Face Reconstruction

Ethical Considerations

Ethical considerations of facial transplantation

The ethics of facial transplantation has stimulated intense debate.

The ability to achieve informed consent for a new procedure, psychological aspects of facial transplantation including altered appearance, concern about the impact of acute and chronic rejection and the need for lifelong immunosuppression, are all highlighted in a report from a special committee of the Royal College of Surgeons (the UK Face Transplantation Team made a major contribution to the committee debate).

Whilst welcoming a debate about these issues, the UK team have opted for a pragmatic approach. We have argued that there is no value in repeatedly revisiting the argument without further research. Using the RCS report as a framework, we have therefore addressed the ethical dimension of face transplant through a pragmatic, research driven strategy. In addition to studies of patients with severe facial injuries, this has included public engagement exercises, work with health professionals including those working in organ transplantation and families of organ donors. This has enabled us to develop screening protocols and care pathways, and, as far as possible, this work has been published and made available for public scrutiny.

Given that an exact risk/benefit analysis can never be provided for a new procedure, we would argue that this is logically, the only sensible way of moving the ethical debate forward.

In terms of the ethical management of patients undergoing this procedure, the UK transplantation team strongly endorse the proposal of the American Society of Plastic Surgeons in producing guidelines for good practice. These recommend that facial transplantation be carried out only in specialist centres that have requisite expertise in facial surgery, management of transplantation, immunology and the psychology of facial reconstruction. There should also be provision for long term monitoring and support.

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The position of the UK team is that ethical issues are best met by rigorous research which addresses the underlying issues.