About Face: the Face Transplant Debate

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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...
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