Vall d'Hebron performs the world's first face transplant from a donor who received euthanasia

BarcelonaBefore arriving at Vall d'Hebron, Carmen had only heard the word No when a doctor visited her. While traveling in the Canary Islands, she suffered an infection that caused necrosis of the facial tissues, leaving her completely incapacitated. She couldn't eat or drink, she couldn't breathe properly, and she was disfigured. "Physically, it was quite unpleasant," recalls the patient, who went through three different intensive care units (ICUs) without any alternative until she met Joan-Pere Barret, head of the Plastic Surgery and Burns Unit at Vall d'Hebron Hospital, who proposed a face transplant. "It was the only solution for me to be able to lead a normal life again; Dr. Barret is my guardian angel," says the patient, her voice filled with emotion, four months after the operation. "Now I don't mind going out, I can eat again, I can drink coffee. I'm back to living a normal life," explains Carmen. A face transplant is a very complex procedure, and only six have been performed in the entire country, half of them at Vall d'Hebron. In fact, the Catalan hospital became the first center in the world to perform a full face transplant in 2010. This time, it was the world's first partial face transplant, with a donor who underwent euthanasia and decided to donate her organs and tissues, including her face.

Fifty-four face transplants have been performed worldwide, and only about twenty centers are equipped to perform facial transplants. Carmen's operation involved a hundred professionals from different specialties. Skin, adipose tissue, peripheral nerves, facial muscles, and facial bone are transplanted: the surgery is extremely complex, as the structures to be reconstructed are small and have a complex three-dimensional structure. The operation can last between 15 and 24 hours in total. "It's not just about placing soft tissues to give a normal appearance. That would be a transplant failure. This operation is performed to restore function and sensation," explains Barret.

A face transplant is a functional surgery performed when the patient has lost areas of the face, such as the orbicularis oculi muscles and the eyes, and these cannot be restored with other standard surgical techniques. Recipients are patients with severe facial disfigurement resulting from diseases, burns, trauma, or congenital defects that affect basic vital functions. "A face that doesn't sit or move is nothing more than a mask. We're talking about structures with all kinds of tissues, with muscles and nerves, some with diameters of 0.2 millimeters, that need to meet and connect," explains Barret.

3D Planning

The euthanasia law in Spain, which came into effect in June 2021, opened a new possibility for transplants and also slightly changed their paradigm, as program coordinators can now interview potential donors at home. In this transplant, once the donor received authorization for assisted dying (PRAM), the hospital professionals planned the procedure. In fact, it was also the first face transplant in the world in which a 3D model could be created for both the donor and the recipient.

The donor was a woman who had requested euthanasia and had expressed her willingness to also donate her face if necessary. She spoke with the transplant team. "Words cannot express the emotional intensity and magnitude of the moment. The only thing the donor wanted was to know if she could donate her face," the professionals explained. In fact, in addition to her face, she also donated her lungs, liver, kidneys, and all kinds of tissues to people who needed them. "Sometimes you find a light that allows you to move forward," says Carmen, who insists on thanking the entire Vall d'Hebron team and, above all, the donor and her family.