Are Face Transplants Ethical?

By Rahul Gladwin

University of Health Sciences AntiguaSchool of Medicine

So what is a face transplant?

Have you seen the movie Face-Off starring Nicholas Cage and John Travolta? This fantasy movie provides a glimpse into the futuristic world, where face transplants would be a norm. Currently, however, doctors across the world are only beginning to fully understand and carry-out this complex and questionable procedure.

Why are face transplants unique?Face transplants are unique because, unlike a kidney

transplant or a heart transplant, face transplants are not necessary and are performed solely due to cosmetic reasons. A disfigured face is not a life threatening situation. Another consideration is that face transplants are very new; no one knows how the body will react to a rejected face, or what are the long-term effects of taking anti-rejection drugs for face transplants.

World’s first face transplant

The world’s first full-face transplant was performed in 1994 by Dr. Abraham Thomas, M.D., one of India’s prominent microsurgeons. This wasn’t a movie, but a real surgery to save the life of a nine-year-old girl, who’s face was destroyed due to a lawnmower accident, and surgeons simply reattached the girl’s original face. This surgery was inspired by previous failed attempts by US and British surgeons.

Face transplant from donor

The world’s first partial face transplant from donor to acceptor was performed in November 2005 by a team of French surgeons led by Professor Jean-Michel Dubernard. This was performed on a women who’s face was mangled by a dog. Surgeons took a triangular piece of face tissue from a brain-dead donor’s nose and mouth, and grafted it onto the patient’s face. This complex procedure was performed within one month of the accident.

So what’s the problem?

The surgery performed by Professor Jean-Michel Dubernard has raised important ethical questions considering the fact that he took the nose and mouth pieces from a brain-dead patient – with the permission of the patient’s family of course. Medical ethicists, including the French ethics panel, raise questions that it is unnecessary to perform face transplants – a high risk procedure – only for the sake of cosmetic reasons.

Surgeons hit back

Professor Jean-Michel Dubernard stated that the woman’s face couldn’t not have been repaired using regular surgery, and even if it was repaired, it would have rendered her unable to eat, drink and speak. Furthermore, the benefits of a face transplant clearly outweigh the risks involved. Without a face, a patient would lead a life of depression and isolation, and have a high tendency to commit suicide.

But risks are high

Patients, who have undergone face transplants, have to spend the rest of their lives on high doses of immunosuppressant drugs, that also increase the risk of cancer, while the risk of rejection lasts a lifetime. Patients take these drugs to ensure their bodies don’t reject the newly transplanted facial tissue.

Did French government agree?No it didn't. The French government ethics panel is

against the procedure of face transplants. They say this woman’s case was classified as an emergency procedure, and face transplants, and informed consents are inappropriate during emergency procedures. Dr. Laurent Lantieri from the French ethics panel further questioned the preparedness of the patient for such a costly and demanding procedure, and the burden of depending upon complex drugs for the rest of her life in order to make this operation a success.

The Question of Self-Image

Some ethicists questioned whether the woman was prepared to live with someone else’s face on, and how would it reflect on her self-image. Will she look like the donor? Will she look like her original self? Or will she look like a hybrid? The truth is, no one knew what the patient will feel like, or how will she look like. The BBC, however, reported that the patient will look like a hybrid because the shape of the face depends upon the underlying bone structure.

The question of personality

Humans recognize each other by their faces, and exchange emotions by facial expressions. If we change the face of a person, does the person become someone else? According to researchers, patients who have undergone hemispheroctomines (removal of half the brain) still retain their pre-surgery personalities. This means that one’s personality has little or nothing to do with ones body organs. A person with a new face will still be the old self with a new body organ.

Where does the US stand?

Face transplants will hopefully be offered by US surgeons and psychologists at two medical centers: Cleveland Clinic and the University of Louisville. Dr. Maria Siemionow from the Cleveland Clinic stressed that surgeons shouldn’t be discouraged or stopped by doing new surgeries. "I hope nobody will be frivolous or do things just for fame. We are almost over-cautious," she said at the time. This high-risk procedure does require doctors to ensure that patients have given valid consent.

What does the future hold?

A relatively new area of medicine called Tissue Engineering will enable people to design their own faces, replace their existing faces with the new one, all done quickly and affordably. It means that if you don’t like your baggy eyes or those wrinkles on your forehead, you could visit your local beauty salon and get a new face in ten minutes right before the Friday night party. The question is: is this morally ok?

No, it is not morally OK

I feel that face transplants should only be used on patients who have injured or mangled their faces, and not on patients who want to get rid of their wrinkles or bags under their eyes. I feel that having a face transplant solely for the purpose of making one look attractive in middle age is very different from having a face transplant for protecting one from a life of depression, loneliness and low self-esteem.

Bibliography & Links

Links:

http://health.discovery.com/centers/plasticsurgery/facetransplant/slideshow/slide.html

http://www.washingtonpost.com/wp-dyn/content/article/2005/12/02/AR2005120201787.html

http://www.cbsnews.com/stories/2005/12/01/health/main1091293.shtml

http://www.iht.com/articles/2004/06/16/edsokol_ed3_.php