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A Stranger in the Mirror: Should Doctors Transplant Faces?
By ERIC F. TRUMP and KAREN MASCHKE

This year is the 50th anniversary of the first successful human organ transplant. Over the last half-century, the improved understanding of how to prevent the body's immune system from rejecting foreign tissue has turned what began as an experiment into a routine procedure. Today, bone and bowel, heart and hand are replaceable.

Now we are confronting the imminent possibility that human faces will be transplanted. This month in The American Journal of Bioethics, a team of transplant surgeons at the University of Louisville announced their intention to pursue the transplantation of faces. Last year, a task force at the Royal College of Surgeons of England cautioned against them.

The British group concluded that "until there is further research and the prospect of better control of complications, it would be unwise to proceed with human facial transplantation," a procedure that requires review board approval.

The Louisville transplant team, on the other hand, led by Dr. John Barker, argued that caution was a form of dawdling. As Dr. Barker told New Scientist magazine: "Caution by itself will not get us any closer. If Christopher Columbus were cautious, I'd probably be speaking with a British accent."

Still, we should be wary of crossing certain frontiers. We now have the ability to excise a face, including nose cartilage, nerves and muscle, from a brain-dead body and suture it to the hairline and jaw of a living person with a disfigured face.

Such a procedure repels and fascinates in equal measure. The face is not like other organs. It twitches, smiles, pouts and squints. It is how we express ourselves to others, and how others recognize us as who we are.

But as grotesque as placing one face over another may seem, surgeons and ethics review boards must confront more than just the "yuck factor" before they enter an international face race, with at least five teams working toward the first face transplant.

Transplanted organs, including the skin (the body's largest), survive because patients are given powerful anti-rejection medications. These drugs can have very toxic side effects, including cancer, kidney failure, diabetes and high blood pressure. For most transplants, the risks of immunosuppression are worth the benefits: the alternative to living without, for example, a lung or liver is death.

But millions of people have learned to live with facial disfigurement, either privately or with the help of counseling. Since disfigured people must try to come to terms with their new appearance anyway, will adjusting to someone else's face be any easier?

Counseling and skin grafts may not be as adventurous as radical surgery for such patients, but at least we know they work, and the risk to patients' survival is minimal. What are the contingency plans if a face transplant fails, for example? About 10 percent of organ recipients reject the transplant within the first year: imagine the horror of losing your face not once, but twice.

Given that a face transplant is not crucial to survival, the risks are simply too great to assume. Ethics review boards would do well to remember the history of hand transplantation. The very first hand transplant was a failure because the patient stopped taking his medications.

In 2003, a group of hand transplant surgeons argued, in an article published in The New England Journal of Medicine, that such transplants should be offered only to people who had lost both hands or were blind because the possibility of rejection and the dangers of anti-rejection medications were otherwise too great.

The lack of empirical evidence or long-term studies on face transplantation means that obtaining informed consent for this experimental procedure is highly unlikely. And even if consent is given, where will face donors come from? We are already in the midst of an acute organ shortage, with over 85,000 people on the national waiting list, suggesting an endemic unwillingness among Americans to donate their flesh, even in death.

How many people can we reasonably expect to give up one of their - or their loved one's - most symbolic body parts? Many funerals call for open caskets, and people typically request that the undertaker preserve the face. Before we find face donors, we may first have to reform our death rituals to ease the discomfort that removing faces will generate.

Dr. Barker argues that caution hinders surgical advancement. But what is more important: winning the face race? Or upholding the principle of "do no harm," as the British team suggests?

Eric F. Trump is a science writer and the associate editor of The Hastings Center Report. Dr. Karen Maschke isthe associate for ethics and science policy at the Hastings Center.

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If Christopher Columbus were cautious, I'd probably be speaking with a British accent.

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I don't really think Columbus is someone to emulate.
 

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Posted by Defenestraitor (Member # 6907) on :
 
Yes, thank god the British didn't discover America. I'm so glad we're all speaking Italian and saluting the Spanish flag.

[ October 12, 2004, 01:45 PM: Message edited by: Defenestraitor ]
 

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Posted by Ben (Member # 6117) on :
 
can i look like John Travolta?
 

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Posted by The Rabbit (Member # 671) on :
 
There are cases where the damage to the face is so severe that plastic surgery can not even begin to repair it. I think that these are the types of cases where they are considering face transplants.

I have really mixed feelings on this one. On the one hand, a face isn't necessary to live but on the other it is hard to imagine having any reasonable quality of life without a face. If my face had been blown off in some horrible accident and my only hope of having a face were a possibly life threatening proceedure I don't know how I'd choose. I certainly wouldn't want to make the choice for someone else.

On yet another hand, I can definitely see this being obused. I can imagine someone like Michael Jackson getting a new face every year just for the novelty or people petitioning beautiful young girls with cancer to donate their face.

If my husband were killed in an accident, I would fully support any type of organ donation but it gives me the creeps to think of someone else walking around with his face. I do wonder if this type of procedure might reduce the number of people willing to donate organs for other procedures.
 

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Posted by BannaOj (Member # 3206) on :
 
It is my understanding that even if somone donated their face after death, it would almost certianly look far different on the person receiving the donation just because of differing facial structures.

One of the biggest areas that skin grafts don't do much good, is burn victims that have had over 70% of their body burned, and have survived. They don't have that much good usable skin left to graft anywhere.

AJ

[ October 12, 2004, 02:13 PM: Message edited by: BannaOj ]
 

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Posted by aspectre (Member # 2222) on :
 
Knowing of people having a kidney yanked out of them for the blackmarket serving the wealthy, imagine what'll happen when wealthy folk who have plastic surgery on perfectly functional faces have the option of face transplants. Consider eg DavidCrosby being given a liver transplant (despite doing his darnedest to destroy his own liver) over someone younger (and innocent of any blame for his/her own liver problem) because of his wealth&fame from being in Crosby,Stills,Nash,andYoung.
I oppose transplants in general for that reason. Wealth and good intentions can too easily change "Treat even though s/he probably won't survive." into "Pull life support. S/he isn't going to survive anyway. And the organs will save/improve somebody else's life."

I wouldn't accept an organ transplant for myself.
However if a loved one needed an organ transplant, and if I were the one with permission authority, I would give an approval.
There is a vast difference between choosing death for oneself and choosing it for another.

And if you are curious, I do carry a donation card giving approval for use of my organs after my death.
It includes a request that I not be resusitated or sustained in the case of severe&irreparable brain damage.

I just don't like the idea of organ transplants being legal at all. They are far too expensive when there are all too many people who have no access to even relatively cheap lifesaving and/or life-improving procedures. And the amount of money and emotion involved makes corruption -- even of those with truly good intent -- far too likely.

[ October 12, 2004, 04:30 PM: Message edited by: aspectre ]
 

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Posted by Miro (Member # 1178) on :
 
Has anyone here ever read The Night Inspector by Frederick Busch? It's about a guy who basically got his face blown off during the Civil War. He walks around with an eerie-looking mask.
 

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Posted by Belle (Member # 2314) on :
 
Well, only the wealthy will be able to afford it. You can bet on the insurance companies not paying for it since it won't be a lifesaving necessity.
 

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Posted by Icarus (Member # 3162) on :
 

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I wouldn't accept an organ transplant for myself.

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You can bet on the insurance companies not paying for it since it won't be a lifesaving necessity.

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But many insurance companies will pay for cosmetic surgery in the event of a disfiguring accident or disease.
 

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Posted by advice for robots (Member # 2544) on :
 
What's funny, Miro, is that I absolutely loved Frederick Busch's Girls (and the short story it is based on) but I couldn't get more than a few pages into The Night Inspector. Is that what it's about?
 

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Posted by Morbo (Member # 5309) on :
 
Aspectre, if you don't like the idea of legal organ transplants, why are you a voluntary donor?
 

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