-eastern France where she
received a new nose, lips and chin after being mauled by her dog in May.

Asked how she reacted on first seeing her new face, she replied calmly: "All I could say was ‘thank you’."

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"Since
the day of the operation I have had a face like everybody else,"
Dinoire said with some difficulty, her cheeks showing fine scars
bordering the new skin.

Her only complaint was about harassment
by journalists eager to snap a picture or glean quotes for a story. She
did not name names but most news and pictures about her have been
published in the British press.

"It would have been good if I
could have avoided all that, especially because they harassed my
family, my neighbours and the family of the donor," she said. "I want
to live with my daughters again and try to live normally and not be
harassed."

Dubernard ended the news conference with an impassioned plea "that her private life and her dignity be respected."

Immediate acceptance

In
their introductory remarks, Dinoire’s surgeons and psychiatrist
responded in detail to several ethical questions that have been raised
in recent weeks.

Dubernard said he made sure she was fully briefed about the risks beforehand and was in a clear mind when she accepted them.

Critics of the procedure have argued that a person with such shocking injuries might not be able to make a rational decision.

Dinoire
wore a mask over her missing nose and lips as they conducted the
operation. "At the end, she took off her mask and, frankly, from then
on I had no hesitation," Dubernard said.

"If that had been one of
my two daughters, it would have been exactly the same thing," he said.
"We’re doctors and our duty is to do everything for our patient."

With her mouth torn away, Dinoire had great difficulty speaking and eating while she waited for the transplant.

Psychiatrist
Sophie Cremades said long talks with Dinoire before the operation
showed she had got over the initial trauma of the mauling and was
looking ahead to getting a new face.

"What struck us all the day
after the operation was her relief at finally having a face after six
months of waiting," she said. "This relief was such that acceptance was
immediate."

Another surgeon, Bernard Devauchelle, said the
alternative – grafting Dinoire’s own skin to rebuild her face – would
have needed 6 or 7 operations and would not be finished even now.

Don’t jump the gun

The
ethics of facial transplants have been discussed in medical circles for
several years, with experts ruling out full transplants and very
reserved about partial ones.

"There are too many questions
remaining about the procedure and problems with immunosuppression to
proceed at this time," Dr William C. Pederson, president of the
American Society for Reconstructive Microsurgery, wrote last autumn.

The image “http://www.laprensahn.com/imagenes/fotos/2006/interiores/3554.jpg” cannot be displayed, because it contains errors.

"Obviously someone is going to have to be the first, but I would urge our colleagues not to ‘jump the gun’," he added.

Britain’s
Royal College of Surgeons, expressing the same view in 2004, asked
about negative psychological reactions because the face is central to a
person’s self-image.

"The potential loss of their old appearance,
however disfigured, could be incalculable," it wrote. "Indeed, even
were the graft to be a technical success, patients may still be highly
distressed by their new appearance."

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