Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements (...) usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase. (shrink)

Two competing intuitions have dominated the debate over facial tissue transplantation. On one side are those who argue that relieving the suffering of those with severe facial disfigurement justifies the medical risks and possible loss of life associated with this experimental procedure. On the other are those who say that there is little evidence to show that such transplants would have longterm psychological benefits that couldn’t be achieved by other means and that without clear benefits, the risk is simply too (...) great. Ethicists on both sides have called for more analysis of the link between the face and personal identity in order to get a better grasp on potential gains and losses. This paper responds to that call by looking at contemporary philosophical analyses of the relation between organ transplants and personal identity and between the human face, human dignity, and human vulnerability. It is argued that the face matters not because it is the unique marker of our identity, but because of its role in the intersubjective constitution of moral identity and human dignity. (shrink)

Ethical lapses associated with the first facial transplant included breaches of confidentiality, bending of research rules, and film deals. However, discussions of the risk-benefit ratio for face transplantation are often deficient in that they ignore the needs, experience, and decision-making capability of potential recipients.

Moodley and Rennie’s paper arguing against penile transplantation stated out of context arguments and wrongly quoted statements. The cost of penile transplantation is much less than portrayed. The burden of cases is much less than is communicated. The men on our penis transplantation programme represent the poorest of the poor and are one of the most discriminated against groups of humans on earth. The false hope said to be created by Moodley is indeed not false hope at all as there (...) is a real possibility that most patients on our waiting list may be transplanted. Moodley argues that government has, in the context of penile transplantation, no duty to cure those who lost a penis after ritual circumcision, but only an obligation to prevent this from happening. A ‘yuk’ reaction, similarly described in facial transplantation, may be present in colleagues arguing against penile transplantation. (shrink)