Ethical issues last hurdle for face transplants

Researchers at the University of Louisville in Kentucky say they have asked hundreds of questions about doing a face transplant and the ones that remain can only be answered after the first transplant is done.

"You're at an edge and you have to jump," said John H. Barker, MD, the school's director of plastic surgery research. "You can't do psychosocial research on a pig."

In addition to weighing improvements in quality of life versus a lifetime of taking immunosuppressive drugs, researchers explored concerns about sense of identity and privacy. They also considered how to inform potential patients about any consequences that may occur. Years of inquiry have been boiled down to a 12-page report in the Sept. 17 American Journal of Bioethics.

"Technically, they could have done [face transplant] 10 years ago," Dr. Barker said. "The big question was the psychosocial and ethical part. Basically, the last three years have been focused on ethics."

The report's lead author, Osborne Wiggins, PhD, a philosophy professor at the University of Louisville, said face transplants are a natural progression from hand transplants, which have been successfully done about 20 times. Hands, like faces, are not necessary for survival, but transplants could have huge impacts on quality of life.

Unexpected benefits reported by hand-transplant patients include simple pleasures such as holding a daughter's hand or wearing a wedding ring again. "If that happened with the hand, imagine what would happen with the face," Dr. Barker said.

Researchers in Cleveland, Great Britain and France are also working toward performing face transplants. Candidates include people who have been disfigured by burns, other injuries, cancer or congenital anomalies.

Dr. Barker said transplanted faces would come from the public pool of tissue donors, so they are working to educate the public. "As it is right now, the tabloids are winning," he said. "We're busy trying to put the science in place, while they're busy writing sensationalistic articles."