The Pros And Cons Of Face Transplants

Face Transplants; Ethics and Technology

Over the past century there has been a considerable improvement in medicinal technology that allows for many life-saving and cosmetic procedures to be undertaken. Face transplants are one such improvement that permit recipients to have a second chance at a relatively normal life. This form of transplantation is used as treatment for victims with severe injuries of the face such as extreme burns that have robbed them of many normal facial features including noses and eyes. In the year 2005, the first partial face transplant took place in France at the Amiens University Hospital, where the patient received new cheeks, lips and part of a chin from a brain dead donor. Since then there have been several successful full face transplants all over the world, especially in Spain and the United States. The qualifications a patient must meet to undergo such a serious surgery are extensive and take into account what kind of deformities the patient has and their state of mind. A potential recipient is evaluated rigorously by psychiatrists to establish if they are mentally capable to cope with such an

immense change. Because the face is such an integral part of a person’s makeup, facial surgeons and psychologists have no guarantee on how a patient will react with such a major alteration in their self-perception. According to Prior and Klein, it is as if there is a shift in a patient’s psych where they now take a part of the donor’s identity and meld it into their own (2011). This concept is the foundation of the argument that many ethicists have against this kind of transplant. To exhibit how face transplantations can improve patients ways of life the arguments for and against this procedure, the psychological risks, technology and complications involved will be examined in the following paragraphs.
The continuous debate between medical professionals, ethicists, and the general public, has highlighted these key points; effects of living with a disfigurement, the significance of a face, and psychological risks that can develop. Even though there have now been several successful transplants collecting data has been difficult and only long term follow-up will show real results and risks (Lantieri, 2011). It has been observed that the way of life for many patients has improved dramatically since their surgeries, many of them finding employment, life partners and other opportunities that before would have been almost impossible. However, the question has arisen that, yes a transplant is feasible, but should it be done? Are the side affects too great? The emotional trauma from “carrying someone else’s face” being the leading point (Lantieri, 2011). A ruling from the National Ethics Committee provided some insight on how to treat these cases. Instead of looking at the transplant as a replacement of one’s face, doctors and patients alike were to view the procedure as a reconstruction and not a total replacement of ones ‘identity.’ On the other hand, many ethicists say that, maybe, the idea of a reconstruction is applicable to partial transplants, but when it comes to a full face transplantation it is a total replacement. There has been much concern regarding how people will treat patients when their ‘new’ face is first observed (Rumsey, 2004). Yet, cannot the patients see this as yet another ‘new’ face since the ones they were born with have already been robbed from them, and they have been coping with these new scarred faces for, sometimes, years on end? In the end the entire purpose of this procedure is to provide scarred victims with an improved way of life by enhancing the function and appearance of themselves (Klein & Prior, 2010).
Because of this debate a protocol of educating potential recipients has been developed to best prepare them for the challenges they will face. This aids in the rehabilitation process and promotes successful procedures. Doctors at Brigham and Women’s Hospital have designed a “multidisciplinary education system that ensures patient satisfaction and continued support” that will comfort patients before and after the procedure (Lamparello, Bueno, Diaz-Siso, Sisk & Pomahac, 2013). It is believed that without this regime the possibility of transplant rejection is elevated because many other types of transplantation have failed due to patients lacking the information necessary to fully comprehend what has happened to their body and mind, how to properly ingest medications and safe practices to avoid failure. Not only is education necessary for patients but also for their support systems. Creating a better understanding may lead to support in following medication guidelines, management of complication or symptoms and psychological support (Lamparello, Bueno, Diaz-Siso, Sisk, Pomahac, 2013). Faces are considered organs and are therefore treated as such when being transplanted.
Facial transplantation, also known as facial allograft transplantation is part of the new vascularized composite allotransplantation surgical discipline that is used to transplant nonparenchymatous tissue composites (Soga et al., 2011). This form of transplantation is far more effective than the conventional procedures such as skin grafts, pedicled flaps which are both multistage treatments that usually provide less than ideal results for severely disfigured patients (Soga et al., 2011). Before the development of this revolutionary practice many patients who underwent grafts and other such measures exchanged one disfigurement for another because the grafts did not blend into the original skins and left substantial and noticeable scarring that, in the end, never truly restored recipients to any sense or ‘normal’ in appearance. Vascularized composite allotransplantation (VCA) involves the transfer of several types of tissue, such as bone, muscle, skin and blood vessels, as well as nerves (Iyer, 2015). This type of reconstruction has the advantage of providing functional and aesthetic parts to the deformed and affected areas (Iyer, 2015). This method is typically used for the abdominal wall, face and upper extremities transplantation. The process of VCA has many stages and necessary components. The first component, a proper tissue donor, is sometimes difficult to come by since the idea of donating something as personal as a face can be hard for the deceased’s family to cope with. Not only is willingness to donate an obstacle, but compatibility among such a small donor pool is also a very prominent limiting factor. Compatibility can be tested through several different methods, such as flow cytometry and virtual cross matching. Once a proper donor has been located several measures are taken to avoid the recipient rejecting the donor tissue. Recognition and rejection of allogeneic tissue by the recipient’s immune system remains the main barrier to a successful transplantation (Iyer, 2015). Blood antigens and the human leucocyte antigens initiate these immune responses. These host immune responses can be stronger in the case of heterogeneous tissues in composite tissue allotransplantation due to the different amounts of major histocompatibility complex antigens being released. To prevent and treat these responses immunosuppression protocols are put into place to deplete certain cell types, suppress antibodies at the time of transplantation and then to maintain levels to avoid acute and chronic rejections. If these protocols are followed correctly, and patients are supported throughout the rehabilitation process there is no reason that they cannot one day lead a successful and normal life.
In respect to the future, there is hope that many more developments can be made in this field and that one day the methods of face transplantation and VCA will be so advanced that a recipient will look as normal as anyone else.

Because, while VCA does restore victims with distinguishable and mostly functioning facial features, many cases do represent with abnormal looking faces. However, it could be inferred that one face is better than no face and at least a patient will be able feel far more attractive and natural than they did originally. Vascularized composite allotransplantation has the potential to positively impact many lives in the future and with new developments each day it will soon be a whole new way to perform surgery. Not only in face transplantation but in other situations such as extreme burn or trauma victims of the

body.