Evolution of Ethical Debate on Face Transplantation

Background: Face transplantation can provide improved quality of life to severely disfigured individuals. The unique challenges of face transplantation prompted much ethical discussion even before the first clinical case. Many deemed it unethical, because of issues ranging from the need for potentially harmful immunosuppression to the potential transfer of identity. Over time, the ethical debate surrounding face transplantation has evolved. Methods: In August of 2012, the authors performed a review of the scientific literature on the ethics of face transplantation, focusing on the evolution of the discussion from before to after the first clinical case in 2005. The authors conducted a primary search (73 peer-reviewed publications) in PubMed using combinations of the terms "ethics" and "face transplantation" and "opinions," and a secondary search (37 peer-reviewed publications) retrieving publications cited in some of the primary search findings. In total, the authors reviewed 110 articles. Results: A series of 15 issues were addressed repeatedly throughout the reviewed articles. The authors observed an evolution of the general opinion regarding face transplantation: initially seen almost unanimously as an outlandish and morally objectionable procedure, it began to be accepted as a feasible and necessary treatment option for the most significant facial defects. Conclusion: With growing clinical experience globally, new ethical questions have arisen that must be addressed to move the field of face transplantation forward in an ethically sound manner.