Currently, organ donation and transplantation is one of the most effective ways of saving lives. One deceased donor can save up to eight lives and can save and enhance more than 100 lives through tissue donation. With this field growing every day medical experts started to debate on the transplantation of composite tissues (a tissue constructed by skin, muscle, tendon, nerves, bone and blood vessels, literally a composition) hands, legs, and most controversially faces. I know, it sounds like the synopsis of a cheap horror movie, however, I can assure you it is very much real and doable.
Initially, the idea of it did actually come from horror and sci-fi movies like Les Yeux sans Visage (1960). However the first attempt of a real operation took place in 1994 when 9-year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher, was rushed to the hospital. Her parents came with her face in a plastic bag and thankfully a surgeon managed to reconnect the arteries and replant the skin. She was left with some muscle damage as well as some scarring nonetheless the operation was successful. This was what most experts coined as “face replant”, not exactly a face transplantation.
The first real transplantation happened on November 2005 in France, 11 years after this first attempt. Isabelle Dinoire underwent surgery to replace her original face, which had been mauled by her dog. A triangle of facial tissue from a deceased donor was grafted onto her. With her new face she lived for 11 more years, unfortunately, she passed away in 2016 at the age of 49 because of cancer. Since then, a total of 40 partial and full facial transplants have been performed around the world. Right now, Turkey, France, the United States and Spain (in order of total number of successful face transplants performed) are considered the leading countries in the research into the procedure. As the number of operations increase, we learn more about the practicality, risks, health implications and costs of these procedures. These are all amazing and life-changing findings but then why is it still so controversial? There is a simple answer, the ethical issues.
Firstly, like the rest of the organ transplantations, the patient has to always use immunosuppressants for the rest of their lives in order to stop their body from rejecting this new part of them. As their name suggests, immunosuppressants suppress the immune system which makes patients vulnerable to infections and cancer. Basically, the primary role of the immune system is our defense against any foreign object, this includes transplanted organs. As a result, your immune system attacks the transplant as it would attack any foreign cell. This can cause severe damage and doctors would be forced to remove the transplant. This is where immunosuppressants become necessary, they reduce the strength of your immune system making it ineffective. Yes, they do stop your body from reacting to the transplant but at the same time, if we suppress the immune system, our line of defense against cancerous cells, viruses and malicious bacteria is gone.
Most organ donations are done under life-or-death situations, the same can’t be said for composite tissue donations. Technically speaking someone can still survive without their face with special aid. Then why would we endanger their life by condemning them to a life of constant medical danger? Unfortunately, this is a very much real concern with a mortality rate of 20 percent. Several treated patients on immunosuppressants have passed away because of easily-cured diseases and cancer.
Furthermore, it has severe effects on a patient’s psychology. With a completely new appearance, they must learn how to cope with their new selves, in addition to a lifetime of rigorous monitoring and medication. Currently, this problem is trying to be eliminated with a vigorous screening of potential recipients by psychologists before the patient selection. Afterwards, the patient who can handle this change the best is chosen. However, we still can’t call this method a complete success. It is reported that most of the patients have faced psychological problems post-operation.
Moreover, some experts believe that this practice will decrease the overall donations. Organ donation already relies on a number of donors that is far smaller than the people on transplant lists. The highly visible failures in face transplantation can reduce the overall donations, which will affect every potential recipient. I think that this highly depends on the public’s perception of the appropriate usage of donated organs and tissues, which again relies o patient selection. For example, a recipient who is relatively young and healthy, and has “more to live” probably won’t cause a public outcry. Additionally, there is no data that supports this claim of potential donation decrease.
With all this said, can we actually call the survival without a functioning face as “living”? For instance, there are a lot of patients whose condition stops them from properly eating, breathing, or speaking. The face is also an essential part of human relations and how we perceive ourselves. So before making a conclusion about this issue, we have to weigh the pros and cons. In one hand, face transplantation means putting a perfectly healthy person at a constant medical danger for the rest of their days but on the other hand, it means a chance of a new life without being afraid of how people will perceive you or how you perceive yourself. Personally, I think -as with most medical cases- informed consent is the key point here. At the end of the day the decision should fall to the patient after getting the proper knowledge about what is going to happen and what having a new face entails.