Facial Transplant, the Latest

Posting Date: 02/17/2004

However, the first facial transplant recipient would be at risk of serious complications. Based on other types of transplant procedures, the authors estimate a ten percent risk of acute rejection. Because transplanted skin is particularly vulnerable to rejection, the long-term risk might be even higher.

The recipient would require lifelong drug treatment to suppress immune system function. Patient failure to take immunosuppressive medication is a widespread problem after transplantation?in fact, it was responsible for the failure of the first attempted hand transplant. Researchers are looking for ways of inducing "immunologic tolerance" in transplant recipients, but any practical technique is years away.

Given the central importance of the face to identity and communication, facial transplantation also raises a host of psychological and social issues. Patients' adaptation to facial disfigurement has more to do with their self-esteem and resiliency than with the severity of their disfigurement. The authors raise the concern that the patients who are most "psychologically vulnerable" may be the most likely to seek facial transplantation. Dealing with unrealistic expectations, the possibility of transplant failure, and others' reactions to their altered appearance would be just a few of the psychological challenges.

The report also raises a key ethical objection to facial transplantation. Obtaining valid patient consent to any form of treatment requires information on the risks of the procedure. The first facial transplant would be highly experimental and likely very hazardous. "The working party believes that until there is further research and the prospect of better control of these complications it would be unwise to proceed with human facial transplantation," the authors conclude.

The report "does not underestimate the suffering" of patients considering facial transplantation, nor exclude the possibility that facial transplants may be a viable option in the future. Rather, the authors believe that research on facial transplantation "should take a much more incremental approach rather than some of the current hype surrounding it has suggested."

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