The face transplant performed a few weeks ago by Dr. Maria Siemionow, a skilled and caring surgeon, and a team of other specialists at the Cleveland Clinic went far beyond several prior experiments, including the world's first such procedure in France three years ago. The Cleveland Clinic doctors replaced nearly the whole face of a woman with one from a female cadaver.
Given the high risk of failure from the rejection of the donor's skin, is such a pioneering procedure worth the danger to the patient’s life?
When face transplants were first proposed 10 years ago I thought they were unethical. But, after the success of the French procedure, and after listening to Dr. Siemionow and other surgeons talk about their preparations for the first nearly total face transplant in the U.S., I no longer think that is so.
A transplanted face is biologically like any other transplanted organ: There is always a risk that the recipient’s body will reject it. The immunosuppressive drugs that must be used to try to prevent such a disaster are powerful, but can cause fatal cancers and other serious side-effects, such as kidney failure. Normally, transplant surgeons don’t worry much about these risks because they pale in comparison to the certain death that awaits someone whose heart or liver have stopped working. But a face transplant is intended to improve the quality of life rather than save a life, as a heart, lung, kidney or liver transplant does.
It’s important to note that the surgical skill required to transplant a face and have it function — chew, smile, frown, breathe, blink — has evolved to the point where the odds now favor success. The management of dangerous immunosuppressive drugs has also improved so that handling rejection of the facial tissue seems feasible. There is no doubt that Siemionow has the competency and her team the skills to try the experiment.
After talking to some people with severe facial disfigurement, I realize it makes ethical sense to offer a form of surgery that might kill the patient, because the suffering of the afflicted is so great that they are willing to risk death. We don’t hear much about those with facial deformities due to birth defects, burns, trauma, cancer or violence. That’s because the stigma of severe facial deformity is so enormous, so staggering, that many simply withdraw from society. Others find that, despite the best efforts of reconstructive surgeons, they are unable to eat, breathe or speak comfortably, and are condemned to lives of suffering and pain.
A face transplant, despite its very real dangers, might bring relief. The science has reached the point where trying to help those who are beyond the help of current medical treatments is not just ethical, but almost obligatory.
No second chances
Yet, even though a strong case can be made in defense of what has been tried in Cleveland, there are ethical concerns about face transplants.
If the woman who received her new face from a cadaver were to begin to lose it due to tissue rejection that could not be stopped, what will happen? There are no second chances with face transplants — the damage of rejection makes that impossible. What if someone facing this horrendous prospect – life with no face at all — says no to artificial feeding or breathing? What if they beg for morphine to help them die painlessly and more quickly? Any team undertaking face transplants must be ready to manage a failed experiment.
The only humane response to the courage it takes to be the subject of a face transplant is to be ready to help that person in any way necessary, including assistance in dying. The idea of assisted-suicide for tragic transplant failures pushes right up against the law, but insisting on life with no face, as opposed to a horribly disfigured one, is too daunting a prospect to proceed ethically — if death is not an option.
Face transplants raise another issue. When you signed a donor card or checked the box on your driver’s license, you probably were not thinking that when you died someone might want to transplant your face. We don’t know what happened in the Cleveland case, but I strongly suspect they used a donor who had a donor card and whose family also approved the removal of the face.
Do we need to insist that no faces be taken from the dead without the advance permission of both the deceased and their family? Shouldn’t the family have some input since they will have to live with the emotional turmoil of potentially seeing a face that somewhat resembles a loved one on another person? And should the laws governing organ donation be revised so donors have the option to give permission, or deny permission, for a facial transplant?
Issues of personal identity
The Cleveland transplant is a ringing alarm clock that it is time to revisit the legislation governing organ and tissue donation. Face transplants raise emotional issues that do not arise when a liver or a pancreas is transplanted. We identify ourselves and each other by our faces. We fall in love with faces. We know much about mood, emotions, and state of mind by simply looking at faces. Some may have no issue giving their liver, corneas, bones, heart or lungs to help others, but the face is simply a different matter.
Should we allow each person to set their limits on what can be taken from their body after death? Facial transplants are the cutting edge of a wave of new forms of transplantation, including hand and limb transplants, ovarian transplants, uterine transplants and testicular transplants. While it is not clear that these newer types of transplants cross ethical boundaries that ought never be crossed, they surely do raise issues of personal identity and reproductive capacities.
The transplant in Cleveland was done with the laudable goal of trying to help those who are often on the margins of society due to their appearance, or because they cannot eat, speak, drink, smile or breathe without huge effort. Some victims take their own lives in despair. These people should be able to take their chances with a facial transplant if nothing else can help them. That said, medical advances in facial transplants push us into a very new ethical world where life after failure may not be an acceptable option, and where some among us may say they are not willing to give what is required to help.
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When are people going to get the fact that from the NANO SECOND a person is born they are already dying.
What's the risk? To live life to the fullest and take chances. If Medical advances can help, there is no risk.
The decision, as all medical decisions, must be left to the patient who is to live or die with the results of that decision and their medical staff. To deny them the right to live free of horrible disfigurement because it may cause rejection and then lead to possible assisted suicide is not our decision but theirs. If they chose that, it is their right and all we need to do is stay out of it. These people have gone through enough, most than enough. They have suffered more than anyone can imagine and the life they have is their own and does not belong to the public domain. If a person chooses a face transplant after being horribly disfigured for whatever reason and it works for however long, the joy they have for that time out weighs anything else.
The prospect of being faceless is horrendous. IF i had a choice between living with no face and jaw or having a face transplant but possibly dying.... guess what, I wouldnt even think twice.
"Is face transplant worth risking patient's life?" Yes. Absolutely. If that's what the patient feels is right then that's it. The final decision should always be left to the patient imo. Who the hell cares if someone /else/ feels that it's not worth the risk? That 'someone else' likely has no idea what that kind of decision feels like and what it would have to be like to make them come to such a decision. And the people who like to b*tch and moan over the safty and morality of such things should question their own morality for putting their noses where they don't belong.
What quality of life does one have whose face is so badly disfigured that they dare not go out in public? They have nothing to lose, so I feel: go for it, and good luck to you.
Now as to the donor's family: The portions of the face that are used, skin, tissue, etc. are placed OVER the donee's existing bone structure, so they're not likely to suddenly "see" their deceased loved one approaching them on the street. Maybe a resemblance: "Haven't I seen you before?" but all in all, I feel this is a wonderful new possibility and I hope it all works out well for all involved.
To have life without living is not a life at all! To be holed up at home afraid to go out because of ridicule, taunting or stares would be hell! If it is worth the risk to the patient, what's it to us??? Who are we to decide for them? Let's get "Big Brother" out of the picture and let the patient decide for themself, regardless of the procedure! Enough of everyone trying to decide for everyone else what is worth the risk and what is not.
I hope and pray that the transplant works and this woman has a normal life. I don't think a person in this position has too much to loose. This person is in my prayers!
Wonderful! At last a breath of fresh air, a new re-affirmation of faith in my fellow man by this story of what we can do RIGHT here in this country. It is so nice to hear a story like this, people going to the NTH degree to help someone who is struggling. I take my hat off to all the medical people involved in this, and I hope and pray that this woman makes a complete recovery with no complications, and is able to lead a normal life once again. Keep up the great work!!!!
Is life worth living if you are so deformed you cannot "live"? Unless any of us here walk in her shoes then our opinions mean nothing. She gave her informed consent and since I did work at CCF (Cleveland Clinic Foundation) they covered all their legal bases for sure. Heck if you really want to get into medical ethics then we should discuss the brain transplants between cows ecperimental surgery at another Cleveland based hospital in the 70"s (yes people that is 1970). I was there in the lab where this was happening. I would imagine there is other cutting edge medicine happening right now somewhere in this world.
OOPS before anyone flames me I am for it - I forgot to say that-brain transplants I am not sure about.
Quality of life is so important, that I can see why some people would risk "quantity" of life in order to improve the quality of life. I certainly hope this operation works and that this woman can live a more normal life from hereon out.
A phenomenal procedure. What hope and prospects of joy this woman must be contemplating at this very moment in time. I didn't see any mention of the donor family, who made the decision to provide a chance at a normal life, but I applaud them. As a donor family, I know the gut retching decisions and thank them for the unselfish gift. God bless both the recipient and the family giving the gift.
If this woman's condition resulted from surgery for a smoking-related cancer, her family should say so. It might help other people to quit. My mother in law had a facial cancer from smoking; she was lucky & didn't have to have extensive surgery, but what she saw at the treatment center got her to stop. We would have bet our house that she would never have quit smoking.
Shame on you! Why would this this lady any less worthy of privacy if she had been a smoker? Only the patient should be allowed to publicize the details of her condition.
I agree that any patient with a disfigurement should be entitled to any corrective surgery available to better their situation. I am not up to date with the current state of physician assisted suicide (the laws regarding it), however, a death by medically assisted suicide as compared to a more dangerous form of suicide inflicted by one's own-self is more easily palatable should killing oneself intentionally be the chosen option.
I am horrified by these responses!!!!!!! I think that our society needs to take a harsh and realistic look at its values and the message that are being sent to our youths. May God bless us each and everyone, He Loves us in spite of the way we look
I am horrified by the your thinking your god is the one who matters to everyone. I would take the risk involved without a problem in this I were in their shoes. If your happy with your gods love thats great. Don't expect everyone else to bow to that.
The choice is the person who needs the transplant, nobody elses. Do not save people from themselves. We need what little choice and freedom we have left in this life.
It isn't like she had an ok face and had it replaced to be a beauty queen. She was missing complete parts of her face...
As the article stated she looks good and in public you almost can't even tell she had a face transplant. Almost...not completely. Which means she still has scaring and possibly other abnormalities. All she wanted was to be able to go grocery shopping without being starred at. And name calling...who would do such a thing. She was literally scaring children...come on! God would never look at her and say she shouldn't have gotten a face, shame on you. No - he is happy for her and for her children.
Unless you are the patient with facial disfigurement or deformities, you are in no position to judge. Not everyone with a disfigurement may want a transplant, that is their right. Not every transplant will be successful, and should the patient opt for assisted suicide, that is their right. I will never understand why it is legally and socially acceptable to abort the unborn, euthanizethe comatose, execute convicted felons but illegal and socially unacceptable to assist in suicide for those persons with incurable (and often horrifically painful) conditions.
I'm happy to see a lot of reason in these posts. I can't imagine being in the shoes of one of these patients. The choices available to them are all bitter pills...but choice is still a worthwhile offering and if, indeed, their lives can be vastly improved by a successful transplant, that is wonderful. The choice of this procedure is between doctor and patient. As should be the choice of next steps if the transplant is not successful. Everything about the life of a human from communicating and eating to being among others requires a face. None of us have any right to judge someone left with these choices. If the name of God has to be invoked, I say invoke it in a blessing: "God Bless the patient and the doctor".
I absolutely think that facial transplants are worth it! Imagine living your life hidden, due to extremes beyond your control and when you come out, children fear you, people stare, and you just feel helpless. If the medical perfection has came this far advanced and it would help a person live a normal life, a more comfortable life, then why not risk it? There is so much more they will learn and this is fabulous that this can be done. Nobody asked for these birth defects, being beat, or any other accident that has put them in such a situation to where they have to live in the dark. To hide from life. It is our society who treats them so badly even though, yes, God loves us no matter how we look but God gives the physicians the knowledge and hands to beautify a persons world. To open it up for them to just take a walk outside. It is up to the patient and doctor, the dangers and what the better outcome is. Freedom from being treated so badly because you are not "one of the beautiful people". And the reason they do this is for a somewhat normal life after years of rejection, again from our society.It's not fun to be one of the people to get snickered at. I believe everyone has a purpose on this earth and maybe this is their purpose. TO teach the doctors and then of course, they will have a wonderful life that so many take for granted. I mean, they operate on tumors that are not cancer, they do face lifts, nose jobs, tummy tucks and all for people who just want to look "better" but these people want to look normal. (or what society thinsk is normal because when they do go out, they get looked at, pointed at, and treated very badly) They didn't ask for whatever may have been their facial appearance issues but I do believe that God gives the doctors the tools to help these people. They just want normal. Or at least some normal. Don't we all?
I am a firm believer that it's what's on the inside that counts. But if someone is extremely disfigured, it's going to begin to alter their inside in the way they treat others (putting up defenses before giving chances) and self-loathing.
If the person is aware of all of the possible risks yet they still want the transplant, then there is no reason to deny it to them.
Since when do we get to make decisions for others? Since when do we decide whether or not they have a good quality of life despite disfigurement? We have no idea what they go through and can't decide for them.
i'm not sure about other states, but when i filled out my first donor card in CA years ago, i remember a section asking you what you were ok with donating. you were allowed to specify what, if anything, you did not give consent to be used.
and to Mc-798023, not everyone believes in god and i would hope that you wouldn't lecture your own child to turn themselves off to the warm approval of others if it was their face that was horrifically difigured to the point where they wanted to die or didn't leave the house.
None of us would want to be denied the opportunity to be fully human once again following a disaster that effectively wipes away a good part of our identity and leaves us with monumental pain as well. So how could we possibly deny relief from pain, ridicule and social isolation to these tragically unfortunate brothers and sisters? Hopefully, they go into surgery positively, but also fully aware of the high risks. I pray that they might gain comfort that they are going to be surrounded by a sea of God's grace, the donor family's unselfishness, and the surgeon's deep, compassionate skill.
My God, I think these people eare incredibly brave!May we all take this opportunity to dxamine ourselves and to resolve to rethink our knee-jerk reactions when we see someone horribly disfigured.
Unless you are the patient with facial disfigurement or deformities, you are in no position to judge. Not everyone with a disfigurement may want a transplant, that is their right. Not every transplant will be successful, and should the patient opt for assisted suicide, that is their right. I will never understand why it is legally and socially acceptable to abort the unborn, euthanizethe comatose, execute convicted felons but illegal and socially unacceptable to assist in suicide for those persons with incurable (and often horrifically painful) conditions.
I just wanted to say that all of you who support a patient's right to choose to risk it are so completely right. I was in an accident as a child, and suffered minor facial/dental disfigurment, but even with that it would seriously deter people from talking with me. I learned not to smile very big. If I had a sincere, hearty laugh that exposed my upper gums, people would stop talking and just stare. Among many complications, there was the head injury- my ability to communicate was terrible. I lose words, change subjects, go blank- on top of looking unhealthy. I have certainly known social rejection. I'm not tooting my own horn here, but I also am a Mensan, so I have ideas that are so hard to express in the first place, but now I am stuck just looking like an ackward fool most of the time. I do not make friends, though I love people. I am lucky in the respect that I have an amazing husband, three great boys, and a comfortable life. I have largely recovered. But before, when I could hardly walk from pain, couldn't remember my middle name, and was treatedlike a drug addict or crazy woman- that is no life. If I had a choice between a 70 years of pain and rejection (no recovery, no chance of marriage and kids), or spiritually moving on, I'd move on. It is my body, my life, and thus my choice. My life is still seriously impaired, but a happy one nonetheless. I was lucky to have a third choice. So, from someone who has had a small taste of that type of suffering, I applaud all of you for the respect and wisdom to support other's right to choose their own course. It heartens me; I feel like compassion and understanding is there for those like me, or worse.
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