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Voice box transplant: questions answered

How is a voice box transplant carried out and will the patient sound like the donor?

Q – What was involved in the surgery?

A – Working in an operating room next door, the team retrieved the donor's entire larynx, thyroid and a 6-centimetre segment of the trachea. The thyroid gland is intricately intertwined with the larynx and provides critical blood supply for the new larynx and trachea.

The larynx was tested in water to ensure it was healthy and working correctly and once the scar tissue and damaged pieces of the recipients own organs were removed the transplant could take place.

The acts of swallowing, moving the vocal cords and breathing entail extremely complex and coordinated movements, requiring good blood supply and well-functioning nerves so reconnecting these properly is vital.

Two teams worked at the same time, one on each side of the patient reconnecting five nerves, three arteries and two veins during the operation.

Q – What kind of patients can have this surgery?

A – Patients who have suffered traumatic injury to the throat such as those in an accident. Other possible recipients might be those who have recovered from diseases that have damaged their voice box. Careful consideration would have to be given to cancer sufferers.

Q – Why is this surgery not being done more widely?

A – It is unlikely this kind of transplant will become as common as kidneys or even heart transplantation. This is because damage to the larynx is not usually life threatening and patients can have a relatively acceptable quality of life so the risks involved with the surgery and critically, the immunosuppressant drugs, has to be weighed carefully against the benefits.

Immunosuppressant drugs can increase the risk of cancer and shorten life which is why transplantation from donors is only really considered in extreme cases.

A team in Britain is working towards carrying out a larynx transplant here but it may be some years yet.

Q – Will the recipient's voice sound like the donor?

A – No, the voice box contains the vocal cords but the sounds of the voice is governed by the whole throat, mouth and lips.