CLEVELAND: A woman so horribly disfigured she was willing to risk her life to do something about it has undergone the first near-total face transplant in the United States.

Reconstructive surgeon Dr Maria Siemionow and a team of other specialists at the Cleveland Clinic in Ohio replaced 80 per cent of the woman's face with that of a dead female donor a couple of weeks ago in a bold and controversial operation certain to stoke the debate over the ethics of such surgery.

The patient's name and age were not released, and the hospital said her family wanted the reason for her transplant to remain confidential. The doctors offered no details about the patient, but said they would discuss her surgery at a news conference later yesterday.

The transplant was the fourth worldwide; two have been done in France, and one in China.

In November 2005, a team in Amiens, France, performed the first partial face transplant on Ms Isabelle Dinoire, then 38, who was seriously disfigured when her Labrador retriever mauled her.

The surgeons grafted a nose, lips and chin from a donor who had been declared brain dead. In a report in December last year, Ms Dinoire's doctors said she was satisfied with the aesthetic result.

In 2006, Chinese doctors did a partial face transplant on a farmer who lost much of the right side of his face in a bear attack. Last year, a French team performed the third partial facial transplant, on a 29-year-old man whose face was disfigured by a genetic disorder. Both are believed to be doing well.

The surgery in Cleveland likely lasted between six and 10 hours as surgeons grafted the blood vessels, muscles and skin from the donor onto the patient, said Dr James Bradley, a professor of plastic surgery at the University of California Los Angeles Medical Centre. He said it could take months to gauge the success of the procedure.

After the swelling subsides, the patient would not look exactly like the donor.

'You look more like a cousin,' Dr Bradley said. 'The bone structure is your own, but the skin is from another person.'

Such transplants are experimental and highly controversial. A main concern is that the recipients must take immune-suppressing drugs for the rest of their lives to prevent organ rejection, raising their odds of cancer. The drugs have severe side effects and could shorten a patient's life by 10 years, doctors said.

What can make a face transplant particularly risky is that, if the drugs fail, surgeons may have little to offer the recipient.

Leading bioethicist Arthur Caplan, who has expressed grave concerns about such surgery, withheld judgment on the Cleveland case but said the woman's doctors should give her the option of assisted suicide if they wind up making her life worse.

'The biggest ethical problem is dealing with failure - if your face rejects. It would be a living hell,' said Mr Caplan, bioethics chief at the University of Pennsylvania.

But Dr Siemionow's long and careful preparation should help prevent such a horrific outcome, those familiar with her said.

Dr Siemionow, 58, a noted hand microsurgeon, and her colleagues at the Cleveland Clinic have spent years preparing for the surgery, practising on animals and doing trial runs on 20 cadavers, said Dr Bradley, who has seen several presentations by Dr Siemionow at research meetings.

The idea of performing a face transplant first dawned on Dr Siemionow when she was training with Dr Warren Breidenbach, a surgeon at Jewish Hospital in Louisville, Kentucky, who did the first hand transplant in the US, in 1999. Many of the patients she treated had extensive burn injuries.

'Those who suffered extensive damage to their faces would forever be socially crippled in a society that appears to value beauty above all other human characteristics,' she wrote in a memoir published last year titled Transplanting A Face.

ASSOCIATED PRESS, LOS ANGELES TIMES, NEW YORK TIMES

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Surgeon Maria Siemionow, a noted hand microsurgeon, and her colleagues at the Cleveland Clinic have spent years preparing for the surgery, practising on animals and doing trial runs on 20 cadavers.