As China’s first facial transplant patient is recovering, debate on the ethics of such a surgery continues
　　
　　On July 28, China’s first facial transplant patient, Li Guoxing, was released from hospital 100 days after undergoing a successful surgery in Xi’an, Shaanxi Province.
　　
　　The transplanted part of Li’s face is alive and he has been doing very well, Guo Shuzhong, Director of Xijing Hospital’s Plastic Surgery Department, was quoted by Xinhua News Agency as saying. Guo directed the 14-hour operation on April 14.
　　Since French surgeons conducted the world’s first face grafting operation last November on a woman disfigured by a dog bite, their Chinese counterparts have been in a competitive mood, angling to be the first to undertake such a controversial procedure in China.
　　In April, Xijing Hospital came out ahead as it performed the first face transplant on Li, a 30-year-old farmer from a poverty-stricken village in southwest China’s Yunnan Province.
　　“I cannot believe this is real,” said Li at his first public appearance after his damaged face was restored.
　　
　　Deeply scarred
　　
　　In 2004, while herding sheep on a mountain near his village, Li was attacked by a bear, which scraped half of his once clean-cut face.
　　“It was an ugly face beyond imagination. Without the nose or the upper lip, all his teeth were exposed. Half of the face was damaged beyond recognition,” said the lead surgeon Guo, describing his shock at seeing Li for the first time despite his broad experience in dealing with similar cases.
　　Li went through numerous facial plastic surgeries after the accident, but they didn’t have much effect. In the two years after his accident, Li suffered from the psychological damage of ostracization. He chose to walk on the edge of the street, his face pressed against the wall, so as not to scare passers-by. Li said that sometimes he felt like a dead man walking.
　　“Many people who survive accidents but are disfigured will die slowly from isolation in society,” said Guo, a veteran surgeon.
　　Plastic surgery in China was energized by the attention given to the facial transplant in France. Surgeons in Beijing, Shanghai and Nanjing have launched their own facial transplant plans.
　　The possibility of grafting one face onto another ignited hope in Li’s heart. Funded by the Nature Conservancy headquartered in Washington, Li was admitted into Xijing Hospital on March 11 for a grafting operation. Doctors at the hospital were previously known in China for successfully transplanting the face of a rabbit onto another.
　　The hospital’s ethics board examined a report submitted by the transplant surgery team in advance, covering the odds of success, what could go wrong, how to deal with such situations and what is the worst-case scenario. After the ethics board ratified the plan for the operation, it was registered with the local health authorities, marking the official activation of the facial transplant project.
　　“The operation in France greatly boosted our morale,” Guo said.
　　Doctors found a face donor a month later, who, according to the hospital, was a brain-dead male. Li went into surgery on April 14, an operation that involved 10 surgeons and gave him a new cheek, upper lip, nose and an eyebrow. Xijing Hospital then declared Li to be the world’s first man to receive a face transplant.
　　Han Yan, another lead surgeon of Li’s operation, said there is no essential difference between Li’s operation and the facial transplant in France, except for that Li’s transplant is more difficult than that of the Frenchwoman. The female recipient in France had lost her nose, lips and jaw while the first face transplant surgery in China involved reconstructing a half-smashed face and the removal of two thirds of facial skin.
　　
　　Challenges to overcome
　　
　　Han also revealed an interesting detail about the operation. Ten hours after surgery, due to the restoration of blood circulation, hair started to grow on Li’s transplanted skin. Li’s family wanted to shave it with an electric razor, but to avoid infection, nurses cut the hair every day with a pair of surgical scissors.
　　“The biggest post-operation concern is infection and all our measures are targeted at preventing it,” Guo said.
　　To create a totally germ-free environment, Li lives in a sanitized hospital ward through the 100-day recovery period, with the air purified and everything in his room sterilized, including food and the clothing worn by medical staff. Before entering the ward, nurses have to pass five disinfection gates and spend almost half an hour changing clothes. After being fully prepared, the nurses have to stay in the ward for at least eight hours, for every visit increases the risk of infection.
　　At the moment, eight nurses have been divided into three shifts to take care of Li round the clock, including giving him eye drops every four hours and cleaning his mouth every two hours.
　　According to a Xinhua report on July 28, the swelling on the transplanted part of Li’s face has now almost disappeared, making his face seem more natural. His upper lip now has a small mustache and there is acne on the right part of his face. Guo said all this showed that Li was recovering well.
　　“Further plastic surgery will be carried out in two or three weeks, to make the right part of his face, his lips and eyes seem more natural,” Guo added.
　　The risk of immunosuppression and rejection is actually the biggest challenge facing Li. To suppress the chronic immunosuppression toward the donor’s tissues, doctors said Li must take anti-rejection medicines for the rest of his life.
　　The lifelong use of anti-rejection medicines not only poses a health risk, but also places a heavy financial burden on Li and his family. For the time being, the cheapest such medicine will cost Li between 1,000 and 2,000 yuan a month, which is almost equal to the monthly income of his whole village.
　　Doctor Teng Li from the Plastic Surgery Hospital affiliated with the Chinese Academy of Medical Sciences said that because of the cost, the anti-rejection drugs are a double-edged sword for recipients of transplant operations. Yet any virus attack could doom the whole procedure.
　　
　　A Face Farce?
　　
　　Some people proclaim the success of the facial transplant operation marks the advent of a new era, one in which changing face will be as normal as changing clothing.
　　Teng Li, a doctor with the Plastic Surgery Hospital affiliated with the Chinese Academy of Medical Sciences, believes facial transplant surgery should be encouraged as a scientific exploration, though he cautioned that experiments on animals should be conducted before clinical trials on humans.
　　“The practice demonstrates that the development of medical science enables human beings to unravel old mysteries,” Teng said.
　　Xia Xueluan, a sociologist and professor at Peking University, however, suggested that facial transplant should never be legalized.
　　“Once it is made lawful, it could be distorted as a normal plastic surgery,” Xia argued. “Since everyone wants to look prettier, what would happen then? It is the face that gives a person identity, so should a person be granted a new identity after being grafted another face?”
　　Xia gave two examples of potential problems. He said people would be panicked if they saw an acquaintance who had died walking in the street. And if a 40-year-old man was given the face of a 20-year-old, the man’s children would have to call a brother-like man father.
　　Another doctor who declined to be named raised additional concerns about the tricky ethical issues that follow a face graft. “Could you imagine your dead husband walking in the street, holding another woman’s hand? Could you imagine embracing your husband’s body but kissing another person’s face?” he asked.
　　Liang Huixing, a civil law expert with the Chinese Academy of Social Sciences, warned that if a facial transplant operation is misappropriated, it will impose a huge challenge on social administration.
　　In China, every identity card carries the person’s picture, which means the face, rather than fingerprint, voice frequency, retina or DNA test, is usually used to confirm a person’s identity. Under such circumstances, criminals could take advantage of a facial transplant operation as a way to dodge the law, Liang said.
　　“Facial grafting is a farce and it will never be allowed by the law,” noted Zheng Yefu, a sociologist at Peking University.
　　Zhou Xiaozheng, a sociology professor at the Renmin University of China, goes even further with his criticisms. “I strongly oppose the idea of changing face. If we can change face today, tomorrow we might want to change head, which would be totally ridiculous. Who will be the person? The owner of the head or the owner of the body?”

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