Face Transplants: Ethical Challenges
You may remember the horrifying story of a young French woman who passed out after taking some sedatives, and her dog tried to wake her up by gnawing on her face. She was the first recipient of a face transplant, and is on immunosuppressant therapy to this day to prevent rejection of the donor tissue. This immunosuppression puts her at greater risk for cancer and infections and raises the issue of whether the benefits (a closer approximation of a normal appearance than reconstruction of her face from her own body tissue) outweigh the risks (a shortened lifespan and potential hospitalizations for infections, eventual tissue rejection, and perhaps cancer.)
Many people suffer severe facial disfigurement from accidents and burns every year. Face transplants could give them a chance at a relatively normal appearance – but American doctors are unwilling to put them at risk for what is in essence a cosmetic procedure. However, Harvard physicians are now offering face transplants to those who are already on immunosuppressants for organ transplants they’ve previously received. As you may imagine, the number of people who qualify for face transplants is rather small – as you’d have to have had an organ transplant and then coincidentally sustained severe trauma and tissue loss to the face.
The Boston Globe ran an interesting story on a man who was severely disfigured by facial burns and could have been eligible for a face transplant in France. He chose to undergo reconstruction from his own tissues, which requires no immunosuppression. He says that he is glad that his body is healthy, that he requires no medications, and that the risks of a face transplant are not worth the benefits, though he remains severely disfigured.
I think it’s interesting that the French took a different stand on this issue – allowing people to choose to have a cosmetic procedure at the expense of general health, longevity, and risk for life-threatening illness.
I have known patients who decline limb amputations for fear of disfigurement – even though the gangrene in the limb is sure to result in sepsis and eventual death. A person’s appearance and personal identity are sometimes inextricably linked – so that some would choose death over disfigurement (even of a limb). Is this choice pathological, or is it their right to choose? Given the choice between disfigurement or death, I’d choose disfigurement. I’d also not choose a face transplant over reconstruction from my own tissues, even if the aesthetic outcome is inferior. Still, I’m hesitant to say that those who’d rather live a shorter, less healthy life with a more natural face are unilaterally making the wrong choice for them. For the time being, though, people who wish to make that choice will need to do so outside of the US.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
A fascinating — if heart-wrenching — question. Very well presented and analyzed. Thanks for taking this issue on!