Newswise — The first face transplant, performed by French surgeons in 2005, raised a host of difficult medical, ethical, and psychological issues. A special section in the April issue of the Southern Medical Journal (SMJ), official journal of the Southern Medical Association, presents a cross-section of opinion on face transplantation from international transplant experts.
The special section appears as part of the Spirituality/Medicine Interface Project, supported by a grant from the John Templeton Foundation to explore the creative interface between science and religion. It includes invited commentaries from surgeons at leading U.S. and European transplant centers.
The special section also reprints official position papers from U.S., French, and U.K. surgical societies—all of which urge further research before additional face transplants are done. The surgeons who performed the first face transplant were invited to submit their viewpoint, but did not respond.
"Experts agree that the technology to successfully perform a facial transplantation is available and is not an issue," points out Dr. Ronald C. Hamdy, Editor of SMJ. Rather than surgical skill, the main medical concern is the need for lifelong immune suppression to prevent the recipient's immune system from rejecting the transplanted tissue.
Like hand transplantation, face transplantation is a "composite" transplant procedure—including several different types of tissue, such transplants carry a high risk of rejection. "Most experts believe that the question is not whether the face transplant will fail, but when it will fail," according to Dr. Hamdy.
Several essays in the special section raise ethical issues surrounding face transplantation, including whether the risks of the procedure are justified by the goal: to improve the patient's appearance and acceptability. There is also concern that the procedure may violate the medical imperative to "do no harm"—while a patient whose kidney transplant fails is no worse off than before, a face transplant patient would be much worse off.
Other commentators voice concern regarding the principle of informed consent: Since there is so little information on the risks of the procedure, can the patient have really understood and accepted those risks?
Although science-fiction concepts of "switching identities" aren't really an issue, the psychological impact of face transplantation— not only on the recipient but also on the family of the donor—remains unknown. Some commentators have suggested that patients who would consider such a drastic procedure might be the least able to cope psychologically with their disfigurement. Others raise concerns about the potentially misleading and intrusive role of the media.
Most of the commentaries concur with the official position statements: that the first face transplant may have been done too soon. Dr. Hamdy concludes, "It is worrisome that virtually all the world experts and scientific organizations at the present time condemn face transplantation on scientific and ethical grounds." Although viewpoints differ, most contributors to the special section urge further research before additional face transplants are performed.
For more information about the Spirituality/Medicine Interface Project please visit the website at http://www.sma.org/spirituality or call 1.800.423.4992.
About the Southern Medical JournalThe Southern Medical Journal (http://www.smajournalonline.com) is published monthly by the Southern Medical Association and Lippincott Williams & Wilkins. Devoted solely to continuing education, the Journal publishes annually more than 200 original clinical articles directed to the practicing physician and surgeon on topics including hypertension, osteoporosis, alcoholism, obesity, dementia, asthma, and diabetes.
About the Southern Medical AssociationThe SMA (http://www.sma.org) has been serving physicians' needs since its inception in 1906. Its mission is to enable physicians to practice the highest standards of medicine by fostering professional development and economic stability through education, services, collegiality, and leadership across multiple specialties. The SMA will be holding its 100th Annual Scientific Assembly October 12-15, 2006 in Charlotte, North Carolina.
About the John Templeton FoundationThe mission of the John Templeton Foundation is to pursue new insights at the boundary between theology and science through rigorous, open-minded and empirically focused methodologies, drawing together talented representatives from a wide spectrum of fields of expertise. Using "the humble approach," the Foundation typically seeks to focus the methods and resources of scientific inquiry on topical area which have spiritual and theological significance ranging across the disciplines from cosmology to healthcare.
About Lippincott Williams & WilkinsLWW is a leading international publisher of professional health information resources for physicians, nurses, specialized clinicians and students. LWW publishes nearly 275 periodicals and 1,500 books in more than 100 disciplines, as well as content-based sites and online corporate and customer services. LWW is a division of Wolters Kluwer Health, a leading provider of information for professionals and students in medicine, nursing, allied health, pharmacy and the pharmaceutical industry. Major WK Health brands include traditional publishers of medical and drug references, tools, and textbooks, such as LWW and Facts & Comparisons; online information services such as Ovid Technologies, Medi-Span, and SKOLAR; and pharmaceutical information provider Adis International.
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