Stanford 2006 Essay competition

	JRI IN THE NEWS
Each year, the Organ Donor Education program at Stanford University holds the James Redford Essay competition. This year's winner is Andrew Hsu, his essay is below. Andrew R. Hsu Stanford University School of Medicine – SMS I, Class of 2009 SUID #: 04747424 654 Cabrillo St. Apt. A Stanford, CA 94305 andyhsu1@gmail.com (650) 906-8923 Re: James Redford Award Essay Submission Facing the future of transplantation surgery ”Let no one ever come to you without leaving better and happier. Be the living expression of God's kindness: kindness in your face, kindness in your eyes, kindness in your smile.” - Mother Teresa People have said that life can be measured in smiles and frowns, and that if you smile at life it will smile back at you. Growing up in a Chinese household, I was frequently told a famous Chinese proverb which simply states that “A smile will gain you ten more years of life.” Whether a smile endows a decade or is simply a mantra for healthy living, it is undeniable that we as a species place enormous importance on our ability to express ourselves. The physical expression of emotions has been a source of inspiration and influence for art, culture, society, and the interpersonal relationships which shape our daily lives. The face transplant recently performed by French surgeons is an extraordinary testament to the advancements in transplantation surgery as well as the dual physiologic and qualitative healing power of modern medicine. It is an achievement which will undoubtedly benefit both patients and science for years to come. This year marks the 52nd anniversary of the first successful human organ transplant, an astounding feat now commonly taken for granted in the medical community. Breakthroughs in organ transplantation research over the past half-century have propelled our understanding of the body’s immune system by leaps and bounds, making it possible to successfully transplant organs such as the bowel, heart, lung, and skin and develop life-saving immunologic therapies. Dr. Jean-Michel Dubernard has now performed the first face transplant, an accomplishment deserving the highest praise and ethical consideration. Transplantation surgery as a whole remains a largely existential endeavor which puts into question our sense of self and identity. Are our personalities and lives separate and distinct from the organs and tissues that comprise us, or do they inherently determine our experience of life? In most cases, the organ transplanted is tucked beneath flesh and bone, hidden away from scrutiny which would spark regular contemplation. Now, though, the organ itself bears the expressions characteristic of rumination. After a savage dog attack mutilated her nose, lips, and chin, Isabelle Dinoire received replacement facial tissue last November from a brain dead woman whose family had given consent to the procedure. Articles heralded the procedure to the world with both acclaim and contempt. The idea of face transplantation is wrought with major medical, ethical, and moral issues. It is first important to understand the vast complexity and risks involved with face transplants. Vascular blockages in any of the hundreds of microvessels could damage or kill the graft, and powerful anti-rejection drugs that will increase the likelihood of cancer will have to be taken on a permanent routine. In addition, risks of graft rejection (10-50% over the first 5 years) could put patients in a worse medical situation then before the operation. These potential pitfalls beg the question: Does this predominantly aesthetic procedure warrant the health risks involved, not to mention the psychological issues that undoubtedly arise from looking in the mirror only to see a stranger looking back? I would argue that yes, in the case of Isabelle Dinoire the potential benefits to the patient and medical community warranted the risks. Although Ms. Dinoire’s life was not in danger without the surgery, that does not mean she was without suffering. The pain associated with disfigurement and the traumatic loss of one’s facial movement is not confined by functional boundaries. How can you objectively assess the value and meaning of a look of joy or sorrow on a person’s face? For many, the ability to fully express ourselves is synonymous with life itself. The late Ray Charles once said “I was born with music inside me. Music was one of my parts. Like my ribs, my kidneys, my liver, my heart. Like my blood. It was a force already within me when I arrived on the scene. It was a necessity for me – like food or water.” Although Mr. Charles’s ability to hear his music was not integral to his physical health, it was a vital part of his soul. Many critics have stated that Dr. Dubernard’s decision to perform the first face transplant was rash and motivated more by fame and recognition than a physician’s duty to practice beneficence or non-malfeasance. While it is true that a high-profile, risky procedure such as face transplantation carries with it media attention, the same can be said of the first kidney transplant in 1954 by Dr. Hamburger or the first liver transplant in 1963 by Dr. Thomas Starzl. Both procedures were highly publicized and considered extremely risky and potentially fatal if unsuccessful. However, both also significantly furthered our scientific understanding, making it possible to now routinely save and improve lives using these techniques. With any groundbreaking work there is a concomitant fissure in ethical viewpoints. In modern medicine, life is often objectified by risks and benefits in a series of computations, algorithms, and equations. While modern medicine accomplishes its goals, it does not give due credit to qualitative health concerns. I agree that Ms. Dinoire’s situation still remains precarious and that much of the physical success of her operation will be determined in the upcoming months. I also acknowledge that her operation will carry with it a psychological component which remains to be seen. However, as a future physician I value the diversity of opinions, choices, and lifestyles which encompass the human experience. Ultimately, in the years to come I believe the success for Isabelle Dinoire and future face transplant patients will not be measurable in terms of symmetry, nerve function, or immunity. As articulated by Mother Theresa in the quote above, I believe their success will be based on their ability to use the gift they were given to benefit humanity.

Each year, the Organ Donor Education program at Stanford University holds the James Redford Essay competition. This year's winner is Andrew Hsu, his essay is below.

Andrew R. Hsu
Stanford University School of Medicine – SMS I, Class of 2009
SUID #: 04747424
654 Cabrillo St. Apt. A
Stanford, CA 94305
andyhsu1@gmail.com
(650) 906-8923

Re: James Redford Award Essay Submission

Facing the future of transplantation surgery

”Let no one ever come to you without leaving better and happier. Be the living expression of God's kindness: kindness in your face, kindness in your eyes, kindness in your smile.”

- Mother Teresa
People have said that life can be measured in smiles and frowns, and that if you smile at life it will smile back at you. Growing up in a Chinese household, I was frequently told a famous Chinese proverb which simply states that “A smile will gain you ten more years of life.” Whether a smile endows a decade or is simply a mantra for healthy living, it is undeniable that we as a species place enormous importance on our ability to express ourselves. The physical expression of emotions has been a source of inspiration and influence for art, culture, society, and the interpersonal relationships which shape our daily lives. The face transplant recently performed by French surgeons is an extraordinary testament to the advancements in transplantation surgery as well as the dual physiologic and qualitative healing power of modern medicine. It is an achievement which will undoubtedly benefit both patients and science for years to come.
This year marks the 52nd anniversary of the first successful human organ transplant, an astounding feat now commonly taken for granted in the medical community. Breakthroughs in organ transplantation research over the past half-century have propelled our understanding of the body’s immune system by leaps and bounds, making it possible to successfully transplant organs such as the bowel, heart, lung, and skin and develop life-saving immunologic therapies. Dr. Jean-Michel Dubernard has now performed the first face transplant, an accomplishment deserving the highest praise and ethical consideration.
Transplantation surgery as a whole remains a largely existential endeavor which puts into question our sense of self and identity. Are our personalities and lives separate and distinct from the organs and tissues that comprise us, or do they inherently determine our experience of life? In most cases, the organ transplanted is tucked beneath flesh and bone, hidden away from scrutiny which would spark regular contemplation. Now, though, the organ itself bears the expressions characteristic of rumination. After a savage dog attack mutilated her nose, lips, and chin, Isabelle Dinoire received replacement facial tissue last November from a brain dead woman whose family had given consent to the procedure. Articles heralded the procedure to the world with both acclaim and contempt.
The idea of face transplantation is wrought with major medical, ethical, and moral issues. It is first important to understand the vast complexity and risks involved with face transplants. Vascular blockages in any of the hundreds of microvessels could damage or kill the graft, and powerful anti-rejection drugs that will increase the likelihood of cancer will have to be taken on a permanent routine. In addition, risks of graft rejection (10-50% over the first 5 years) could put patients in a worse medical situation then before the operation. These potential pitfalls beg the question: Does this predominantly aesthetic procedure warrant the health risks involved, not to mention the psychological issues that undoubtedly arise from looking in the mirror only to see a stranger looking back?
I would argue that yes, in the case of Isabelle Dinoire the potential benefits to the patient and medical community warranted the risks. Although Ms. Dinoire’s life was not in danger without the surgery, that does not mean she was without suffering. The pain associated with disfigurement and the traumatic loss of one’s facial movement is not confined by functional boundaries. How can you objectively assess the value and meaning of a look of joy or sorrow on a person’s face? For many, the ability to fully express ourselves is synonymous with life itself. The late Ray Charles once said “I was born with music inside me. Music was one of my parts. Like my ribs, my kidneys, my liver, my heart. Like my blood. It was a force already within me when I arrived on the scene. It was a necessity for me – like food or water.” Although Mr. Charles’s ability to hear his music was not integral to his physical health, it was a vital part of his soul.
Many critics have stated that Dr. Dubernard’s decision to perform the first face transplant was rash and motivated more by fame and recognition than a physician’s duty to practice beneficence or non-malfeasance. While it is true that a high-profile, risky procedure such as face transplantation carries with it media attention, the same can be said of the first kidney transplant in 1954 by Dr. Hamburger or the first liver transplant in 1963 by Dr. Thomas Starzl. Both procedures were highly publicized and considered extremely risky and potentially fatal if unsuccessful. However, both also significantly furthered our scientific understanding, making it possible to now routinely save and improve lives using these techniques. With any groundbreaking work there is a concomitant fissure in ethical viewpoints.
In modern medicine, life is often objectified by risks and benefits in a series of computations, algorithms, and equations. While modern medicine accomplishes its goals, it does not give due credit to qualitative health concerns. I agree that Ms. Dinoire’s situation still remains precarious and that much of the physical success of her operation will be determined in the upcoming months. I also acknowledge that her operation will carry with it a psychological component which remains to be seen. However, as a future physician I value the diversity of opinions, choices, and lifestyles which encompass the human experience. Ultimately, in the years to come I believe the success for Isabelle Dinoire and future face transplant patients will not be measurable in terms of symmetry, nerve function, or immunity. As articulated by Mother Theresa in the quote above, I believe their success will be based on their ability to use the gift they were given to benefit humanity.