AAFPRS Official Policy on Face Transplantation

A Significant amount of recent media interest has been paid to face transplantation.  In order to seriously address this issue, the following must be made clear.  This procedure represents a potentially valuable reconstructive option in highly selected patients . Misconceptions propagated by movies suggesting that surgeons can switch a patient’s face for another’s are false.  Face transplantation, if it is ever successfully performed, should be reserved for replacing missing facial tissue resulting from cancer, serious injury, or congenital deformity.  It is the opinion of the AAFPRS that such a transplant should only be performed when no other medically viable options are available, and all other treatment possibilities have been exhausted.

More specifically, the first face transplants should be exclusively limited to patients with extremely serious conditions that cannot be reconstructed by other current techniques.  Attempting transplant of a new organ or large body part in and of itself is extremely high risk. Therefore, a medically stable, facially deformed patient who can be treated by skin grafts or flaps should not be considered for transplant until this procedure is proven to be safe and technically feasible in more critical cases.  We believe that face transplantation, with the life-threatening potential of both the procedure and the requirement for life-long immunosuppressive drugs, is not justified for purely skin and soft tissue restoration at this time .  Once the technical, ethical, logistic, economic, and social implications of face transplantation are evaluated through the treatment of patients with more serious conditions, it could then be considered for medically stable patients desirous of an aesthetic restoration from conditions such as superficial burns. We believe that examples of patients to be considered for early from face transplantation include, but are not limited to, severe facial trauma or burns with exposed brain in the acute or semi-acute setting, extensive facial tumors with exposed brain and/or globes (eyes), extensive congenital deformity with exposed brain, or other situations where bilateral eye exposure is present, potentially resulting in permanent blindness.

Considerations for these procedures are lengthy. Technically, the procedure would resemble well established protocols for hand and organ transplantation and involve physicians of numerous specialties working in concert. Donor procurement would be difficult and precise. All patients would then require life long immunosuppression, which has both physical and economic considerations. Ethical and psychological issues will be paramount. With all transplantation patients and donors, offering and receiving transplanted tissue, especially a face would require careful personal and family counseling. Leaving a donor without facial tissue would also need to be measured.

In conclusion, face transplantation is an extremely serious procedure to consider for a patient. Any and all other methods for reconstruction should have been either tried or seriously considered first. Recipients are most likely those with no other hope. Lastly, this procedure must be treated with respect and privacy as mandated by human ethics and HIPPA regulations. Face transplantation is not a procedure to be taken lightly nor be used to gain media attention, especially since it is theoretical at present.

Refs:

  1. Sieminonow, M, Ozmen, S, Demir, Y. Prospects for Facial Allograft Transplantation in Humans, Plast. and Reconstr. Surg.
    115(5) April 2004 , 1421-1428.
  2. Petit, F. Paraskevas, A, Minns, A.B., Lee, A. Lantieri, L.A. , Face Transplantation: Where Do We Stand?, Plast. and Reconstr. Surg. 115(5). April 2004, 1429-1433.