Are Face Transplants Ethical?

1
Are Face Transplants Ethical?

• By Rahul Gladwin
• University of Health Sciences Antigua
• School of Medicine

2
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.

3
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.

4
Worlds first face transplant

• The worlds first full-face transplant was
  performed in 1994 by Dr. Abraham Thomas, M.D.,
  one of Indias prominent microsurgeons. This
  wasnt a movie, but a real surgery to save the
  life of a nine-year-old girl, whos face was
  destroyed due to a lawnmower accident, and
  surgeons simply reattached the girls original
  face. This surgery was inspired by previous
  failed attempts by US and British surgeons.

5
Face transplant from donor

• The worlds 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 whos face was mangled by a dog. Surgeons
  took a triangular piece of face tissue from a
  brain-dead donors nose and mouth, and grafted it
  onto the patients face. This complex procedure
  was performed within one month of the accident.

6
So whats 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 patients 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.

7
Surgeons hit back

• Professor Jean-Michel Dubernard stated that the
  womans face couldnt 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.

8
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 dont reject the
  newly transplanted facial tissue.

9
Did French government agree?

• No it didn't. The French government ethics panel
  is against the procedure of face transplants.
  They say this womans 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.

10
The Question of Self-Image

• Some ethicists questioned whether the woman was
  prepared to live with someone elses 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.

11
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 ones
  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.

12
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 shouldnt
  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.

13
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 dont 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?

14
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.

15
Bibliography Links

• Links
• http//health.discovery.com/centers/plasticsurgery
  /facetransplant/slideshow/slide.html
• http//www.washingtonpost.com/wp-dyn/content/artic
  le/2005/12/02/AR2005120201787.html
• http//www.cbsnews.com/stories/2005/12/01/health/m
  ain1091293.shtml
• http//www.iht.com/articles/2004/06/16/edsokol_ed3
  _.php