Changing identity – face transplant ethics

Face transplant ethics involved with changing identity

Altered or changing identity is often the first issue raised when face transplant ethics are discussed with health professionals, patients and the general public.

The face, as the central organ of communication, the focus of sexual attractiveness and the means of immediate recognition by others, is directly linked to a person’s identity. And changing your face – and by association the identity – is a complex issue that needs to be discussed.

However the issue of changing identity is one with which patients potentially face already. Severe burns and injuries result in a very different facial appearance to which the person must also adapt to.

Changing identity: similarities in coming to terms with facial disfigurement and transplant

Patients who have suffered facial disfigurement, such as burns, often comment on the length of time it takes after an accident to recognise the differences in their face as their own. Eventually though, over a period of many years, identity and appearance merge and people who have lived with the disfiguration - sometimes for longer than with the original face - become familiar with it, and positive about their altered appearance. 

From this point of view, a face transplant represents a similar journey of changing identity but is provided by plastic surgery instead of the natural healing process. A face transplant represents the same loss and process of adjustment as natural healing, and has the potential to also last for many years.

Face transplants: disturbing for patients and their families?

Some have argued that the issue of changing your face, and taking on another identity, is potentially deeply disturbing; not only for potential recipients but for donor families too. The extent to which a new face will resemble the patient’s original appearance after a face transplant is dependent on the facial surgery and the face of the donor. However, according to research, this change remains a focus of anxiety in both the literature and the general public.

Popular films, such as 'Face Off', do not help in their wild and inaccurate portrayal of the probable outcome of facial transplantation; not least because they ignore the psychological and physical healing process.

Modelling a face transplant: before and after forecasting

Peter Butler, head of the face transplantation team at the Royal Free London NHS Foundation Trust, and his colleagues, have attempted to model the identity change involved in face transplants with the use of laser scanning and photography to produce a computer model of the likely appearance after the plastic surgery. 

Researchers in Louisville have employed a different technique but both groups suggest that the resulting image, even though it retains some of the superficial features of the donor, eg facial hair, produces a third face with an identity of its own. This makes sense as a full-face or partial-face transplant will still preserve the underlying bone structure of the patient’s face.

Face transplant: before and after example 

Using the computer graphics imaging technique developed by the face transplantation team at the Royal Free London, here’s how merging the faces of Fergus Walsh, BBC medical correspondent, and Royal Free plastic surgeon, Peter Butler, appears when the facial skin of one is placed over the bone and muscle structure of the other:

As can be seen from the images above, a third identity is created and the original donor cannot be recognised.

Find out more about the how the Royal Free London face transplantation team responds to face transplant ethics and about our current face transplant services in the left hand navigation.