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Ideas

For transplant purposes, your face is now an organ

A new federal rule opens a window onto a strange new medical universe

photo illustration by lesley becker/ globe staff; istock

When you agree to be an organ donor, you might imagine that one day your kidneys or liver may no longer be yours. Modern medicine has taught us to accept, in kind of grisly fashion, that our bodies consist largely of interchangeable parts—“your” liver is really just a liver, another organ that might be equally useful in someone else’s body.

This summer, the list of interchangeable parts gained a couple of new members that might not seem as easily shareable. On July 3, a new rule from the Department of Health and Human Services went into effect that classifies faces and hands as “organs,” for the purposes of transplant surgery. The change in status—prompted by the recent success of a small number of hand transplants and face transplants—brings these body parts under the regulation of the National Organ Transplant Act of 1984.

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If the face and hands don’t quite seem like typical “organs,” there are plenty of reasons why not. Medically, they’re more complex assemblies of tissue. Colloquially, we think of organs as almost invisible motors inside us; you never see your own lungs or pancreas, and if someone gets a skin graft from your body, it won’t be recognizable as yours. You can register as an organ donor without thinking too much about prominent parts of your body living on without you.

Now that’s changing. The first face transplant was performed in 2005 in France, and since then more than 20 more have been conducted around the world, including a number at Brigham and Women’s Hospital. Modern hand transplants date from the late 1990s. The procedures are still exotic and risky, but are likely to become more common.

Before the new definition, these experimental transplants were the responsibility of the FDA, which oversees medical products for use in humans—including body parts like corneas and heart valves—but not organs. The change allows face transplants to take advantage of the government’s expertise in monitoring transplants, as well as the sophisticated national network of organizations that coordinate them. “There’s this whole machinery that’s highly efficient and very well trained to do [organ transplants], but as it stood with a face transplant...it was like a mom and pop operation,” says Sue McDiarmid, a transplant surgeon at UCLA and chair of the committee with the United Network for Organ Sharing that lobbied for the new rule.

McDiarmid is quick to note that classifying faces as “organs” doesn’t mean that organ donors are now also potential face donors. “We don’t think the general public is at a point now where we can rip off somebody’s face just because they signed a state registry....The policy is you have to have separate, explicit consent from the family for hands and face,” she says.

Calling faces and hands “organs” may make sense as a regulation, but it’s a viscerally strange way to see them. “The thought of transplanting such a highly visible personal part of somebody is a very different concept than thinking of putting someone’s kidney in you,” says McDiarmid.

We’re cognitively hard-wired from birth to recognize people by their faces, and across cultures, people touch each others’ hands as a way of knowing them, says Michael Sims, author of the book, “Adam’s Navel: A Natural and Cultural History of the Human Form”: “I think part of the weirdness is we’re demoting these things from symbolic to merely functional.”

Medically speaking, faces and hands haven’t quite been given the same status as a pancreas; they’re considered “vascularized composite allografts,” acknowledging that they’re made of a wider range of tissues than a typical organ, though like an organ, they perish quickly without a blood supply.

As remarkable as it seems now, faces and hands are likely to be the most commonly transplanted parts among this new class of organ, says McDiarmid, driven in large part by injuries suffered by soldiers in the Iraq and Afghanistan wars. (Legs are transplanted less often because transplanted legs work less well than prosthetic ones.) But there are more coming down the road, she suggests, some of which raise equally strange prospects. “There [have been transplants] of the larynx, of a whole vascularized knee joint,” says McDiarmid. “There’s been some (very few) uterus transplants, even some thoughts of penile transplants....It’s a very wide open field.”

Kevin Hartnett writes the Brainiac blog for Ideas. He can be reached at kshartnett18@gmail.com.
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