Face transplants

I heard a story on the radio the other day about new research in face transplantation. Yes, transplanting a whole face.

It seems that your standard skin-grafting reconstructive surgery doesn't work so well on faces. Faces have lots of little muscles, and the skin can stretch and contort in all sorts of ways that your mother threatened would become permanent if done too often. People who require facial reconstruction because of serious burns and the like standardly undergo scores of surgeries, none of which usually do a satisfactory job.

The option that's being explored experimentally is transplanting entire faces (skin plus underlying tissue) from cadavers. Of course, doing this requires the removal of the skin and underlying tissue of the face recipient, leaving the facial muscles.

So, without even getting into the new identity-theft possibilities this might open up, there is some question of how ethical this kind of medical procedure could be.

The risks are pretty extreme. If you reject a skin graft, they can take it off and try again. If you reject a whole face, taking it off leave you with no face to fall back on. What kind of back-up would we want the doctors to have in place if the first face transplant for patient X fails? A second face available to transplant (and a third, and a fourth)? Extensive skin grafts ready to go? (How will the success of this more standard approach to reconstruction be affected by the full face removal that precedes an attempted face transplant?) Something else?

The big ethical question here is whether the likely benefits of the procedure outweigh the potential risks. And just how to measure this is the puzzle. For the burn victim, a successful face transplant might be like winning the lottery -- the last surgery you need to have a face that functions fully (and doesn't necessarily mark you forever as a burn victim). Of course, this sets aside issues like the effects of the non-rejection medications you'd have to be on for the rest of your life. But, like the lottery, the likelihood of success might be very, very small. Given the expected payout when the odds of success are very small, is it rational to undertake the risk (especially of less risky treatments are available and well-understood)?

But, I can imagine a burn victim arguing that this is an instance where, given full information about the potential risks, the potential benefits, their anticipated probabilities, and the available alternatives, she ought to be able to decide whether to gamble on this new procedure. Mortality and morbidity are not the only factors that matter to her. Being able to be done with surgery might be a real benefit. Being able to go through life with a face that looks and functions like a face might feel like the biggest benefit at all. Who should tell the burn victim that she can't rationally decide it's worth risking everything else for that?

If it happens, I imagine the doctors will develop a wicked-good waiver of liability!