In the light of new information on facial transplantation?including the psychological and ethical aspects of the controversial procedure?a Working Party of the Royal College of Surgeons of England now endorses moving cautiously forward in performing further face transplants, according to a report published in the Jan_27 issue of Transplantation.
In its initial report in 2003, the Working Party concluded that facial transplantation should not be attempted until further research was done to define the risks. The new report cites several new developments since then?most significantly, the encouraging results of a partial face transplant procedure performed by a French surgical team. The panel also notes progress in experimental studies of facial transplantation and more follow-up information on patients undergoing hand transplantation and other types of “composite” transplant procedures.
The past few years have also seen “a deepening understanding of the potential psychological problems of facial transplantation as well as a very considerable debate on the ethical aspects of the procedure.” The new report states, “[T]he working party now accepts its inevitability but endorses the urgency of establishing sound ethical principles” for performing face transplants.
The panel reiterate their concerns about the ethical aspects of face transplantation, including the difficulty of obtaining valid patient consent when the risks of the operation are simply unknown?the “Catch-22” of needing to proceed with research in order properly to establish the risk of an experimental procedure
To address these concerns and provide protections for patients, the report lists recommended standards for any surgical team contemplating a facial transplant procedure. Of course, the surgeons and hospital must have the skill and ability to provide optimal surgical and medical care. There must be set procedures for patient selection, as well as for presenting the risks in a way that allows patients to make a true informed decision.
Expert psychological care must be provided for patients before and after transplantation?including arrangements for long-term psychological support, whether the procedure is a success or failure. The guidelines also call for care and support for family members of both the transplant donor and recipient.