Facial Transplantation: Eye of the Beholder?

History of Face Transplants A face transplant is a procedure to replace all or part of a person's face. Patients that have suffered disfiguring burns, trauma, birth defects, or diseases are often ostracized by society because they do not look "normal." Proponents of face transplants state that a successful surgery would help them fit into society better, improving the quality of their lives significantly. The actual procedure involves transplanting skin and possibly muscle tissue from a cadaveric (or deceased) donor to a living person as well as reconnecting blood vessels. This procedure is technically challenging due to the multiple layers of tissue that need to be reconnected, the thin and delicate tissues of the face, as well as the need for the most cosmetically appealing end result as possible.

The first full-face operation in the world actually was an autologous donation, that is the donor and the recipient were the same person. Tragically, a nine-year old girl in India lost her face and scalp in an accident with a thresher in 1994. Thankfully, her surgeon, one of India's foremost microsurgeons, was able to sew her face and scalp skin back on successfully. Please see the multimedia for pictures before and after the operation, as well as pictures of other potential patients for face transplants.

The world's first face transplant was actually a partial face transplant after a dog in France mauled a woman's face in 2005. The woman received a nose and mouth skin tissue donation from a brain-dead patient. In 2007, the world's first full-face transplant was performed in France on a man that suffered from a disfiguring facial tumor. A greater step forward was made in 2008 when a team of physicians at the Cleveland Clinic in the US performed the world's first near total full-face transplant. The team of surgeons transplanted not only skin tissue, but also muscle and some bone tissue in a procedure that lasted 22 hours. The transplant was performed on a woman that had suffered from severe trauma several years prior to the operation.

The Popularity of Face Transplants in Popular Culture

Since 1994 when the autologous face transplant procedure was completed and more intensely after 2005 when hospitals raced to complete successful face transplants, media coverage has been obsessed with the idea of transplanting one's face. In some lights, the procedure has been portrayed as "life-giving" since it allows people cast off by society to rejoin and live "normal" lives. Others have painted face transplants as dangerous experimentation with troublesome ethical implications.

The Picture of Dorian Gray by Oscar Wilde was published in 1891. This classical work tells the story of a young man that sells his soul so that a portrait of him ages rather than himself. The novel examines the importance of physical looks in society. This importance is one that potential patients for face transplant are well aware. In a sense, the physical nature of their disease, trauma, etc. is only one portion of their suffering. An equal, if not greater component is the social stigma of not looking "normal."

After watching this classic episode of The Twilight Zone, consider these questions:

1. What are some of the ethical questions raised by the episode?

2. What is the nature of the pressure Janet Tyler feels to "fit in" to society? Does current society pressure others to conform as is portrayed in the episode and to what extent?

3. How important is how you look to your social interactions and sense of self? For example, how do you feel when you have a pimple, scar, or cut on your face?

What Are Some Of The Ethical Issues Raised?

There are a wide variety of ethical issues that have been raised by face transplants. Many of these are raised by the portrayal of face transplants in popular culture as well as in real life. Some of these are -

Experimentation in Disability Therapies One of the major criticisms of face transplants is the still experimental nature of the procedure. Unlike proven therapies, much is unknown about the short- and long-term side effects of face transplants. The known risks are similar to other organ transplantation procedures such as a need for lifelong immunosuppressive medications, diabetes, lymphoma, risk of infection, and risk of rejection. Do the benefits outweigh the risks? What do you think? Many other organ transplantations are life saving, for example liver or heart transplants. But a face transplant is not a life saving procedure. Should this mean that lesser risks should be taken? Or is the social pressures faced by the potential patients enough of a cause to undertake these risks?

Embodiment Another question raised by face transplants is the unique nature of the face compared to other tissues transplanted. The face, unlike the liver or heart, is interwoven with a person's identity, sense of self, and self-expression. To what end does transplanting another's face transplant another person's identity? Are you truly the same person you were before you had a face transplant? Proponents of face transplant argue that since only skin and sometimes muscle is being transplanted, the recipient's underlying bone structure still determines the final appearance of the face. Therefore, it is not simply transferring one person's appearance to another. Also, should you be allowed to choose your donor so that race, skin type, gender matches more closely to your own - something that is not done for other organ transplantation procedures? Finally, should the motivations for the donor be examined? In the case of other organ transplantation procedures, pure altruism is generally the motive. Yet, some argue that the donor might want to "live on" by donating their image. In other words, how special is facial tissue and to what extent is it "you?"

Stigma & Justice The potential patients for face transplants already report feeling ostracized by "normal" society. If we start "fixing" their faces, are we sending an additional message that they do not fit in or are less valued by society? This is a common argument put forward by the disability community, as medicine advances to cure more and more diseases. Are we devaluing their way of life? Also, face transplants are extremely expensive procedures. Are we willing to pay for them through societal funds, or are they elective procedures that patients should have to pay for them themselves? In that case, is it fair to those that cannot afford the hundreds of thousands of dollars required?

Review Questions 1. Discuss some of the ethical questions raised by face transplants in popular culture and reality. 2. To what extent do you think that face transplants should be performed, given the medical and ethical risks? 3. Discuss some other situations in which a patient's sense of self is changed or challenged by a medical procedure? 4. How else do we as society pass judgment on people who are different? Is this a legitimate concern when we talk about face transplants? Why or why not?