Ethical Aspects of Face Transplantation

  • George J. Agich


To date, ten face transplants have been performed around the world with two deaths neither of which was directly caused by the transplant. So, while this procedure is still innovative, it is clearly technically feasible, though it is fraught not only with risk, but ethical concerns. In the end, whether face transplantation will become a regular reconstructive surgical alternative for severe facial deformity will depend not only on scientific and technical issues, but the degree to which the clinical ethical problems are identified and addressed. In this chapter, I will focus on the concrete ways that these issues need to be addressed in developing and implementing face transplantation protocols.


Psychological Assessment Ethical Question Protocol Development Live Donor Kidney Transplant Transplant Team 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Gordon CR, Siemionow M, Papay F, et al. The world’s experience with facial transplantation: what have we learned thus far? Ann Plast Surg. 2009;63(5):572-578.PubMedCrossRefGoogle Scholar
  2. 2.
    Anonymous. In your face: if the idea of a hand transplant seems hard to take, just wait. New Sci. 1998;160(2154):3.Google Scholar
  3. 3.
    Altman LK. New direction for transplants raises hopes and questions. New York Times. May 2, 1999;1:46–47.Google Scholar
  4. 4.
    Hettiaratchy S, Butler PE. Face transplantation – fantasy or the future? Lancet. 2002;360(9326):5-6.PubMedCrossRefGoogle Scholar
  5. 5.
    Betterhumans Staff. Face transplant planned for Irish girl. March 6, 2003.Google Scholar
  6. 6.
    Randerson J. Face transplants ‘still too risky’. New Sci. 2003;180(2422):10.Google Scholar
  7. 7.
    American Society of Plastic Surgeons. Science fiction of face transplants may be closer than you think: reconstructive plastic surgeons perform miracle transplants now. American Society of Plastic Surgeons. 2004. Accessed June 3, 2010.
  8. 8.
    Clark J. Face transplants technically possible, but “very hazardous”. CMAJ. 2004;170(3):323.PubMedGoogle Scholar
  9. 9.
    Kirby R. Face switching procedures could be the next big thing. The Salt Lake Tribune. January 22, 2004.Google Scholar
  10. 10.
    LaFee S. Trading faces: proposed transplants promise new outlook but at unseen cost. San Diego Union-Tribune. February 18, 2004.Google Scholar
  11. 11.
    Baylis F. A face is not just like a hand: pace Barker. Am J Bioeth. 2004;4(3):30-32.PubMedCrossRefGoogle Scholar
  12. 12.
    Caplan A, Katz D. About face. Hastings Cent Rep. 2003;33(1):8.PubMedGoogle Scholar
  13. 13.
    Working Party on Facial Transplantation of the Royal College of Surgeons of England. Facial Transplantation: Working Party Report. London, UK: Royal College of Surgeons of England;2003.Google Scholar
  14. 14.
    Comité Consultatif National d’ Ethique pour les sciences de la vie et de la santé. L’ allotransplantation de tissu composite (ATC) au niveau de la face (Greffe totale ou partielle d’ un visage). Paris: Comité Consultatif National d’Ethique pour les sciences de la vie et de la santé, Opinion 82. 2004.Google Scholar
  15. 15.
    Gordon CR, Nazzal J, Lozano-Calderan SA, et al. From experimental rat hindlimb to clinical face composite tissue allotransplantation: historical background and current status. Microsurgery. 2006;26(8):566-572.PubMedCrossRefGoogle Scholar
  16. 16.
    Gordon CR, Siemionow M, Coffman K, et al. The Cleveland Clinic FACES Score: a preliminary assessment tool for identifying the optimal face transplant candidate. J Craniofac Surg. 2009;20(6):1969-1974.PubMedCrossRefGoogle Scholar
  17. 17.
    Knobloch K, Vogt PM. Plastic surgeons’ tradition in transplantation medicine in light of composite tissue allotransplantation. J Am Coll Surg. 2009;209(5):674-675.PubMedCrossRefGoogle Scholar
  18. 18.
    Pomahac B, Aflaki P, Chandraker A, Pribaz JJ. Facial transplantation and immunosuppressed patients: a new frontier in reconstructive surgery. Transplantation. 2008;85(12):1693-1697.PubMedCrossRefGoogle Scholar
  19. 19.
    Pomahac B, Aflaki P, Nelson C, Balas B. Evaluation of appearance transfer and persistence in central face transplantation: a computer simulation analysis. J Plast Reconstr Aesthet Surg. 2010;63(5):733-738.PubMedCrossRefGoogle Scholar
  20. 20.
    Pomahac B, Lengele B, Ridgway EB, et al. Vascular considerations in composite midfacial allotransplantation. Plast Reconstr Surg. 2010;125(2):517-522.PubMedCrossRefGoogle Scholar
  21. 21.
    Siemionow M, Papay F, Kulahci Y, et al. Coronal-posterior approach for face/scalp flap harvesting in preparation for face transplantation. J Reconstr Microsurg. 2006;22(6):399-405.PubMedCrossRefGoogle Scholar
  22. 22.
    Siemionow M, Agaoglu G. The issue of “facial appearance and identity transfer” after mock transplantation: a cadaver study in preparation for facial allograft transplantation in humans. J Reconstr Microsurg. 2006;22(5):329-334.PubMedCrossRefGoogle Scholar
  23. 23.
    Siemionow M, Agaoglu G, Unal S. A cadaver study in preparation for facial allograft transplantation in humans: part II Mock facial transplantation. Plast Reconstr Surg. 2006;117(3):876-885.PubMedCrossRefGoogle Scholar
  24. 24.
    Siemionow M, Sonmez E. Face as an organ. Ann Plast Surg. 2008;61(3):345-352.PubMedCrossRefGoogle Scholar
  25. 25.
    Siemionow M, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374(9685):203-209.PubMedCrossRefGoogle Scholar
  26. 26.
    Siemionow MZ, Papay F, Djohan R. First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries. Plast Reconstr Surg. 2010;125(1):111-122.PubMedCrossRefGoogle Scholar
  27. 27.
    Thorburn G, Hettiaratchy S, Ashcroft R, Butler PE. Patient selection for facial transplantation III: ethical considerations. Int J Surg. 2004;2(2):118-119.PubMedCrossRefGoogle Scholar
  28. 28.
    Toure G, Meningaud JP, Bertrand JC, Hervé C. Facial transplantation: a comprehensive review of the literature. J Oral Maxillofac Surg. 2006;64(5):789-793.PubMedCrossRefGoogle Scholar
  29. 29.
    Unal S, Agaoglu G, Zins J, Siemionow M. New surgical approach in facial transplantation extends survival of allograft recipients. Ann Plast Surg. 2005;55(3):297-303.PubMedCrossRefGoogle Scholar
  30. 30.
    Vasilic D, Alloway RR, Barker JH, et al. Risk assessment of immunosuppressive therapy in facial transplantation. Plast Reconstr Surg. 2007;120(3):657-668.PubMedCrossRefGoogle Scholar
  31. 31.
    Yi C, Guo S. Facial transplantation: lessons so far. Lancet. 2009;374(9685):177-178.PubMedCrossRefGoogle Scholar
  32. 32.
    Goering S. Facing the consequences of facial transplantation: individual choices, social effects. Am J Bioeth. 2004;4(3):37-39.CrossRefGoogle Scholar
  33. 33.
    Wiggins OP, Barker JH, Martinez S, et al. On the ethics of facial transplantation research. Am J Bioeth. 2004;4(3):1-12.PubMedGoogle Scholar
  34. 34.
    White RJ. Ethics of the face transplant: focus on the positive. New York Times. December 11, 2005.Google Scholar
  35. 35.
    Agich GJ, Siemionow M. Until they have faces: the ethics of facial allograft transplantation. J Med Ethics. 2005;31(12):707-709.PubMedCrossRefGoogle Scholar
  36. 36.
    Clark PA. Face transplantation: part II – an ethical perspective. Med Sci Monit. 2005;11(2):RA41-RA47.PubMedGoogle Scholar
  37. 37.
    Ad-El DD. On the ethics of composite tissue allotransplantation (facial transplantation). Plast Reconstr Surg. 2007;119(2):747.PubMedCrossRefGoogle Scholar
  38. 38.
    Barker JH, Furr A, McGuire S, Cunningham M, Wiggins O, Banis JC Jr. On the ethics of composite tissue allotransplantation (facial transplantation). Plast Reconstr Surg. 2007;119(5):1621-1622.PubMedCrossRefGoogle Scholar
  39. 39.
    Brown CS, Gander B, Cunningham M, et al. Ethical considerations in face transplantation. Int J Surg. 2007;5(5):353-364.PubMedCrossRefGoogle Scholar
  40. 40.
    Barker JH, Brown CS, Cunningham M, et al. Ethical considerations in human facial tissue allotransplantation. Ann Plast Surg. 2008;60(1):103-109.PubMedCrossRefGoogle Scholar
  41. 41.
    Grayling AC. Face transplantation and living a flourishing life. Lancet. 2008;371:707-708.PubMedCrossRefGoogle Scholar
  42. 42.
    Johnson SE, Corsten MJ. Facial transplantation in a new era: what are the ethical implications? Curr Opin Otolaryngol Head Neck Surg. 2009;17(4):274-278.PubMedCrossRefGoogle Scholar
  43. 43.
    O’Neill H, Godden D. Ethical issues of facial transplantation. Br J Oral Maxillofac Surg. 2009;47(6):443-445.PubMedCrossRefGoogle Scholar
  44. 44.
    Alexander AJ, Alam DS, Gullane PJ, Lengele BG, Adamson PA. Arguing the ethics of facial transplantation. Arch Facial Plast Surg. 2010;12(1):60-63.PubMedCrossRefGoogle Scholar
  45. 45.
    Martin J. Face transplantation: psychological, social, ethical and legal considerations. Rev Méd Suisse. 2005;1(8):583-584.PubMedGoogle Scholar
  46. 46.
    Trachtman H. Facing the truth: a response to “On the ethics of facial transplantation research” by Wiggins et al. Am J Bioeth. 2004;4(3):W33-W34.Google Scholar
  47. 47.
    Strong C. Should we be putting a good face on facial transplantation? Am J Bioeth. 2004;4(3):13-14.PubMedCrossRefGoogle Scholar
  48. 48.
    Petit F, Paraskevas A, Lantieri L. A surgeons’ perspective on the ethics of face transplantation. Am J Bioeth. 2004;4(3):14-16.PubMedCrossRefGoogle Scholar
  49. 49.
    Butler PE, Clarke A, Ashcroft RE. Face transplantation: when and for whom? Am J Bioeth. 2004;4(3):16-17.PubMedCrossRefGoogle Scholar
  50. 50.
    Peled ZM, Pribaz JJ. Face transplantation: the view from Harvard Medical School. S Med J. 2006;99(4):414-416.CrossRefGoogle Scholar
  51. 51.
    Walton RL, Levin LS. Face transplantation: the view from Duke University and the University Of Chicago. South Med J. 2006;99(4):417-418.PubMedCrossRefGoogle Scholar
  52. 52.
    Banis JC, Barker JH, Cunningham M, et al. Response to selected commentaries on the AJOB target article on the ethics of facial transplantation research. Am J Bioeth. 2004;4(3):W23-W31.CrossRefGoogle Scholar
  53. 53.
    Barker JH, Furr A, Cunningham M, et al. Investigation of risk acceptance in facial transplantation. Plast Reconstr Surg. 2006;118(3):663-670.PubMedCrossRefGoogle Scholar
  54. 54.
    Barker JH, Furr LA, McGuire S, et al. Patient expectations in facial transplantation. Ann Plast Surg. 2008;61(1):68-72.PubMedCrossRefGoogle Scholar
  55. 55.
    Barker JH, Stamos N, Furr A. Research and events leading to facial transplantation. Clin Plast Surg. 2007;34(2):233-250. ix.PubMedCrossRefGoogle Scholar
  56. 56.
    Moore FD. Therapeutic innovation: ethical boundaries in the initial clinical trials of new drugs and surgical procedures. CA Cancer J Clin. 1970;20(4):212-227.PubMedCrossRefGoogle Scholar
  57. 57.
    Moore FD. The desperate case: CARE (costs, applicability, research, ethics). JAMA. 1989;261(10):1483-1484.PubMedCrossRefGoogle Scholar
  58. 58.
    Moore FD. Therapeutic innovation: ethical boundaries in the initial clinical trials of new drugs and surgical procedures. Daedalus. 1969;98:502-522.Google Scholar
  59. 59.
    The English position: position paper of the Royal College of Surgeons of England. South Med J. 2006;99(4):431.Google Scholar
  60. 60.
    Barth RN, Nam AJ, Stanwix MG, et al. Prolonged survival of composite facial allografts in non-human primates associated with posttransplant lymphoproliferative disorder. Transplantation. 2009;88(11):1242-1250.PubMedCrossRefGoogle Scholar
  61. 61.
    Landin L, Cavadas PC, Gonzalez E, Caballero-Hidalgo A, Rodriguez-Perez JC. Sensorimotor recovery after partial facial (mystacial pad) transplantation in rats. Ann Plast Surg. 2009;63(4):428-435.PubMedCrossRefGoogle Scholar
  62. 62.
    Morris P, Bradley A, Doyal L, et al. Face transplantation: a review of the technical, immunological, psychological and clinical issues with recommendations for good practice. Transplantation. 2007;83(2):109-128.PubMedCrossRefGoogle Scholar
  63. 63.
    Siemionow M, Klimczak A. Advances in the development of experimental composite tissue transplantation models. Transpl Int. 2010;23(1):2-13.PubMedCrossRefGoogle Scholar
  64. 64.
    Ulusal BG, Ulusal AE, Ozmen S, Zins JE, Siemionow MZ. A new composite facial and scalp transplantation model in rats. Plast Reconstr Surg. 2003;112(5):1302-1311.PubMedCrossRefGoogle Scholar
  65. 65.
    Washington KM, Solari MG, Sacks JM, et al. A model for functional recovery and cortical reintegration after hemifacial composite tissue allotransplantation. Plast Reconstr Surg. 2009;123(2 Suppl):26S-33S.PubMedCrossRefGoogle Scholar
  66. 66.
    Whitaker IS, Duggan EM, Alloway RR, et al. Composite tissue allotransplantation: a review of relevant immunological issues for plastic surgeons. J Plast Reconstr Aesthet Surg. 2008;61(5):481-492.PubMedCrossRefGoogle Scholar
  67. 67.
    Belanger M, Harris PG, Nikolis A, Danino AM. Comparative analysis between scientific and the media communication following facial transplantation. Transplant Proc. 2009;41(2):485-488.PubMedCrossRefGoogle Scholar
  68. 68.
    Siemionow M, Ulusal B, Engine UA, Ozmen S, Izycki D, Zins JE. Functional tolerance following face transplantation in the rat. Transplantation. 2003;75(9):1607-1609.PubMedCrossRefGoogle Scholar
  69. 69.
    Silverman RP, Banks ND, Detolla LI, et al. A heterotopic primate model for facial composite tissue transplantation. Ann Plast Surg. 2008;60(2):209-216.PubMedCrossRefGoogle Scholar
  70. 70.
    Coffman KL, Gordon C, Siemionow M. Psychological outcomes with face transplantation: overview and case report. Curr Opin Organ Transplant. 2010;15(2):236-240.PubMedGoogle Scholar
  71. 71.
    Brill SE, Clarke A, Veale DM, Butler PE. Psychological management and body image issues in facial transplantation. Body Image. 2006;3(1):1-15.PubMedCrossRefGoogle Scholar
  72. 72.
    Hurlburt M. Facial transplantation: understanding the interests of patients and hurdles to informed consent. Med Sci Monit. 2007;13(8):RA147-RA153.PubMedGoogle Scholar
  73. 73.
    Renshaw A, Clarke A, Diver AJ, Ashcroft RE, Butler PE. Informed consent for facial transplantation. Transpl Int. 2006;19(11):861-867.PubMedCrossRefGoogle Scholar
  74. 74.
    Rumsey N. Psychological aspects of face transplantation: read the small print carefully. Am J Bioeth. 2004;4(3):22-25.PubMedCrossRefGoogle Scholar
  75. 75.
    Drane JF. Competency to give an informed consent. JAMA. 1984;252(7):925-927.PubMedCrossRefGoogle Scholar
  76. 76.
    Morreim EH. About face: downplaying the role of the press in facial transplantation research. Am J Bioeth. 2004;4(3):27-29.PubMedCrossRefGoogle Scholar
  77. 77.
    Morreim EH. High-profile research and the media: the case of the AbioCor artificial heart. Hastings Cent Rep. 2004;34(1):11-24.PubMedCrossRefGoogle Scholar
  78. 78.
    Maschke KJ, Trump E. Facial transplantation research: a need for additional deliberation. Am J Bioeth. 2004;4(3):33-35.PubMedGoogle Scholar
  79. 79.
    Agich GJ. Extension of organ transplantation: some ethical considerations. Mt Sinai J Med. 2003;70(3):141-147.PubMedGoogle Scholar
  80. 80.
    Allen W. Louisville doctors studying face transplants weigh ethical issues. The Courier-Journal. November 16, 2003.Google Scholar
  81. 81.
    Powell T. Face transplant: real and imagined ethical challenges. J Law Med Ethics. 2006;34(1):111-115.PubMedCrossRefGoogle Scholar

Copyright information

© Springer London 2011

Authors and Affiliations

  1. 1.Department of Philosophy, Social Philosophy and Policy CenterBowling Green State UniversityBowling GreenUSA

Personalised recommendations