Facial transplantation in a new era: what are the ethical implications?

Abstract

Facial transplantation has become a clinical reality, with the successful completion of five procedures to date in France, China, and most recently the United States. The technical and immunological obstacles associated with this procedure have largely been overcome. There is ongoing debate, however, regarding the ethical implications of the procedure. The early literature in facial transplantation stressed the ethical concerns regarding the procedure and recommended that the procedure not be attempted. Recently, however, ethicists and surgeons have created strict ethical guidelines regarding patient selection, informed consent, and accurate evaluation of the risks of the procedure - both medical and psychological. Research has demonstrated that individuals would be willing to accept significant risk to undergo facial transplantation, given the devastating nature of facial disfigurement. In addition, no insurmountable technical or immunological obstacles have been identified to prevent the further success of facial transplantation. The ethical issues associated with facial transplantation will be further refined as more experience is gained with the procedure. With these strict ethical guidelines and with significant efforts in patient selection and preoperative counseling, facial transplantation will likely continue to remain a viable option for patients with significant facial disfigurement.