How Face Transplants Work

We're like Pete Townsend and Roger Daltery they do that, or like the Gallagher brothers from Oasis. Yeah, they hate each other, but when they get together it's like your gold. You know, it's magic man. So, Chuck, have you ever seen then John wou movie Face Off? I have not good Chuck. You want to talk about face transplants? Yes, you remember Travis the Chimp. It was like my first blog post ever. Ah yeah, yeah, that chimp that went crazy and Hampshire. Yeah, well apparently he tore that woman's

face off. Yeah. There There was a transcript of the of the nine eleven call and one of the cops is like, you need to send an ambulance out here. There's a man down. He is in trouble. The guy couldn't even tell it was a woman, like her face was pulled off. Um and uh. One of the things, one of the first things I heard after the detail at Grizzly Detail emerged was that this woman would likely

get a face transplant. Right. And I'd heard of him, but vaguely, and hadn't really put much thought into a face transplant, you know, I remember just from and we'll talk about her later. But the French woman was the one that came to mind. I hadn't heard about her. I wasn't paying attention, I guess. And what two thousand five, That was a rough year for you, it was, let me think, pretty hazy. Huh, Holy cow, I lost two

thousand five. I'm gonna have to give some thought to this while we're practicing new intros, right, okay, so um, so yes, this this poor woman who was attacked by this rampaging chimp, who was eventually shot to death by the police. Um, we'll likely get a face transplant. And we just so happened to have an article on the site appropriately titled how face transplants work. And that's what we're gonna talk about today, right. Yeah. I love this article.

By the way. It was gruesome. It was gruesome, but it was really I don't know, Stephanie Watson wrote, it's just really well written. It is well written. I agree wellheartedly. Um, there's all sorts of pictures, um. And actually there's an illustration like that I did too. Yeah. Um, the faces kind of draped over the skull. I like the face on ice. Yeah. Yeah, that was the best one. I think. I wonder if Marcus did that one. We'll never know.

We'll never know, no, so chuck um there. The first successful transplant of any kind was what nineteen and there was a physician I think he was in Boston named Joseph Murray, and he carried out the first successful kidney transplant. And he did it using identical twins, which was the key early on, like people had tried transplanting things before. But you know, in the transplant went well, but ultimately

the body rejected it. You know why, Uh, I want to hear your explanation, pal, Well, it's because the body isn't very receptive to foreign tissue. So when you get we're back in those days when you would get something transplanted. Your body sees that as a foreign invader, just like it would a disease or something, and the white blood cells kick into gear and just go into attack mode. The body no likely foreign invaders now, But if you're identical twins, um, you had enough of a match to

where it worked out. Right. The problem is that most people who need transplants don't have identical twins, so it's a it's a terrible way to you know, establish medical procedure, but it was a good way to starting well sure, and it was successful. He showed that you can transplant human tissue from one person to another and it be successful. So that was like the real milestone. Uh. And then after that, you know, people started exploring other ways to

do this without uh, you know, um, identical twins. You know how I want to hear your explanation. Well, you're really piping up today, aren't Uh. By the nineteen sixties, what they figured out is that they could suppress your immune system. Then you could using drugs like a cyclosporine, you could you could be successful with the transplant. And what they're trying to suppress their things called and egens,

which are proteins. They're found on the exterior of uh tissue tissue cells, right yeah, um, and and those are the things that create that prompt an immune response. So they're the ones that sense like, well, whoa, whoa, I don't remember this hand being here before we lost our hand. What's going on here? Go get rid of that hand, right, And then the white blood cells attack like the cavalry, which is awesome. I mean, it's great. It's cool that your body does this because that means you have a

robust and violent immune system. Of course, if you're trying to get a transplant, it's no good. But you want your body to go after things with bigger like yeah, like mersa, you don't want that, no, no, but yeah, if you have a hand, you you you wish you could tell your your antigens to just settle down. It's your new hand and you're pretty fond of it to

keep it right. So, so the problem is the the drugs that they came up with were immune suppressive, meaning okay that the antigens are no longer being prompted to attack the hand or send the white bloods also attack the hand, but they're also not being prompted to go attack the mersa bacteria that's in your body. Now, Um, you left you susceptible to other problems that pretty much everything else. I mean, how many uh, bacteria and viruses just germs in general do we come in contact with

any every day and we don't even notice? Like we did that one on toads causing wards and like twenty million people have the human pablova virus and um, you know, very few are actually suffering from it. We don't even know where carriers because their bodies can ward it off, right, So we had to come up with something better, and they did, but it was along the lines of immunosuppressive drugs. We just got the most slightly more refined, right Exactly.

Once we had that down, we started really going crazy with heart transplants transplants. Eighties and nineties is when they really kind of started mastering this whole technique, right, And then after that, after the vital organ transplants, we started getting into those hand transplants. I gotta tell you, I find that fascinating. Very Look, Skywalker, S know you're gonna say that, thank you. You know me so well, well, the way you're doing your hand, it was like the

scene from the movie. Yeah, it looks like it. Oh yeah, they can't see okay. Um. So, so inevitably we end up at facial transplants and it took a little while, but really, if you think about it, we went from the first successful kidney transplant to the first successful face transplant about fifty years. Not bad. That's pretty quick. Yeah. Yeah, So so let's talk about you want to talk about that poor girl in uh sound deep coo are or Josh.

She was nine years old in northern Indian. She was chopping grass to feed her buffalo, her family buffalo, which is a noble pursuit very much, and her hair got caught in the threshing machine and basically pulled her entire face and scalp and hair right off of her, clean off of her. Yeah, and and her family reacted promptly. They threw her face into a bag, put the girl on the back of a moped and drove to the

closest hospital, which was three hours away. So they drove their faceless, scalpless, hairless daughter to the hospital on a moped for three hours, and the doctors took a look at her and we're like, we can't do skin grass. This girl is never going to function properly again. So they actually put her face, scalp and hair back on and she she's functioning. Yeah. Actually, just I saw a picture of her at nineteen on the internet. She looks good,

you know. I mean, there's some scars, obviously, and I think her right eye has a little bit of a droop to it, so, I mean you can tell, but you know, if your face has been pulled clean off by a treasure, you really can't complain about the little droopy. I so that that was technically the first facial transplant, but the first real transplant from a donor came in two thousand five. Can I handle the grizzly details on

this one please. There's something that I noticed in researching how face transplants work, and that is that all face transplants begin with a horrible, gruesome event. Yeah, there's really no way to lose your face unless there's some horrible accident. And even if there's like a disease, it's a ravaging, horrible disease to like tumors or something, or the well, the elephant man disease. I think it is what they call it. Yes, he was not an animal, no um.

So this woman was named Isabelle Dean Noir and uh, she's a frenchwoman. And in two thousand five, she popped some sleeping pills, passed out on her couch and she woke up. I don't know if this is a normal habit of hers or not, but she woke up, and uh, I went to go light a cigarette and found that it kept falling out of her mouth. She didn't know what was going on. So she goes to the mirror and the lower half of her face I took from below her nose down was gone. She was nothing but

like tissue and teeth. And apparently, from what I understand, and I know you know something different, I'd like to hear it. From what I understand, her black lab chewed the bottom of her face off while she was sleeping. True. Is that true? It is true, But there's and I couldn't get a straight answer. I read a bunch of articles and follow up articles on this today and I still didn't get what I think is the absolute truth

of what happened. Some people um claimed she was committing suicide, and then the doctors denied it, but then one doctor said that she had tried to commit suicide. And um, then the the whole dog situation. You know, black labs,

I mean, you're a dog guy. They aren't to believe that a lab would do that, right, So what they think might have happened was she was out and the dog was concerned because they thought she was dead, and was pawing at her face and became really agitated and upset and pawed and scratched to the point where you know, there was blood probably, and then started chewing up like trying to evidently trying to wake her up. But there's speculation about that too. But they but they think the

dog did do it for some reason or another. They think the dog did it for a reason, trying to arouse her from her slumber. Um, because I think I read someone else said that you'd have to be so far out of it to not wake up with that kind of pain sensation that it had to have been a suicide attempt. So I thought it was a little odd that she took pills and fell asleep on the couch, right, I mean, yeah, And then she came out later and said that she hit her head and was knocked out,

so I'm not exactly sure what happened. All I know is the dog was put to sleep, which really is upsetting to me. That is upsetting, especially if it was trying to rescue her. I mean, the whole thing is upsetting. Regardless of what happened. Isabel Dean Noir got a face transplant. She did. Indeed, h this is the first major news uh worthy face transplant, which I still didn't hear about. That was a rough here for you. Um so uh.

Apparently they could have taken tissue from her chest to repair the damage, but she wouldn't have had very much movement, right, It would have just looked like a face, but not really exactly a fake eye or something. Right. But they what they want is feeling and function going on. They wanted to be able to smell and feel and have all the senses reacting, and that's the ideal. Most surgeons are perfectionists. Yeah, So, so what they did was they

found a donor. Here's what we're getting to, the ethical aspects. Can we jump ahead and move around a little bit please? Okay, there's the only person who can be a face donor is one who has to be on life support on life support, Well, someone has to be alive, right, but but you wouldn't give up your face? Sure, no, no

one's that. I just want to get specific. It has it has to come from a live donor, and the only scenario where that could happen is if you're brain dead on life support and then the family has to agree to pull the plug essentially, right, And remember we did the how comas work and we were we were positing whether or not people feel pain in deep vegetative states, and you gotta hope not when they're taking your face,

because that's exactly what they do. They go to the donor, they moved the donor into the operating theater, they take the face off. I imagined they cut around the scalp and then down behind the ears, maybe in front of the ears, whatever, below the chin, and that would be a full face transplant, as our illustration shows, they put it on ice. Well, this was a partial face transplant, okay, so it would have been like the lower part of

the face. But whatever part of the face you need, whether it's full or partial, it would be cut off removed, depending on whether or not any of the connective tissue was needed. Still any bone, any fat muscles, all of that stuff may be taken as well, and then it's again put on ice or whatever, transported to wherever the recipient is. And then all of these things are reattached. Blood vessels are reattached, a connective tissue, all this stuff. Um, and you have to do it in such a way. Well.

Number one, skin tones kind of a big, a big consideration. To find a match. Um, you want to find somebody, you have to do h l a testing or matching, which is that antigen testing to make sure that that you have a similar enough immune system that there won't be a rejection. Um, you may have to put bone down, as was the case with a Chinese guy in what two thousand six and uh, he was malled by a bear? Right, what what is going on? Right? He was malled by

a bear. And this was a unique case different from the French woman because he was missing skin and part of the bone in his nose and cheeks. He was a huge challenge. Hers was just skin in and his required quite a bit more. And we're talking like teams of fifteen to twenty doctors over the course of fifteen to twenty hours. Well with Madame de Noir. She had

a team of fifty doctors. They started at ten thirty at night and they finished at four the next day, four after four in the afternoon, went straight through the irony is as if she did try to commit suicide. Her face was donated by a woman who failed in a suicide attach. Yeah, how about that. Yeah it's a little odd, but yeah, okay. So they they also practice

the people of rats, cadavers, rabbits. There's a picture of I guess one of their test subjects, a rabbit with a face transplant on page zero, the first page of this article, and it's just cute as a button. But it's also furry. We don't have the luxury of fur as humans, so they kind of have to do a relatively good job reconstructing a face, and it usually takes more than once. They'll be several phases of surgery. Yeah, it shows, uh, And I've seen pictures of the frenchwoman

over the course of different surgeries, getting better and better. Um. What I thought was interesting was that once you have the surgery, you need to be on these immuno suppressant drugs for the rest of your life. So it's it's good that you're able to live through this and get a new face. But these drugs also put a serious DNT and your ability to survive and live a long life right, And apparently Madame de Noir is not really

helping things along. She refuses to quit smoking, and I thought you might respect that, and the doctors are like, come on, she smoked pretty soon afterward too. Yeah. Well, I mean, if you're a smoker, you're a smoker, dude, face transplant or no, I guess. So. Yeah, my first father in law got like shunts put in. He was smoking and golfing like a couple of days later. Really, he just wouldn't stop heart shunts. I should say, okay,

cardiac shunts. Um. Now, Josh, these are all partial transplants, even in the case of the one from China, and as of the writing of this article, we actually need to update this article. There were no full transplants, but there have been since then. Chuck, I have to say you were killing it today the external research. You corrected me at least once, if not twice. I am proud of Chuckers compass head hearts Chuckers um. So yes, Josh, I'm ignoring your praise there have been two transplants that

I know of. There may be more, but I've noted a couple that have happened that are full facial transplants. One of them was a woman in Chicago who they haven't named, keeping that quiet, who the doctor basically said she didn't have a nose, she didn't have a midface at all. And they were able to transplant Josh almost eighty three square inches of skin with muscle bone, upper lip, and nose from the donor still attached. Isn't that amazing? And Uh, the Cleveland clinic is where all this is

going on. Man, if you need a face transplant, you want to be in Cleveland. Uh. And then there was a man, a Frenchman who had the elephant man disease. Yeah, I see you have a sure there, kenseee wow played a difference yea. And this was just um March of two thousand and eight. He had a transplant and new lips, new cheeks, new nose, new mouth. We should we should publish this that that before and after photo and a blog. After the blog, this podcast comes out. What do you think? Yeah,

let me look and see if we can get right. Yeah, I think we can. But yeah, though, so apparently they can do full facial transplants now, it's it's an amazing and amazing thing. Well, that brings up another ethical concern besides, you know, taking the face of somebody who's not dead but his brain dead. Um. The other ethical concerned that that some parts of the medical community worry about is what happens when the wealthy are like, you know, I don't want collagen or botox. I'm just gonna get a

facial transplant from a poor, brain dead person. You know, I'll pay the family like dollars and take the face. I saw that in the article and don't buy it because right now, like, they do a good job with these transplants, but the end results certainly doesn't. You know. If you're like, if your aim is to be extremely handsome or beautiful, that's not what you're gonna get right now with a face right now. Sure, but again, Chuck, we went from the first kidney transplant to face transplants

in fifty years. Where are we going to be fifty years from now? And I mean, really, is there anything stopping vanity? No, there's not. And it's especially especially if we harness um genetics so that we can age right, we can we we we harness longevity, um, but we still kind of age poorly. You don't think that people are going to pay for a face transplant by e D if we're living to like one twenty on average. What I think will happen by in fifty years is

there will be other ways to make yourself beautiful. Like you said, to stop the aging process, there will be other ways besides uh, finding a beautiful brain dead person to take their face. I think that's just that's just me. We'll see, of course, you know, learning I'll be long gone. Both of us will check. Yeah, I think I'm going first too. Don't make your face no, And actually, let me also say this. This is such a tangential aside.

Did you know that if you are an organ donor, you should and you have a problem with your head being used for cosmetic surgery practice, you have to specify I do not want my head use for cosmetic surgery practice. Yeah, because they if you go into a med school that focuses on cosmetic surgery heads and they practice on you doing faceless and stuff. Interesting. Yeah, so organ donor, and actually I need to make that little caveat there, like,

do not use my face, it's too pretty. I wonder if I noted that you can use my face, but let me wear my flat cap. That would be cool. Yeah, it would like your tongue hanging out in one eye open still but your flat caps on cool to the end. Nice. So, of course, the best thing you could do is learned to be pretty on the inside, and then you wouldn't have to worry about anything unless you're all. Buy a bear, your black live, choose the bottom of your face off.

Then you get a pass for the face transplant thing. You want to learn more about that. It's a really cool article. You can type how face transplants work into the handy search bar and how stuff works dot com? And are we still doing plug fest? Alright? Our producer Jerry says yes, So let's do it, Chuck. Let's start with the blog abbreviated version. Yes, blog good, blog fun Josh Chuck Right, blog fans read blog fire bad? All right?

Moving on, Okay, the stuff you should know super Stuff Guide to the Economy that's on iTunes, worth the money getting good feedback. Type in super stuffed on the search bar on iTunes and you can get it all right, plug fest is over, Okay, so then it's time for reader mail. And uh, I see that that podcast finally came out where we said hi Ku is dead once

and for all. Yeah, yeah, that was great. It's interesting we still have some people writing in that are upset about the lack of hikus, and then um many others writing in saying thank you because I was tired of it as well. Well. In case anyone didn't get the memo, let's play that little clip from that that listener mail where we do say that hi Ku theaters dead. Here it is right, Josh. This is significant because today is the day where we retire Haiku Theater. Thank you. Did

everyone here that we are retiring Hiku Theater. We love your high Kus and you can still send him if you want, but we're not going to read him anymore. Agreed. Thank you, Chuck, Thank you, Thank you Chuck. So as you can see, I'm not lying, Hiku Theater is clearly dead. I don't see any reason for anybody sending Hiku. But what is not dead, Josh, are mistakes that we occasionally

make that will never will never die. And we got a correction, um from one we just did on the World ending in twelve and this is a good one, and I'd like to read the good ones. Yeah, the good science one. Um. I just wanted to make a small correction. You mentioned that the lava flows can be used to determine the direction of magnetic north in the past, which is true, but it is not because the lava actually flows toward the pole. So evidently, Josh, there are

magnetic properties of some of the individual mineral grains. And I know someone mentioned iron in one of their emails inside the molten lava, and that becomes a line with the direction of the pole. So when the lava cools and hardens, that direction is locked in. So the lava doesn't necessarily have to be flowing north, but the iron particles and other minerals in there are pointed north. And evidently you said the lava flows north, then that's not true, buddy.

So samples of the lava, if collected with care to note the original orientation, can then be brought into the lab and GEO referenced. And we get a big cheers from Jessica for that one. And also Peter wrote in about that, and John the Yellow Dart, thank you. John the Yellow Darts and we're not allowed to say last things anymore. That's why. If you're wondering gonna get in trouble for the Yellow Dart, then no, that was it was actually John the Yellow Dart blank. Oh got you? Okay,

well thanks, can we say blank? Then sure, John the Yellow Dark blank. So his last name is not blank? We know for a fact. Okay, because wouldn't that be ironic? All right, Well, thanks to all of you wrote in to correct me. You know how much I love that. And if you want to send a correction in or tell Chuck that his hair is beyond awesome, you can do that by sending an email to Stuff Podcast at how stuff works dot com for more on this and

thousands of other topics. Is it how stuff works dot com brought to you by the reinvented two thousand twelve Camray. It's ready, are you