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Royal College Issues Revised Guidelines for Face Transplantation

In the light of new information on facial transplantation—including the psychological and ethical aspects// of the controversial procedure—a Working Party of the Royal College of Surgeons of England now endorses moving cautiously forward in performing further face transplants, according to a report published in the Jan. 27 issue of Transplantation.

In its initial report in 2003, the Working Party concluded that facial transplantation should not be attempted until further research was done to define the risks. The new report cites several new developments since then—most significantly, the encouraging results of a partial face transplant procedure performed by a French surgical team. The panel also notes progress in experimental studies of facial transplantation and more follow-up information on patients undergoing hand transplantation and other types of "composite" transplant procedures.

The past few years have also seen "a deepening understanding of the potential psychological problems of facial transplantation as well as a very considerable debate on the ethical aspects of the procedure." The new report states, "[T]he working party now accepts its inevitability but endorses the urgency of establishing sound ethical principles" for performing face transplants.

As in 2003, the technical skill to perform face transplantation is not at issue. Rather, the obstacle is the high risk that the recipient's immune system will reject the transplanted tissues. Recipients require lifelong immunosuppressive drug treatment to prevent rejection. Updated experience with hand transplants, as well as the French face transplant recipient, suggests that close monitoring and treatment adjustments can head off problems with acute rejection. However, the risks of chronic (long-term) rejection remains unknown—based on experience with other types of transplants, a 30 to 50 percent risk seems "a reasonable estimate."

The report cites the many p
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