Wedding Affirms Quality of Life for Face Txp Recipient

Yesterday's marriage of face transplant recipient Dallas Wiens and 70% burn victim Jamie Nash in Fort Worth, Texas was a triumph of love, medicine and social support.   Five years after he was burned in the Ridglea Baptist Church when the cherry picker he was using to paint the church touched a high power line, he returned to the same church for his vows with the woman he had met in a burn victims support group in Boston, the site of his face transplant.

Reported by the Boston Globe to be both the nation's first full face transplant, and the world's first without any rejection, in contrast to the recent sensitized patient (this blogger has no inside information), this face transplant marks the solid establishment of the era of Quality of Life Transplantation. Face, hand, uterus, and larynx transplants are performed to make people's lives better, not to directly prolong their survival. This is an enormous step forward from the prior fifty year long era of Life Saving Transplantation in which transplants were not optional - done only to salvage the life of the dying person with the luck to be selected and allocated an organ in time.

How have we gotten here - slipped virtually seamlessly into this new era? Evolutionary improvements in the armamentarium of immunosuppressant medications available to prevent +/or reverse rejection, better selection of donor and recipient through changes in tissue typing techniques, and overall improvements in medical/surgical care coalesce to make success predictably attainable in life saving transplantation. Results are so good today that we have created our own supply and demand crisis. So many people with kidney, liver, heart, lung, intestinal failure are suitable candidates for life saving transplants that we cannot offer them all organs - 18 die per day waiting for transplants in the U.S. alone.

That predictability of successful transplantation has empowered surgeons to brazenly perform these Quality of Life transplants, knowing the control of rejection can probably be achieved for their patients. With careful informed consent, people like Dallas Wiens, who said "I miss the sensation of my face and my sense of smell the most" in 2010 (AP 2010), can now have the life transformations they dream of.  Following the first laryngeal transplant in 2001, transplant surgeon Anthony P. Monaco MD, PhD, who had himself undergone laryngeal removal for cancer seven years earlier, wrote in the New England Journal of Medicine that "if I were 40 year old, I would probably consider undergoing the operation myself. For Dallas, who at age 27 can again eat, drink and smell normally (though he is blind), and his bride Jamie, all stars have aligned. May the quality of their married lives together also be the stuff of dreams, as his transplant has been to date.