About Face: The Face Transplant Debate By Sherri L. Rodney-Kahle HCA 322 Health Care Ethics and Medical Law Professor Dolores Thomas July 13, 2009 About Face – The Great Face Transplant Debate The first successful human organ transplant in the United States was performed on December 23, 1954. On that date, a kidney was successfully transplanted, with the organ donated by a living identical twin of the recipient (Kaserman, 2007).

More than fifty years have now passed since that first successful human organ transplant and since then, organ transplantation has moved from the experimental stage to assume an important role in the treatment of organ failure stemming from a wide variety of underlying causes. Today, kidneys, hearts, livers, lungs, and other organs are routinely transplanted to patients whose lives would otherwise soon be ended.

Moreover, unlike some life-extending measures that substantially lower the quality of life, where organ transplants succeed, recipients’ health can be restored dramatically. It is only natural that phenomenal strides in transplant science and surgery now present society with a much different and complex prospect: transplantation of the human face. Until recently, transplant procedures were done only in life-threatening cases, and transplanted organs were internal and non-visible.

Essential to each of us and to the whole of humanity, the face is primal in its individual image and identity. It is intrinsically connected with us in a way that defied question—until now. The mere idea that surgeons could remove a deceased person’s face for use by someone else elicits responses ranging from thoughtful contemplation to revulsion. Surgery to transplant human facial tissue to another creates discomfort because of a face’s personal nature as essential to individuality and identity.

In essence, the ability to perform such surgeries has become a volatile ethical subject of public debate, which raises the question: will facial tissue transplantation become widely accepted as a necessary medical practice? Viewed as the next step in the substantial strides yielded by composite tissue allotransplantation, including hand transplant, surgeons and scientists envision facial transplant as a revolutionary advance in treating persons who are severely disfigured by burns and traumatic deformities.

Current surgical techniques in facial reconstruction use the person’s own skin for grafting, which ultimately produces an asymmetric patchwork of tissue and non-pliable scars. The grafted tissue–a thin piece of skin–has no intrinsic blood supply and relies on the ingrowth of vessels from the recipient’s underlying facial muscles, thus restricting movement and resulting in a mask-like appearance. From a surgical standpoint, facial transplant offers an attractive option.

By transferring an entire facial skin flap, including the vascular supply, from one person to another, surgeons envision optimal outcome with muscle function that most people take for granted, such as breathing, chewing, and closing their eyes to sleep (Hartman, 2005). This functional improvement should also coincide with improved aesthetic appearance, including a return of facial expression as the donor tissue melds to the recipient’s bone structure, muscular sutures heal, and nerves regenerate.

This functional and aesthetic improvement requires fewer surgeries than incremental tissue grafting. A facial tissue transplant is estimated to be a twenty-four hour procedure; twelve hours for facial-flap removal from the donor and twelve hours for surgical attachment to the recipient. Thus, scientists and surgeons urge its progress as an “alternative for patients with complex facial deformities that cannot be corrected by application of currently available reconstructive procedures” (Hartman, 2005).

The nature and extent of unknown risks make conceptualization of the procedure germane not only to biomedical science and its relationship with society, but also to law and regulatory policy. It is unclear, for instance, whether this procedure should be conceived as transplant and, thus, fall within regulatory guidelines for procurement and allocation under the federal National Organ Transplantation Act (“NOTA”) and the Uniform Anatomical Gift Act (“UAGA”), which have been adopted in some form by every state.

While tissue allograft resembles transplant in terms of requiring surgical transfer of human tissue from a donor to recipient, it does not conform to a traditional transplant model because the primary skill involved relates to plastic and reconstructive surgery both at the procurement and allograft stages (Hartman, 2005). Further, there are more complexities involved with matching donors with recipients beyond matching blood types. With a visibly accessible organ such as skin, physicians also need to match gender, age range, skin type, and color of donor and recipient (Powell, 2006).

Long-term consequences are starkly unknown, such as genetic tissue mutation or psychological impact. Additionally, short-term risks, such as infection and additional scarring, are enduring and possibly permanent. Conceding untold results and risks for humans, including tissue rejection by the host immune system and long-term healing, research scientists and surgeons nonetheless forecast transferring transplantable tissue to a recipient, including some “architecture” from a donor face, such as shape and proportion of brow lines, noses, cheekbones, and mouth formation.

They maintain, however, that a facial transplant recipient would look neither like one’s former self nor the donor; rather, a recipient would adopt altogether a new facial identity. This phenomenon is described as a “third identity,” contrary to sensationalized reports of “wearing a dead person’s face” (Hartman, 2005). Lifetime compliance with a higher dosage regimen of current immunosuppressive drugs demands vigilant post-transplant care.

In the event of noncompliance with prescribed immunosuppressive drugs, the effect and extent of facial tissue rejection remain a serious risk. A failure of the procedure could further compromise the patient’s appearance and his ability to adjust, and could also be life-threatening. The added trauma and disfigurement to the recipient raise concerns as to the remedy, and the extent to which it is even possible; for example, would that remedy entail another facial transplant?

Put differently, could the transplant recipient be worse off than having not undergone the facial transplant? (Hartman, 2005) An example of this was the partial face transplant done in China in April, 2006. Dr. Guo Shuzhong is one of China’s most celebrated plastic surgeons who had ambitions to perform the world’s first full face transplant. However, for his first partial face transplant, he selected the wrong type of patient—30-year-old Li Guoxing, a man from a remote rural part of Yunnan province who was attacked by a black bear.

The operation went well, Li spent 14 months in the hospital, but tired of city life and, against medical advice, returned to his family in his remote village. The doctor tried to dissuade him because he needed lifelong care and the drugs he needed to take could have had serious side effects. Two years after the operation, Li’s body started to reject the transplant, but he refused to return to the hospital and refused to take the life-saving drugs (Pratt, 2009). Li abandoned the immunosuppressive medications in favor of herbal remedies and died in July, 2008 (Jesitus, 2009).

Biomedical principles of beneficence, nonmaleficence, nonmalfeasance, and fidelity must not be overlooked in facial transplant. As a life-enhancing option to permanent disfigurement, facial transplant commands a sustained, cautious approach, rather than improvised response, given the untold degree of risk to the recipient, who is a vulnerable patient with hope of improved aesthetic and functional results. Mere promise of aesthetic and functional improvement does not reasonably, or morally justify, maiming or harming a person.

Proceeding surgically with a shortsighted view of risk undermine professional responsibilities of nonmaleficence, fidelity, and nonmalfeasance by dimming potential harm, both physically and psychologically, to patients with facial disfigurement that is not absolved by promises for improved aesthetic and function. By bringing sharply into focus the enormity of risks, contemporary customs and commitments that maintain virtues in medical practice impact how persons suffering with facial disfigurement should be engaged in the autonomy of decision-making about facial transplantation.

Simply put, predictable and unpredictable risks should be discussed (Hartman, 2005). This issue questions whether informed voluntary consent is possible, let alone acceptable, in this context. In fact, any concept of informed decision-making in this context seems counterintuitive; a facially-disfigured person’s euphoric anticipation, accompanied by rekindled hope and expectation, work against voluntary decision-making, which is an element crucial to the legal and bioethical contours of informed medical decision-making.

Informed consent is steeped in principled views of individual autonomy and personal wellbeing that rely, in important part, on voluntary decision-making (i. e. , that personal choice should result from one’s own values unencumbered by coercive influences). Because the face closely correlates with identity in a constitutive sense, the degree of invasiveness to bodily integrity alone suggests an inherently suspect decision (Hartman, 2005).

Many concerns exist with respect to screening and selecting prospective recipients. In short, who would determine prospective candidates for facial transplant and how would they be selected? A key selection criteria should be the psychological state of the prospective candidate, as the ability to cope with stressors and intensive post-surgical care influences transplant success and survival. A facial transplant intensifies these stressors.

Ongoing compliance with complex immunosuppressive protocols and psychological integration of a new identity with self-image will be difficult, as was the trauma that accompanied a disfigurement and exacerbated a patient’s vulnerability (Hartman, 2005). The degree of facial disfigurement is another major criteria. Presently, facial transplant is intended as a procedure for persons severely disfigured by burn, accident, or disease. Yet, what about people suffering from a vascular birthmark or a botched face-lift?

While research suggests that a universal concept of facial disfigurement exists and may be reliably measured, these findings further suggest that degrees of disfigurement are still influenced by systematic and subjective elements. Disfigurement, as with defect or deformity, is a social construction shaped by cultural forces, and, thus, subjective elements shaped by social and cultural norms accompany any determination of facial disfigurement within purview of the procedure and resource allocation (Hartman, 2005).

Certainly, the specter looms that someone facially disfigured as a result of choosing to undergo numerous cosmetic surgeries may want to undergo facial transplant. Whether personal choice that proves detrimental, such as undergoing, for pure vanity, what ultimately proves to be deforming plastic surgery, constitutes a legitimate factor when considering prospective candidates who are facially disfigured warrants exploration. This point reflects the debate about whether alcoholism should factor into consideration among candidates competing for a lifesaving liver transplant.

In contrast to facial transplant, however, liver transplant is more difficult from an ethical standpoint given that resource allocation is life-saving; whereas, facial transplant would be life-enhancing and other options exist, such as reconstructive surgery using one’s own skin for grafting (Hartman, 2005). Currently, physicians have limited consideration to those patients who have been severely disfigured by burns or trauma and who have been left with functional impairment, such as an inability to close their eyes or mouth.

Such patients often have badly scarred faces that look like multicolored immobile masks; features such as noses, eyelids, or lips may be missing or misshapen. It is estimated that there are thousands of severely disfigured people in the United States, many of them so socially isolated that they are invisible to the general public (Okie, 2006). The end result is not to be beautiful; it is to have a face . . . any face (Bachrach, 2006). The psychological impact on the recipient following the procedure is also germane.

It is at least imaginable that a recipient of a facial transplant could experience psychological shock equal to or exceeding that of the original disfigurement. The nature of the psychological shock carries implications apart from difficulty in adjustment and adaptability, such as a recipient perceiving a stranger’s presence engrafted onto one’s self and, thus, feeling foreign to one’s self or even violated. This could impact self-relationship and interpersonal relationships with others, entailing the need for sustained psychological support as part of follow-up care.

For example, studies with solid organ transplant recipients report “that some people feel that their personality, behavior or attitude have changed because they have received in their body an organ from another individual” (Hartman, 2005). The same controversy surrounded heart transplants several decades ago, when some worried that the procedure might somehow transplant the donor’s personality or emotion. But a heart is an internal organ, which made it easier for people to accept.

The face, however, is intensely personal and unique (Victory, 2005). A major change seems to occur with the advent of visible and non-vital organ transplants, in particular of the hand and the face. These forms of transplantation raise new ethical issues, both for the donor and recipient. On the donor’s side, ethical issues focus on the family circle, who must come to terms with the continuing identity of a loved one, when the hand (or even the face) of a deceased relative comes to life again as part of someone else’s body.

Although the donation of visible organs is rare, the topic is well publicized in the lay media; anonymity of the donor and recipient can hardly be preserved, making the ethical issues all the more pressing (Carosella ; Pradeu, 2006). The transplantation of visible organs provokes more serious questions for the recipient. Visible organs are components of an individual’s identity, and may be involved in the person’s relationships with other people and in the image they convey.

Hands are an important means of action and communication, often being involved in our interactions with others. The face expresses a person’s identity even more directly. For a recipient, encountering a visible transplant every day can be difficult because it implies accepting the constant presence of another person, and even a modified expression of the recipient’s personality. For a visible transplant, the donated organ exercises not only an organic function, but also the expression of this function.

Thus the organ contributes to the formation of the image that an individual has of him or herself, to the image others have of them, and above all to the image that he or she believes others have– the social mirror image (Carosella & Pradau, 2006). With the transplant of a visible organ, a deep identity split occurs, because one’s self-image is modified substantially. Even if functionality is given to the grafted organ, the recipient still has to come to terms with this new organ: to recognize him or herself in the everyday use of the organ, which indeed is both self and different from self.

In some cases, transplantation is essential, particularly when a patient’s life is threatened by depression. Therefore, both the living conditions of the patient and their capacity to rebuild identity must be taken into account. For instance, the New Zealander Clint Hallam received a hand graft in 1998, but his hand, which he started to consider as “other” (foreign), became unbearable for him; he stopped taking immunosuppressive drugs, rejection took place, and eventually he asked that his hand be amputated” (Carosella & Pradeu, 2006).

Every graft of a visible organ leads to an identity split, the consequences of which can be very serious if the recipient does not succeed in psychologically accepting the organ and in rebuilding its social expression in everyday life. Thus a transplant can be considered successful if it assures not only the function of the organ, but also the rebuilding of the recipient’s identity. This difficult rebuilding work can be fruitful, because identity is characterized by a continuous evolution.

The graft of a visible organ can lead to a full expression of one’s identity, making the individual aware that to be oneself is to change constantly, and to accept oneself as changing. Ethical debates must be opened on specific questions about the projection of the donor’s identity and the rebuilding of the recipient’s identity (Carosella & Pradeu, 2006). The question of how the transplanted face will look is critical not only to the recipient, but also to the relatives of potential donors. You would want to be sure that the family understands that the appearance of their loved one will not at all be replicated,” said Eric D. Kodish, chairman of bioethics at the Cleveland Clinic Foundation and a member of the transplantation team. British doctors have used a software program developed by forensic anthropologists to demonstrate to British transplantation coordinators that the new face will combine aspects of the donor and the recipient, with the underlying skeleton and muscles largely determining its shape and final appearance. You don’t get donor identity transplant, you don’t get quite back to where you were. It’s a hybrid,” he said (cited in Okie, 2006). The world’s first partial allotransplantation of a human face occurred on November 27, 2005 at a French hospital. Surgeons transplanted a triangle of tissue that included the lower part of the nose, the lips, and the chin of a woman whose face was destroyed by a dog. The transplant contained the skin, fat, mucosa, and the muscle groups that control the puckering and elevation of the lips (Okie, 2006).

Two years after the surgery, the patient, 40-year-old Isabelle Dinoire, still struggles to pucker up for a kiss and recounts her initial revulsion at “having the inside of someone else’s mouth—it didn’t belong to me” (cited in Jesitus, 2008). She achieved normal sensation in the transplanted tissue four months post-surgery (Jesitus, 2008). While she is pleased with how far she has come, the sense of what she has lost is never far from her mind. “A part of me and my identity disappeared forever. And I have precious memories of what I was” (cited in Hewitt, 2007).

The next concern is, where would a steady supply of facial tissue donors come from? The face arguably is more personal to us than our kidneys and lungs. So, a face transplant makes doctors, ethicists and researchers stop to ponder: Who would be willing to part with it at the end of his or her life? And even if the donor gave previous explicit permission, would family members allow their loved one to be disfigured after death? Would the family worry that the recipient might resemble the donor? Or even that their loved one might meet the afterlife faceless? Victory, 2005) “I will thank them all my life,” French transplant recipient Dinoire said of the family of the donor of the facial tissue she received (cited in Hewitt, 2007). The donor was said to have been a woman who committed suicide. A cast was made of the donor’s face, from which doctors made a synthetic mask that was reattached to her body for burial Hewitt, 2007), which is required by French law. “Families, societies and religious leaders are going to have to decide whether donating a face or part of a face is a noble thing,” said orthopedic and plastic surgeon L.

Scott Levin, of Duke University Medical Center in North Carolina. Public opinion could advance or slow the establishment of face transplant surgery centers. Even if the science is up to speed, as Levin notes, transplant surgery is not possible without willing donors (cited in Victory, 2005). Any candidate who is chosen must be able to accept not only the medical risks, uncertainty of success, and the likelihood of relentless media attention, but also the possibility that the operation may never take place at all.

They may understand that they have to wait a little bit, but they may not understand that it may be eternity, if there is no donor (Okie, 2006). The issue of confidentiality is one that also raises some disturbing concerns. The French team who performed the first facial transplantation may not have been the most ethically reflective of the groups who are performing such procedures. There were actions associated with the surgery that may represent ethical lapses. Reportedly, the surgeon used an experimental technique of transplanting cells from the donor’s bone marrow along with the facial skin in the hope of preventing rejection.

Such a combination of two experimental procedures is not consistent with best practices in research, and will make it difficult to assess the reasons for the success or failure of the experimental surgery. Far more disturbing, however, is the news that the physicians, the recipient, and a British film-maker signed a lucrative film deal several months in advance of the surgery. Such a plan suggests a serious conflict of interest for the physicians, who would have a reason other than the patient’s best interest to proceed with the transplant (Powell, 2006).

In addition, the public should not know the name of the recipient, though it has been widely reported by the international press, nor should it have been learned the donor’s name and reports that she died by suicide. This information could only have come to the press by leaks from health professionals. These breaches of confidentiality for both the patient and donor are egregious ethical lapses. This rough treatment of donor and family will hardly inspire confidence in others who contemplate the donation f any organ (Powell, 2006), and puts the principle of fidelity into question when promises of confidentiality have been clearly broken by the medical team. One of the lead French surgeons aptly described the media coverage as “odious. ” Though he was referring to breaches of confidentiality, such a description suits the New York Times story in which a woman interviewed in a day spa commented: “accepting a skin transplant from an organ donor just to look like Angelina Jolie somehow doesn’t set right with me. ” This discussion and many similar ones are insultingly removed from the realities of transplantation (cited in Powell, 2006).

Today, people die each day awaiting organs for transplantation. Because of the shortage, physicians have redoubled their efforts to make the best possible use of those organs that are available, transplanting organs from donors far older and sicker than was once thought possible. In this context, it is hard to imagine an abundance of facial skin donations. A significant percentage of brain dead donors die of head trauma, meaning that donors of facial skin will be rare, nor is there any reason to expect that they would be young and wrinkle free.

With a visually accessible organ like skin, physicians need to match not only blood type but also color and gender. Facial transplantation carries all the surgical and immunological risks to the recipient discussed earlier. Speculation about facial transplant for the wrinkled rich, who simply prefer a newer, younger face in the popular press, is offensively out of place (Powell, 2006). Would it be better if we as a society learned to be less ignorant and cruel, so that those with disabilities were treated with the respect that they deserve?

Absolutely. But to require those with facial disfigurement to forego treatment (if they wish treatment) while awaiting behavioral improvements in the able-bodied seems both cruel and ineffective. In the end, many of the discussions, which include ethicists, seem to ignore the needs and opinions of candidates for facial transplant. There were both definite and arguable ethical lapses associated with the first facial transplant, including breaches of confidentiality, bending of research rules, and film deals.

However, we cannot know the suffering of the woman who received the transplant, nor the state of her decision-making capacity. The choice to pursue new, even risky, treatments will always raise ethical concerns. Plastic surgeons have been at the forefront of transplantation medicine since its inception. The first organ transplant, a kidney transplant done in 1954, was done by a plastic surgeon, and the first successful hand transplant was performed by a plastic surgeon in 1998.

In 2006, the American Society of Plastic Surgeons (ASPS) and the American Society for Reconstructive Microsurgery (ASRM) took a strong stand and issued Guiding Principles to assist plastic surgeons who may choose to participate in facial transplantation. The Guiding Principles help plastic surgeons decide who is a good candidate for this procedure through everything from in-depth evaluation of prospective patients’ physical and psychological condition to informing the patients of the very latest information about risks and outcomes.

The Guiding Principles carefully protect patient rights and emphasize the ethical principles and values of the medical profession relating to what is currently known about facial transplant procedures by establishing suggested standards for the procedure, such as: 1. Facial transplantation should only be utilized for patients with severe facial deformities who cannot be helped through traditional reconstructive surgical measures. 2.

Facial transplantation should only be undertaken in institutions with appropriate Institutional Review Boards familiar with the many intricacies for approval and application of new clinical procedures and protocols. 3. Facial transplantation should be conducted in the context of a transplant team having appropriate institutional resources and commitment to the project. The team should be ideally composed of specialists representing the disciplines of plastic surgery, immunology/transplant, medical ethics, psychology, infectious disease, oncology, medico-legal, physical therapy, pharmacology, and patient advocacy. . Appropriate patient selection criteria should be established and a complete risk/benefit ratio must be considered for each patient on a case-by-case basis. 5. To facilitate informed consent: a. The physician must provide the patient with the latest and complete information on the risks associated with facial transplant. b. The preoperative evaluation of potential donors may involve additional considerations as more experience is gained. At this time, the results of facial transplantation are unknown.

If early results are less than optimal, potential patients should be informed of any newly-indentified limitation of the procedure. c. Patients must demonstrate a thorough understanding of all the known risks and benefits. d. The physician should regard the facial transplantation procedure as experimental and it should be subjected to the evaluation of an independent research ethics committee. This committee should subject the transplant and informed consent proposal to the rigors of valid consent for treatment in the context of surgical research. . The informed consent should include an alternative and acceptable solution for management of the recipient’s face in the event of transplant failure. 6. Candidates for facial transplant should undergo a complete psychological evaluation as well as an evaluation of their psycho-social support system. 7. Patients with known psychological or psychiatric diagnoses, poor coping skills, or a poor support system are poor candidates for facial transplantation. 8.

As with any new medical/surgical innovation, incremental steps are necessary to ensure its appropriate application. 9. Peer review of the results of facial transplantation is mandatory to assure compliance with medial standards of care and objective assessments of outcome. 10. The ethics of performing an experimental procedure with a potentially fatal or deforming outcome for the purposes of advancing science must be carefully weighed against the few potential benefits for a small group of patients, and society in general.

The Guiding Principles may be accessed at http://microsurg. org/ftGuidelines. pdf. A sense of interconnectedness is commonly derived through communicating face-to-face, which emphasizes the face as essential to our being and relating to others. There is a moral significance to the human face that exceeds a fingerprint to individuate us. This moral significance requires us to recognize that there is something special about the face that distinguishes it from other bodily parts. Human faces are vested with special aspects of personality, such as mood and disposition.

As a repository for physical particulars associated with personal identity, such as profiles and expressions, the face is etched with unique experiences and is a portal through which one’s inner self is expressed. Through the face, individual aging experiences, for instance, give “character” to our existence, such as genetic heritage (i. e. , looking more like a parent with passing years), laugh lines expressing joyful times, or brow furrows that convey sad or stressful times. The face is a perpetual constant in human existence, relied on for personal expression and interaction with others.

By our faces, others distinguish, recognize, and react to us. Thus, the value of the human face, primarily encoded with our personal identity and exhibiting our common humanity, demands far more consideration and should be the starting point for developing legal policy and public oversight in the context of facial transplant (Hartman, 2005). Alleviating human suffering drives scientific freedom and societal choice for scientific progress, but compassion and preserving the value of human life and dignity should also drive science and society.

At times, these priorities compete and converge in a way that presents an unprecedented challenge to what it means to be human. The prospect of facial transplant is one such challenge. Central to this challenge is the significance of the human face and the developments in biomedical science and technology that could alter that significance in a way that foreshadows the never to be replicated meaning of that which has long been a symbol of common humanity.

Facial transplant could corrode that meaning by suggesting disposability of what the human face symbolizes in terms of our identity and essence (Hartman, 2005). Precisely because the prospect of facial transplant so deeply touches upon our humanity, it obligates us to frame issues that optimize thoughtful response to what is at stake and how it may affect humanity for future generations. Safeguarding the human future relies in part on society’s ability to steer a prudent course in the pursuit of biomedical progress.

There is every reason to believe, based on prior progress in transplant surgery and science, that the prospect of widespread facial transplants will be realized. But, it is unacceptable not to deal with the problems of otherwise promising progress when it has the potential to vitiate a vital aspect of human existence and respect for humankind as we know it. That we owe this duty to future generations, not just to ourselves, endows us with a sense of something beyond mortality.

Thus, pursuit of science should not outpace a decisive societal response resulting from serious thought that, when considered prudent, may constrain its advancement. On the other hand, face transplantation is an enormously costly, intricate procedure that does not prevent imminent death, which is the justification for most other organ transplants. The cost of a full facial transplantation surgery is estimated at between $300,000 to $400,000—steep for a procedure that isn’t considered life-saving (Winslow, 2009).

The immunosuppressive medication regimen is estimated to cost between $12,000 and $24,000 per year, must be followed for the recipient’s life, and is associated with an increased incidence of serious side effects (Okie, 2006). At the present time, insurance has not been extended to cover this kind of surgery or follow-up treatment. It is also not known whether face transplants will widely result in restoring much function to the recipient’s faces (Coghlan, 2005). On the other hand, it could offer an option to veteran soldiers in the Iraq war who have suffered major facial injuries.

Surgeons argue that those in the best position to accurately balance the risks and benefits of facial transplantation are the severely disfigured patients who are appropriate candidates, and that they deserve the opportunity to do so. “Only they are in a position to understand the benefit, and that doesn’t disqualify them from assessing the risk,” says Eric D. Kodish, chairman of bioethics at Cleveland Clinic Foundation and a member of the transplantation team. “People with disfigurement this severe, you don’t see them in the grocery store or the gas station. This is not a nose job . . it’s a medical procedure. I would really frame it the same way I would . . . the risks and benefits of a liver transplant or a heart transplant” (cited in Okie, 2006). The position could certainly be defended that such a procedure is life-saving, especially when the impact of a severe facial deformity could have the effect of suicidal depression on such a patient. An era in which face transplants are done fairly frequently is difficult to imagine, partly because it’s so dependent on willing donors, said Dr. Raffi Der Sarkissian, of Boston Facial Plastic Surgery.

Der Sarkissian is also an assistant clinical professor at the Boston University School of Medicine. “I think it will be a huge challenge to find a donor, unless you get into a situation where a person wants to perpetuate their person after death,” he said (cited in Victory, 2005). I believe as the medical profession is able to carefully progress and learn more about such intricate procedures, as well as effective ways to manage the complex issues involved, there will be more acceptance among the field and more surgeons willing to perform such operations.

Conversely, as more of these transplantations take place and the public realizes that facial transplantation is not a superficial cosmetic procedure, but a potentially life-saving technique for those with serious facial injury, the procedure will become more accepted. I project that eventually, every nation will have several transplant centers capable of performing facial and other tissue transplants. However, due to the complexity of the facial transplants, I don’t expect a substantial number of these procedures to occur for the next several years.

However, with good long-term outcomes in those who have had the procedure, high patient satisfaction, and the emergence of insurance coverage for these procedures, I believe that such restorations could become routine and widely accepted, if acceptable donors could be identified and tissue properly registered, stored, and fairly distributed from tissue banks as non-visible organs presently are. Phenomenal strides in biomedical science and technology have endowed us with the notion of the impossible becoming the possible.

Those strides inspire in us an enduring sense that we are part of something beyond mortality in the continuum of humanity, obligating us to deal with the perils posed to humankind and future generations. In the end, it has been said, all we really have is our good name and reputation. That good name and reputation, and the dignity found therein, are inextricably linked to the human face, suggesting a moral significance to the face that exceeds fingerprints or signatures to individuate us.

Selfhood is distilled in the human face; therefore, the face and its value deserves nothing less than careful, intelligent deliberation for unique ways to utilize it for the benefit of all mankind in the alleviation of human suffering. References Bachrach, J. (2006, June). A Change Of Face. Allure,198. Retrieved July 12, 2009, from Research Library. Carosella, E. , ; Pradeu, T. (2006). Transplantation and identity: a dangerous split? The Lancet, 368(9531), 183-4. Retrieved July 12, 2009, from Research Library. AndCoghlan, A. (2005, December). The face-transplant benefit that will speak for itself. New Scientist, 188(2529), 10.

Retrieved July 12, 2009, from Research Library. | Hartman, R. (2005). Face Value: Challenges of Transplant Technology. American Journal of Law and Medicine, 31(1), 7-46. Retrieved July 12, 2009, from Research Library. Hewitt, B. (2007, July). Face Transplant Update: ‘It Will Never Be Me’. People, 68(4), 108. Retrieved July 10, 2009, from Research Library. Jesitus, J. (2008, February). About faces: Transplant patients continue to progress. Dermatology Times, 29(2), 1,22-24. Retrieved July 12, 2009, from Research Library. Jesitus, J. (2009, February). Facing forward. Dermatology Times, 30(2), 16,25-27.

Retrieved July 10, 2009, from Research Library. Jesitus, J. (2006, December). Saving face. Dermatology Times, 27(12), 32-33. Retrieved July 12, 2009, from Research Library. Kaserman, D. (2007). Fifty Years of Organ Transplants: The Successes and The Failures. Issues in Law ; Medicine, 23(1), 45-69. Retrieved July 10, 2009, from Research Library. Okie, S. (2006). Brave New Face. The New England Journal of Medicine, 354(9), 889-894. Retrieved July 11, 2009, from Research Library. | Powell, T. (2006). Face Transplant: Real and Imagined Ethical Challenges. The Journal of Law, Medicine ; Ethics, 34(1), 111-5, 4.

Retrieved July 10, 2009, from Research Library. Pratt, S. (2009, April 22). Tonight’s TV – Face off. Northern Echo,21. Retrieved July 10, 2009, from ABI/INFORM Trade & Industry. Victory, J. (2005). Would you donate your face for a transplant? ABC News. Retrieved July 10, 2009 from http://abcnews. go. com/Health/Cosmetic/story? id=1448863 Winslow, R. (2009, May 6). U. S. News: Face-Transplant Patient Emerges — Woman, First in U. S. to Undergo Procedure, Has Visage That Is 80% New. Wall Street Journal  (Eastern Edition),  p. A. 3. Retrieved July 10, 2009, from ABI/INFORM Global.

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