When the first U.S. face transplant was performed at the Cleveland Clinic in late 2008, public relations practitioners at the non-profit academic medical center in Ohio played an essential role in helping to establish whether the risky and controversial surgery would be judged successful by the medical community, the news media, and the public. This descriptive case study uses agenda-building theory and the related concept of information subsidies to examine how practitioners planned and implemented media relations for one of the year's top medical stories, a story accompanied by challenging ethical issues. Strongly influenced by what they believed was a media relations fiasco involving the world's first face transplant, which had been performed three years earlier in France, Clinic practitioners effectively used information subsidies with reporters while tightly controlling information about and access to the patient. The study finds that the Clinic's media relations activities resulted in highly positive media coverage that enhanced the Clinic's reputation while also appearing to help reshape the U.S. media agenda on face transplants. (C) 2010 Elsevier Inc. All rights reserved.