British surgeons could perform the world’s first full-face transplant within months after being given the go-ahead yesterday.
Consultant surgeon Peter Butler and his team received the green light from the ethics committee at the Royal Free Hospital in Hampstead, north London.
It could mean that the transplant takes place there within a year, although there is stiff competition from other countries, including the US and France.
Mr Butler has already been approached by 34 patients from all over the world, but will select just four from the UK or Ireland.
As the news broke, the speed at which the decision was made criticised by the Royal College of Surgeons (RCS).
Its working party is looking at the issue and will release a report with full recommendations next month.
The hospital’s ethics committee is an independent body and was free to make its decision without consulting the RCS.
In a statement, the RCS said: "The College still has grave concerns about face transplantation, and will continue to advocate a cautious approach, but in the light of research over the last three years, and more recent evidence, the working party will suggest minimum requirements that must be fulfilled before a unit or institution should contemplate undertaking facial transplantation.
"We hope that the outline of minimal requirements will be of assistance to ethical review bodies, and we understand that the Royal Free LREC ethics committee will review their decision in the light of our report when it is published.
"We would urge the trust not to allow this surgery to proceed until that review has taken place.
"To reiterate the above, we believe that facial transplantation should only take place if all of the minimal requirements we will set out can be met."
The 44-year-old said: "I feel delighted that we have got the go-ahead. It’s been a long journey, but this is just the beginning, really.
"The most important part of the process starts now, which is selection of the patients."
The patients are all likely to have pan-facial disfigurement - which means the whole face has been affected by injury, such as severe burns spreading to the scalp or ears.
Mr Butler said: "These patients will have already undergone reconstructive surgery - perhaps they will have had 50 to 70 reconstructive operations.
"They have reached the end of the reconstructive ladder and there’s nothing more it can offer them."
Such patients are still affected by their injuries, such as not being able to fully close their mouth or eyelids, he said.
"Then they have the problem of integration into society, of being able to walk down the street in society without anybody staring at them. That’s all these people want - to be normal."
The full transplant would be carried out in a 10 to 12-hour operation.
Mr Butler said he hoped face transplants would become the first choice in reconstructive surgery if the operation proved a success.
Studies have shown that public support for face transplants is high, he said, and much has been done to allay people’s fears.
"One of the questions you get asked is: ‘If I donate the face of my loved one, am I going to see them walking down the street?’."
But computer modelling showed that facial characteristics following transplant are mostly those of the recipient rather than the donor, he said.
The main reason is that the skin is pliable and falls across the bone structure and cartilage of the person receiving the new face.
"There will be a transfer of things like skin colour and hair colour, but you would not be able to tell it is the donor’s face," Mr Butler said.
Four to six surgeons would be involved in the operation, with other staff, including nurses, anaesthetists and psychologists, working with the patient, the donor family and staff.
The surgery involves removing skin, underlying fat and various blood vessels, arteries and veins from the donor.
Mr Butler said the team would perform the first transplant and then wait around another six months before operating on a second patient.
After the operation, the patient is likely to need immunosuppressant drugs for the rest of his or her life to help prevent rejection of the new tissue.
The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) welcomed yesterday’s news.
Its president, Robert Page, said: "BAPRAS looks forward to facial transplantation becoming a routine procedure (as has happened with other tissue and organ transplants) when the specific challenges associated with the face have been fully addressed."
