Face Transplantation: When and for Whom?

Response to Selected Commentaries on the AJOB Target Article “On the Ethics of Facial Transplantation Research”

“…) to enable us to do so. Butler, Clarke, and Ashcroft (2004) suggest that face transplantation should be offered only when it is unlikely that psychosocial intervention, such as that described by Robinson, Rumsey, and Partridge (1996), will be unhelpful. We agree that transplantation should be contemplated only when less invasive approaches have been attempted and found to be unsuccessful in achieving desired outcomes.…”

Facing the Future: Media Ethics, Bioethics, and the World's First Face Transplant

“…Some physicians and bioethicists have expressed concern that a thorough discussion of ethical issues could be bypassed in the race to pioneer facial transplantation: "The temptation to perform the world's first face transplant may relegate the ethical considerations to the sidelines while the surgical team and the patient take center stage" (Butler et al, 2004). The international competition to perform the world's first partial face transplant was won by a team of French surgeons at a hospital in Amiens on November 27, 2005.…”

Facial Transplantation

“…This multidisciplinary team should include plastic surgeons, transplant surgeons, immunologists, psychiatrists, psychologists, infectious disease specialists, ethicists, patient advocates, social workers, lawyers for the medical community, public relations experts, and representatives of the media. 3,15,[37][38][39]63 Moreover, because face transplantation would require lifelong immunosuppression, which exposes the recipients to significant life-threatening complications and uncertain benefits, the question has been raised of whether or not surgeons should nevertheless proceed. 37 Agich and Siemionow have emphasized that patients with severe facial deformities should reserve the right to improve their quality of life and should therefore be included in any discussions or decisions regarding facial transplantation.…”

“…3,15,[37][38][39]63 Moreover, because face transplantation would require lifelong immunosuppression, which exposes the recipients to significant life-threatening complications and uncertain benefits, the question has been raised of whether or not surgeons should nevertheless proceed. 37 Agich and Siemionow have emphasized that patients with severe facial deformities should reserve the right to improve their quality of life and should therefore be included in any discussions or decisions regarding facial transplantation. 64 In 2004, the French National Ethics Advisory Committee concluded that it was too early to approve facial transplants from cadaveric donors.…”

“…It has been suggested that face allotransplantation could be a reconstructive alternative for patients with facial deformities that cannot be addressed through the application of currently available reconstructive procedures. [30][31][32][33][34][35][36][37][38][39] TECHNICAL APPLICABILITY AND FEASIBILITY OF FACIAL/SCALP TRANSPLANTATION: OVERVIEW OF THE LITERATURE Reconstructive surgeons attempting to transplant facial allografts must address not only technical issues but also several other chiefly nontechnical issues, specifically (a) determining, feasibility, and applicability of face transplant; (b) developing protocols for lifelong immunosuppression; (c) discerning ethical, social, and psychological concerns; (d) obtaining institutional review board approval; (e) identifying appropriate recipients thorough a screening process based on specific inclusion and exclusion criteria; and finally (f) finding appropriate donors. 1,3,15 The vascular anatomy of the human face is wellknown.…”