A delicate touch: Securing donors requires sensitivity, French surgeon says

Key Points

"People have no consciousness of their internal organs," says Laurent Lantieri, M.D., head of plastic surgery and leader of the face transplant team at Henri Mondor Hospital, Créteil, France.

That's why French law assumes everyone is an organ donor, except people who specify otherwise, he says.

"So, there's a philosophical and ethical difference - not an immunological or technical difference - between internal and external organs in terms of harvesting," he says.

With face or hand transplants, therefore, "You must have the acceptance of the family," he says. "It goes beyond just getting a signature."

Securing family approval for the face transplant he performed required a series of conversations with the French organ procurement agency, all of which were taped for legal purposes, Dr. Lantieri tells Dermatology Times.

Agency representatives first asked the family if the potential donor had ever discussed organ transplantation with them.

"Once they were OK with the idea of organ transplants," Dr. Lantieri says, "then organ procurement representatives told them that this patient was potentially matching a recipient that we had in terms of skin color and blood type."

Representatives also explained that surgeons might not be able to find another donor for six months or more, he says.

Dr. Lantieri's team also made a mold of the donor's face before harvesting tissue. From the mold, team members made a resin mask painted to match the donor's skin. They placed the mask over the donor's face before returning the body to the donor's family.

"We're very grateful for the family for having accepted (tissue donation) for the patient," says Dr. Lantieri.

But in the French population at large, he says awareness of the need for face-transplant donors remains low. This situation may change, he says, as physicians and journalists help people to understand the importance of these organs.

"It's only a question of time," he says. "I believe in the next five to 10 years, there will be many face and hand transplants."

Disclosure: Dr. Lantieri reports no relevant financial interests.

For more information: http://www.hmn.ap-hop-paris.fr/