A University of Louisville-led research team studying the face transplant has developed guidelines it says are critical to the success of the still-untried procedure.
The guidelines are outlined in a Sept. 17 article appearing in the American Journal of Bioethics, On the Ethics of Facial Transplantation Research.” The article is accompanied by critiques from more than a dozen leading bioethicists, psychologists, reconstructive surgeons and others.
Today’s scientists have the skills and experience to transplant a human face but they also need to consider the wide array of ethical and psychological issues involved, says the team, which also includes researchers from Utrecht University in the Netherlands.
“Our goal is to encourage open discussion of the ethics of doing a face transplant before it is performed,” says John Barker, team leader and U of L’s director of plastic surgery research.
The hopes, anxieties and emotional stability of transplant recipients have always posed ethical concerns and these issues that would become even more critical in face transplants, says Osborne Wiggins, a philosophy professor and clinical investigator at U of L who was lead author on the article.
“At stake is a person’s self-image, social acceptability and sense of normalcy,” Wiggins says.
Analyzing and evaluating the ethical and psychological implications of a possible face transplant is one part of an ongoing face transplant research program at U of L. Several milestones still need to be crossed before launching a clinical program, including:
- An application needs to be submitted and defended to an external, independent institutional review board. Such boards are charged with considering issues related to patient protection, safety of the experimental procedure and the processes in which the research volunteer is informed of the benefits and risks of the procedure.
- A full clinical team needs to be identified, coordinated and trained. This team will likely include nurse coordinators (patient selection triage and patient education); clinical social workers, psychiatrists and psychologists; operating room staff; and a rehabilitation team (physical therapists, speech therapists, occupational therapists).
- A program for tissue procurement needs to be developed with Kentucky’s organ procurement agency.
- A patient advocate program model needs to be identified.
- Potential face transplant recipients need to be identified, screened and recruited.
- A funding strategy needs to be developed. For example, should the ability to pay for lifelong anti-rejection medicine be a factor in patient selection?
- A hospital needs to be selected.
Face transplants are not intended to provide cosmetic enhancement, but to provide enough improvement to allow the most disfigured people to re-enter society. Experts at U of L have been conducting research for years on transplanting multiple tissue from one person to another. In 1999, a team from the university performed the first hand transplant in the United States at Louisville’s Jewish Hospital.