Responding to face transplant ethics

Face transplant ethics: concerns and issues

Face transplant ethics is a subject of intense debate, due to concerns about:

  • the ability to achieve informed consent for such a new and uncertain procedure
  • the psychological aspects of facial transplantation and altered appearance 
  • the impact of acute and chronic rejection of a face transplant and the need for lifelong immunosuppression drugs.

These concerns have been officially highlighted in a face transplant ethics report from a special committee of the Royal College of Surgeons (RCS).

The Royal Free London view: responding to face transplant ethics with research

Our UK face transplantation team welcomes these views but takes a pragmatic approach. We feel there is no value in repeatedly revisiting the arguments without conducting further research. So, our approach is to use the RCS report as a framework, and carry out research to address and respond to the issues raised around face transplant ethics.

The research that we do includes working with patients with severe facial injuries, as well as with healthcare professionals in the field, such as those working in organ transplantation and families of organ donors.

Our work, when possible, has been published and made available for public scrutiny.

Given that an exact risk/benefit analysis can never be provided for such a new procedure – the first full-face transplant was only carried out in Spain in 2010 – we would argue that this is the only sensible way of moving the ethical debate forward. In short, the position of the Royal Free London face transplantation team is that ethical issues are best met by rigorous research that practically addresses the theoretical issues raised.

To ethically manage patients undergoing this procedure, our face transplantation team also endorses the proposal of the American Society of Plastic Surgeons in producing guidelines for good practice. 
The recommendation is that face transplants only be carried out: 

  • in specialist centres 
  • with the required expertise in facial surgery, management of face transplants, immunology and the psychology of facial reconstruction
  • with provision for long-term monitoring and support.

–Find out more about our face transplant research and face transplant procedures at Royal Free Hospital in the left hand navigation.