Face Reconstruction
Psychology
Attitudes and beliefs about facial transplantation
Eliciting the views of people with functional facial
impairment and disfigurement comprises an important part of the research that Peter
Butler and his colleagues have been pursuing at the Royal Free Hospital. Public
engagement and debate is a similar strand of our research and has helped us to
identify public attitudes towards face transplant and the aspects of the
procedure that elicit the greatest concern.
The team studied 304 visitors to an interactive exhibition about reconstructive surgery and face transplant at the 2004 Royal Society Summer Science Exhibition. Visitors to the exhibit entitled 'Transplanting Faces'; viewed video, written and pictorial information about the reconstructive challenges of facial injury including case examples, and technical explanation of the surgical procedures involved in free tissue transfer. Posters included examples of "exchanged" faces between two of the research team members generated by computer modelling from photographic and laser scanned images as above. After viewing the exhibit, participants were asked to complete a short on-line questionnaire which was designed to sample those issues identified in the Royal College of Surgeons working party report. Results showed that the acceptability of the procedure was generally high with over 70% of participants happy to receive or donate a face even where resemblance to the donor remained high. Perhaps the most interesting finding in this survey was that whilst immunosuppression was identified as the major barrier to face transplantation in the group as a whole, the 11% who remained staunchly opposed to the procedure identified the issue of compromised identity as the major barrier.
We believe that people make rational judgments about face transplant based on the current available evidence and that the barriers to proceeding are perceived to be the need to do more research, particularly on immunological issues, rather than fundamental opposition to the idea under any circumstances.
Donor populations
As yet there is no published work which reports the
attitudes and concerns of potential donors, however, the UK facial
transplantation team carried out a focus group with five families who had
donated the organs of a relative at their death. These families were enormously helpful in
identifying the potential barriers to donation of facial tissue. Stressing the
privilege they felt in being able to help other people through the UK organ
donor programme, they were positive about donation of facial tissue to someone
with a severe facial injury, particularly when this reflected the wishes of
their relative. Contrary to the suggestion that there is no-one who would be
prepared to donate a face, this focus group and the information generated by
public engagement exercises, suggests that there is a population big enough to
support a facial transplant programme in the UK.
Patient selection
Thorough psychological preparation is vital to the
successful selection of patients and this is a major strand of our research.
The challenge we face is that the people who cope least well with facial injury
may also be the population that cope least well with facial transplantation and
its long-term impact on lifestyle. We therefore need to identify those
psychological beliefs and behaviours which predict good outcome in other forms
of transplantation including solid organ and composite tissue transplantation. Research in this area is continuing.