Surgeons are now considering replacing some rib bone with other organ transplants, he said.

Translating research to surgery, or "bench to bedside," is something Maryland's leaders want to continue to promote, said Dr. E. Albert Reece, vice president of medical affairs at Maryland and dean of the medical school.

"This should affect the lives and well being of patients who before were without hope," he said of the face transplant.

The first few face transplants were limited to skin and some underlying tissue. In 2008, a team at the Cleveland Clinic transplanted a face and jawbone, according to Dr. Chad R. Gordon, who participated in the surgery while he was a fellow in Cleveland.

Gordon, who did not participate in the Maryland transplant, now works with a team at Johns Hopkins Hospital that expects to be ready to perform facial transplants within the year. This team also has been working to further advance the anti-rejection research.

The Hopkins protocol aims to reduce the daily drugs to one a day, also by employing the donor's bone marrow, said Gordon, assistant professor of plastic and reconstructive surgery at the Johns Hopkins University and clinical director of the hospital's craniomaxillofacial transplantation program.

That will leave the patients more ability to fend off bugs that can sicken or kill them. So far, two of the 22 face transplant recipients worldwide have died, one of infection, Gordon said.

All, however, have had episodes where their faces were nearly rejected. Typically, a patient will have two or three episodes in the first year and remains at risk of rejection forever. Someday, Gordon said, doctors hope to eliminate that risk.

"Imagine a seesaw," Gordon said. "On one side is a transplant patient who rejects everything including their new face. On the other side is a transplant patient who doesn't reject anything at all, including much simpler things such as the common cold or flu. Therefore, we need to get in the middle of the seesaw."

Norris has shown no signs of rejection yet, but doctors will be watching him closely. They expect him to leave the hospital in a few weeks but remain in Baltimore for about three months.

The surgeons expect Norris to only need "nips and tucks" via outpatient surgery in the future. Bartlett said he soon will be "downright handsome."

meredith.cohn@baltsun.com

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