Face transplants come with ethical questions

A face transplant is different from other kinds of transplants, medical ethicists said on Wednesday, and the risks and benefits to the patient must be weighed carefully.

For one thing, the surgery requires the patient to spend a lifetime on immunosuppressant drugs, which can have negative side effects and even cause death.

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Cleveland Clinic

In this undated photo, Dr. Risal Djohan, left, Dr. Maria Siemionow, center, and Dr. Daniel Alam perform a near-total face transplant at the Cleveland Clinic in Cleveland. Reconstructive surgeon Siemionow replaced 80 percent of the patient’s face, with that of a deceased female donor.

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GERARD CRIGNIER/Bloomberg News / File

In 2006, Isabelle Dinoire became the world’s first face transplant recipient in France.

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“Not to downplay the difficulties of having a facial disfigurement, but one can live a long life and be disfigured,” said Stuart G. Finder, director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles.

On the other hand, he said, the benefits of a face transplant are not just cosmetic.

“The repair of the face can also have significant social consequences,” he continued, “like the ability to speak, or the ability to eat that can be replaced because of having lips.”

Dr. Mark Siegler, director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, said face transplant surgery should be evaluated in the same way other surgical innovations were.

“What you need is a kind of process that assures four things,” he said. Those criteria are “adequate scientific background” to suggest that the procedure has a good chance of success; a medical team with the skill and experience to pull it off; a medical institution motivated not by the desire for publicity but by a perceived medical need, and the “open display, public evaluation and professional discussion” of the proposed surgery well before it is performed.

That said, Dr. Siegler added, “the face is a little different from internal organs because so much emotion and expression is in the face.” For that reason, he believes that many families will be reluctant to allow a deceased loved one to become a face donor.

Dr. Finder said a broader “social justice” cost-benefit analysis should also be done, perhaps especially in the current climate.

“This is very resource-intensive, and we are at a time when economically our nation is seriously shaken,” he said, adding that some people would ask: “Is this the best way that our health resources ought to be used? This helps one person. How many children could have received basic health care and for how long?”

The other side of that argument, he said, is that medical innovations often have wider benefits that cannot be predicted. “With face transplant, we know that we will learn something about something, but we can’t say what that is. We know that it will help many people beyond those getting the surgery. Some people will say you take the risk now with the expectation of a payoff later. Others will say, ‘No, we have a problem now.’ “

Professor Finder recommended that for now, surgeons hold off on further face transplants.

“We’ve done this, so we now know it’s technically possible,” he said. “We probably shouldn’t be going wholeheartedly, guns blasting away, down the road to do this. Now we need to pause and say, ‘Is this the right thing to do?’ “