Ethical Issues in Pediatric Face Transplantation: Should We Perform Face Transplantation in Children?

Abstract

After careful consideration of the physical, psychological, and ethical aspects of such a procedure, the authors found no such barrier that would either disqualify such vulnerable subjects as profoundly disfigured children or conflict with their best interests.

The Ethics of Facial Allotransplantation: A Systematic Review

“…In all 148 articles included, nonmaleficence was the most frequent ethical principle addressed (117/148, 79.1%), 1–3,7,10–121 followed by beneficence (116/148, 78.3%), 1–3,5,7,10,13–24,26–29,32–42,44,46,48,49,51–56,58,60,61,63–66,69–84,86,87,89–93,95–137 justice (103/148, 69.6%), 2,3,5,7,11,14,17–22,24–28,30–32,34,35,38,39,41–44,46,48,49,51,52,54,55,57,58,60–64,66–73,75–77,79,82–85,87–92,94,95,97–102,104,105,107–112,114,117,119–121,123,125,129–131,135,138–147 and autonomy (86/148, 58.1%). 1–3,5,7,12…”

“…The most frequent addressed themes under the principles were risk of immunosuppression or rejection (n = 88, 59.5%), 1–3,7,10–12,14,16–19,22,23,25,29–41,43–56,58–64,66,67,69,71,72,75–79,81,83–85,87–92,95,97,100,102–106,108–112,114,115,117–119,121 followed by informed consent or donor family consent (n = 67,45.3%), 1–3,5,12,14,15,23,25,27,28,32,34,35,38–41,44,46,48,49,53,56,58,61,63–66,69–74,80,82–84,88,94,97,100–105,107,111,116,117,120,121,130,131,133,136,138,141–143,145,147,149 facial tissue donation and restoration (n = 49, 32.9%), 2,11,14,…”

Recipient Selection Criteria for Facial Transplantation

“…For the programs listing pediatric age as an exclusion criterion, 7,18,61,73,98,109 there were concerns about the effects on tissue development, the availability of alternative procedures, the harsh immunosuppression regimen, and the enhanced malleability of self-identity in childhood. In contrast, the main concern of supporters of pediatric FT was whether pediatric patients could properly give informed consent before proceeding with the surgery 37,53 . The field of hand transplantation also grappled with determining if a child could consent to lifelong immunosuppression and the rigorous long-term medical care necessary to justify hand transplantation, and the procedure was ultimately performed in the pediatric population 118,119 .…”

“…The field of hand transplantation also grappled with determining if a child could consent to lifelong immunosuppression and the rigorous long-term medical care necessary to justify hand transplantation, and the procedure was ultimately performed in the pediatric population 118,119 . If informed consent is deemed obtainable, pediatric FT has the potential to reduce the psychosocial consequences of facial disfigurement, overcoming the obstacle of minimal native tissue availability for autologous reconstruction in children 37,53 …”

The Ever-Important Role of Ethics in Plastic Surgery Today

“…6 Lee and colleagues reported on the ethical implications of surgical innovation in plastic surgery, concluding that increased efforts must be made to ethical training in plastic surgery. 9 Articles have also addressed the use of social media in plastic surgery, 10 as well as the ethics of transplantation in plastic surgery 11 and aesthetic surgery. 12 Despite an increase in the discourse of ethical issues in plastic surgery, a common theme is consistently highlighted by authors.…”