According to a report published in the January issue of Transplantation, in the light of new information on facial transplantation—including the psychological and ethical aspects of the controversial procedure—a Working Party of the Royal College of Surgeons of England is endorsing moving cautiously in performing face transplants.
In its initial report in 2003, the Working Party concluded that facial transplantation should not be attempted until further research was done to define the risks. The new report cites several new developments since then—most significantly, the encouraging results of a partial face transplant procedure performed by a French surgical team. The panel also notes progress in experimental studies of facial transplantation and more follow-up information on patients undergoing hand transplantation and other types of “composite” transplant procedures.
The past few years have also seen “a deepening understanding of the potential psychological problems of facial transplantation as well as a very considerable debate on the ethical aspects of the procedure.” The new report states, “The working party now accepts its inevitability but endorses the urgency of establishing sound ethical principles” for performing face transplants.
As in 2003, the technical skill to perform face transplantation is not at issue. Rather, the obstacle is the high risk that the recipient’s immune system will reject the transplanted tissues. Recipients require lifelong immunosuppressive drug treatment to prevent rejection. Updated experience with hand transplants, as well as the French face transplant recipient, suggests that close monitoring and treatment adjustments can head off problems with acute rejection. However, the risks of chronic (long-term) rejection remains unknown.
The report cites the many psychological issues that face transplant recipients must confront, including unrealistic expectations, the risk of devastating transplant failure, and the reactions of others to their altered appearance. Face transplantation also entails “invasive press interest and publicity,” as demonstrated by the French case.
“We hope that the second edition of our report, including the minimal requirements we define, will allow face transplantation to progress in a rational way that protects the interests of vulnerable patients,” says Sir Peter Morris of the Royal College of Surgeons of England and the Centre for Evidence in Transplantation, London School of Hygiene and Tropical Medicine. “Face transplantation raises a number of complex medical, ethical, and psychological issues, and we encourage others both inside and particularly outside the transplant community to review and comment on our review and recommendations.”
[newswise.com, January 19, 2007]