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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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Posts: 12591 | Registered: Jan 2000  |  IP: Logged | 

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

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Posts: 2149 | Registered: Aug 2000  |  IP: Logged | 

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I wouldn't accept an organ transplant for myself.

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Posts: 13680 | Registered: Mar 2002  |  IP: Logged | 

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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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Posts: 12591 | Registered: Jan 2000  |  IP: Logged |