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.

- 3 comments by 1 or more people Not publicly viewable

  1. We give breast enlargements to masectomy patients and I think this is in the same league. Yes it’s cosmetic, but people place a whole lot on cosmetic things. Lacking a face would be an awful way top live. Yes, there’s the problem of rejection but people aer made well aware of the risks, they have been primed to deal with any consequences.

    Also they’ll have had to live with the half face for a while before nay operation, so they’ll be used to not having their old face. I think having any face is better than a half face, whether it’s different to your previous one or not.

    20 Oct 2006, 15:21

  2. James

    Sarah, as far as I can see the only moral issue raised by the operation is whether public funds should be committed to what is, on one view, a cosmetic procedure.

    The answer is that I don’t think it can be called a ‘cosmetic’ procedure any more than Holly’s example of a breast reconstruction after a masectomy, or some of the procedures done for burns victims. The transplant seems to have been done in this case because the patient’s injuries were so extensive as to make conventional reconstruction procedures impossible. But if they were not, she would have had a series of operations first intended to ensure her survival, and then to improve her appearance so as to return her life as close as possible to how it was before the injuries. I don’t think it would be accurate to label such procedures as cosmetic, even if they are aimed purely at improving someone’s appearance rather than saving their life.

    25 Oct 2006, 15:34

  3. James

    Seems there was a bit more to this than I gave credit:

    http://www.guardian.co.uk/commentisfree/story/0,,1934829,00.html

    30 Oct 2006, 11:25


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