PARIS (AP) – An ethics debate broke out over the world’s first partial face transplant Thursday with one surgeon challenging the decision to operate, while others suggested a bit of jealousy might be at play.

At the same time, several doctors raised concerns about the psychological health of the French woman who received a transplanted nose, lips and chin on Sunday. She had been brutally mauled by a dog in May, and her identity remains unknown.

Dr. Laurent Lantieri, an adviser to the French medical ethics panel, said the surgeons who operated violated the panel’s advice because they failed to try reconstructive surgery first. He said a transplant donor was immediately sought without trying to repair the woman’s face with more conventional surgery.

Lantieri, who had seen a picture of the woman, said, “She had a complete amputation of both lips. The tip of the nose was amputated.” Her new donated facial parts came from a brain-dead woman.

The panel had previously objected to full face transplants but said partial ones could be considered under strict circumstances, which included first trying normal surgery.

“The ethics committee said this kind of transplant should never be considered as an emergency procedure,” Lantieri said.

However, surgeon Denys Pellerin, of the National Consultative Ethics Committee advised by Lantieri said, “as long as the transplant is not total, it is not unethical.”

And Dr. Jean-Pierre Chavoin, secretary general of the French society of plastic surgery, noted that Lantieri had planned to do a face transplant himself and had been beaten.

Carine Camby, director general of the agency under the French Health Ministry that coordinates organ procurement, said normal reconstructive surgery could not have been used in this case.

“It is precisely because there was no way to restore the functions of this patient by normal plastic surgery that we attempted this transplant,” Camby said. “She could no longer eat normally, she had great difficulty speaking and there is no possibility with plastic surgery today to repair the muscles around the mouth which allow people to articulate when they speak and not spit out food when they eat.”

Camby also said the patient “received many psychiatric examinations. The psychiatrists decided that she understood the surgery and that she accepted all of the consequences, including the risk of rejection and of failure, the risk of immune supression treatments and the need to take them for life.”

But Chavoin, who took part in preparatory meetings about the patient’s case over the last several months, questioned her psychological health.

The patient “seems to have quite a depressive profile,” he said.

The operation was done at a hospital in Amiens, in northern France, by ground-breaking transplant surgeon Dr. Jean-Michel Dubernard and Dr. Bernard Devauchelle. Dubernard led teams that performed a hand transplant in 1998 and the world’s first double forearm transplant in January 2000.

The hand transplant recipient later had it amputated. Doctors said the man failed to take the required drugs and his body rejected the limb.

Lantieri said he was fearful that this operation could turn out like that first hand transplant if the patient is psychologically unstable.

Dubernard did not return a phone call seeking comment Thursday. A news conference is set for Friday.

The face transplant patient, now in Dubernard’s ward in a Lyon hospital in southern France, was also to have a second experimental treatment – an infusion of the donor’s bone marrow – to try to prevent rejection of the new tissue.

“Maybe Jean-Michel Dubernard is revolutionizing the concept of transplantation,” Lantieri said, but added that the patient now was being subjected to two untested treatments.

Lantieri, who developed his own plans to attempt a partial face transplant, said members of Dubernard’s team contacted him last spring, seeking details of his protocol.

He said that a surgeon in Lille where the transplant donor lived, had reviewed the woman’s record and told him he was concerned about the circumstances of her injury. It involved one or two dogs, Lantieri said.

In the United States, surgeons and psychologists at two medical centers that hope to offer face transplants – the Cleveland Clinic and the University of Louisville – declined to comment Thursday on the French case.

In an interview at the Cleveland Clinic in July, surgeon Dr. Maria Siemionow stressed the several years she had spent developing procedures and how carefully her team now is working to select potential candidates for the operation.

“I hope nobody will be frivolous or do things just for fame. We are almost over-cautious,” she said at the time.

Another surgeon familiar with the French case sounded more optimistic despite the woman’s horrific injuries, which he said were caused by her own dog.

“She still has her own eyes, which are a lot of a person’s expression … we’d expect she’d turn out to be a pleasant-looking girl,” Dr. Earl Owen told the Sydney Morning Herald in Australia.

Owen said he supervised the French surgeons as they practiced for the procedure. He said the woman will look more like herself than the donor, who he said was a woman.

“We expect the bone structure underneath to be a more powerful delineator of what the outcome will be physically than the skin and the nose and the lips,” Owen told the Morning Herald.

Lantieri also said that while he had concerns, “I’m still very positive.

“Dubernard is a great surgeon. We have to wait now to see if it succeeds.”

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John Leicester is chief of the Associated Press’ Paris bureau and Marilynn Marchione is a medical writer based in Milwaukee. Associated Press writer Carole Bianchi contributed reporting from Lyon, France.

AP-ES-12-01-05 1904EST

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