Advances in the procedures involved in facial transplants have increased rapidly in recent years but how have ethics studies helped this development? The answer to this largely revolves around how the discussions of ethics have been used to inform research and subsequent development of practices pertaining to facial reconstruction.
The discussion around facial transplants has taken a long journey in the last decade. Harriet Kiwanuka from Brigham and Women’s Hospital in Boston identified 110 papers discussing ethics that were written between 2002 and 2011. Half of these papers were written between 2004 and 2006, directly surrounding the first facial transplant, which was performed in 2005 in France. The tones of these papers follow a timeline that begins with strong recommendations against performing facial transplants and transitions into unanimous endorsement of the practice.
Initially, there was concern that there would be extremely dire psychological consequences to giving a person the face of another, as the face was considered to be so closely tied to identity. For multiple types of transplants, including those of vital organs such as the heart, some were worried that characteristics of the organism that provided the transplant tissue would transfer to the person receiving the tissues. These fears were especially potent when concerning the transplantation of the face as expressiveness, so inherent to the face, is often tied closely to personality.
Other concerns raised involved the necessity for immunosuppressant drugs to prevent the body from rejecting the transplanted facial tissue.
Over the course of the first and 24 subsequent successful facial transplants, issues centered on different topics such as whether those capable of coping with the process of a facial transplant were able to cope with their injuries and therefore less eligible for the procedure than those who were more socially isolated by their disfigurement but perhaps more vulnerable to the stress of the surgery.
By utilizing studies that recognized the ethics surrounding facial transplants, plastic surgeons at Brigham and Women’s Hospital were able to improve upon the procedures themselves making them better able to help their patients. Led by Dr. Bohdan Pomahac, the surgical team have worked doggedly through the process of developing a way to transplant a new face with minimized risk to everyone involved, including the patients due to receive other organs from donors that would need to be recovered after the facial tissue.
Since 2009, Pomahac and his colleagues have performed five facial transplants, making Brigham and Women’s Hospital the leading facility for facial transplants in the country.
The first surgery was a partial facial transplant given to a man named Jim Maki. Maki was seriously injured in 2005 when he fell onto an electric train rail in a subway station in Boston. The damage repaired by surgeons at the hospital was extensive and involved reconstructing his mouth, cheek, nose and lips. The procedure gave him back the ability to chew, swallow, speak and breath.
The next patient to receive a transplant was Dallas Wiens. Wiens was the recipient of the first full face transplant in the nation and the success of his reconstruction has garnered national attention.
Pomahac’s current research has expanded to include finding ways to help patients prevent their bodies from rejecting transplanted tissues without being dependent on immunosuppressant drugs for the rest of their lives. His research continues to address ethical issues raised by studies performed by his peers which serves to help with the development procedures and the execution of facial transplants. The goal of his work is to release patients from the prison of social isolation that accompanies such drastic damage to their faces in the most effective ways and with the most benefit to all who are involved.
By Vanessa Blanchard