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Royal College Issues Revised Guidelines for Face Transplantation

sychological issues that face transplant recipients must confront, including unrealistic expectations, the risk of devastating transplant failure, and the reactions of others to their altered appearance. Face transplantation also entails a host of social issues—including "invasive press interest and publicity," as demonstrated by the French case.

The panel reiterate their concerns about the ethical aspects of face transplantation, including the difficulty of obtaining valid patient consent when the risks of the operation are simply unknown—the "Catch-22" of needing to proceed with research in order properly to establish the risk of an experimental procedure.

To address these concerns and provide protections for patients, the report lists recommended standards for any surgical team contemplating a facial transplant procedure. Of course, the surgeons and hospital must have the skill and ability to provide optimal surgical and medical care. There must be set procedures for patient selection, as well as for presenting the risks in a way that allows patients to make a true informed decision.

Expert psychological care must be provided for patients before and after transplantation—including arrangements for long-term psychological support, whether the procedure is a success or failure. The guidelines also call for care and support for family members of both the transplant donor and recipient.

Adequate long-term funding for all aspects of care must be provided, without compromising care for other patients in need. The recommendations also address concerns about the availability of independent experts, who should be included on the review committees that will consider applications for facial transplant procedures. "If all of these requirements are met, review committees might reasonably take the view that individual patients may proceed with facial transplantation in an appropriately regulated research setting," the Working Pa
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