The surgeon who performed China's first face transplant in 2006 said he has been waiting years to help a second patient but cannot find a donor.
Guo Shuzhong, a top expert in reconstructive surgery, revealed in an exclusive interview that an unwillingness among families to donate a loved one's face after death is potentially holding back progress in the field.
"The surgery remains at the research stage, although knowledge and techniques have largely improved," Guo said. "But I have a female patient now who has been waiting years for the surgery, as there is no suitable donor."
The woman, a mother of two in her late 30s from Anshan, Liaoning province, was disfigured in a fire while in her 20s, he said, adding that she wears a mask to prevent her children from seeing the extent of her injuries.
Guo performed a partial face transplant in 2006 on a man from Yunnan province who had been mauled by a bear. It was a first for China and only the second time the operation had been performed worldwide.
Since then, the surgery has been performed 39 times worldwide, mostly in the United States and France. However, unlike organ donations, biological compatibilities like blood type alone cannot lead to suitable matches for face transplant patients.
"Other factors like gender, bone frame and appearance have to be considered, too," said Guo, who works for the First Affiliated Hospital of Xi'an Jiaotong University in Shaanxi province.
For instance, a woman, in theory, could receive a male's face as long as the necessary biological compatibilities are satisfactory. Laser therapy can also be used to remove excessive hair from the donor face.
However, he said, the patient in Anshan has said that she might not be happy with a "new face from someone of the opposite sex".
In terms of plastic surgery, there are more social determinants like tradition, social norms and aesthetics, Guo added. "One receives a liver transplant to survive. A face transplantation is for someone to feel alive again."
Demands for facial transplants exist mostly from those disfigured by war, disasters or accidents, he said, adding that the US has invested a lot in research due to demands from injured soldiers back from fighting in Iraq and Afghanistan.
But few families are willing to donate a loved one's face after death, and it's even harder to land a female donor because of social norms, he said.
"It's a common challenge worldwide," he said. One international practice is to reconstruct a donor's face using silicone, so that at their funeral they look the same as before they died, which can be a comfort to relatives, Guo said.
Another major challenge is post-operation tissue rejection. This happens when the transplanted tissue is rejected by the recipient's immune system, which in turn damages the transplanted tissue.
Compared with organs like the liver and kidneys, human skin is more prone to rejection, Guo said, citing international studies. The recipient must receive post-operation rejection treatments with drugs that suppress the immune system.
Isabelle Dinoire, who received the world's first partial face transplant in 2005, died in April. According to medical research, immunosuppressant drugs might have triggered the cancer that killed her.
Guo said his team had been dedicated to researching the link between the drugs and post-operation recovery.