All entries for Friday 20 October 2006

October 20, 2006

Face transplants – an ethical and practical dilemma

The other day I sat down (a relatively rare occurrance at the moment) and watched the Horizon programme about Isabelle Dinoire, the first person to receive a face transplant. Isabelle was mauled by her pet dog, an horrific incident which left her without her lips, part of the flesh on her chin and the bottom half of her nose. Nearly a year ago she underwent the first ever face transplant operation, which was a success.

Whilst Isabelle was, herself, incredibly positive about the operation and its results, a huge amount of contraversy and argument has surrounded the proceedure.

  • Whilst the majority of transplant operations that are currently carried out routinely are life-saving, face transplants are not essential to survival in any way. It the proceedure a luxury that we don’t need?
  • On the other hand, as a result of the way she looked, Isabelle’s life changed dramatically. For example, she had to wear a mask over her face when she went out. Is this deterioration in quality of life enough of a justification?
  • A vastly important consideration in any transplantation proceedure is the risk of rejection. The immune system of the recipient will attack the transplanted tissue unless strong immunosuppressant drugs are taken by the for the rest of their lives. These drugs make the patient more susceptible to infection and increase the risk of cancer. Despite these drugs, there is still a 5% risk of rejection.
  • Along similar lines, a disfigured person (for example a burn victim) will often have large amount of skin and facial tissue left, and may have already undergone many operations to improve their appearance, facial function and comfort. To carry out a face transplant on that patient will mean removing all of their skin and a large amount of the soft tissue order for them to receive the new face. If their immune system then rejects it they would be in a far worse situation than they were before the operation.
  • The other, less tangible, issue is a psychological one. The face is associated far more with identity than any other part of the body. Although the transplanted tissue moulds to the bone structure of the recipient, the face will still be considerably different from their own. Is this too much of a hurdle to jump for some patients? In contrast, some might say that the patient might have already undergone so much adjustment to become accustomed to their disfigured state that making the jump to transplantation is not so great.

October 2006

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