Investigation of risk acceptance in facial transplantation.
BACKGROUND
The surgical techniques necessary to transplant a human face are well established, and the early success of human hand transplants suggests that the immunological hurdles of transplanting human facial tissues have largely been overcome. Therefore, it is the ethical barriers that pose the greatest challenge to performing facial transplantation. At the center of the ethical debate is the question, "Do the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving a face transplant?" In this study, the authors answer this question by assessing the degree of risk individuals would be willing to accept to receive a face transplant.


METHODS
To quantitatively assess risks versus benefits in facial transplantation, the authors developed the Louisville Instrument for Transplantation, or LIFT, which contains 237 standardized questions. Respondents in three study populations (healthy individuals, n = 150; organ transplant recipients, n = 42; and individuals with facial disfigurement, n = 34) were questioned about the extent to which they would trade off specific numbers of life-years, or sustain other costs, in exchange for receiving seven different transplant procedures.


RESULTS
The authors found that the three populations would accept differing degrees of risk for the seven transplant procedures. Organ transplant recipients were the most risk-tolerant group, while facially disfigured individuals were the least risk tolerant. All groups questioned would accept the highest degree of risk to receive a face transplant compared with the six other procedures.


CONCLUSIONS
This study presents an empirical basis for assessing risk versus benefit in facial transplantation. In doing so, it provides a more solid foundation upon which to introduce this exciting new reconstructive modality into the clinical arena.
Barker
John H
JH
Department of Surgery, University of Louisville, KY 40202, USA. jhbark01@louisville.edu
Furr
Allen
A
Cunningham
Michael
M
Grossi
Federico
F
Vasilic
Dalibor
D
Storey
Barckley
B
Wiggins
Osborne
O
Majzoub
Ramsey
R
Vossen
Marieke
M
Brouha
Pascal
P
Maldonado
Claudio
C
Reynolds
Christopher C
CC
Francois
Cedric
C
Perez-Abadia
Gustavo
G
Frank
Johannes M
JM
Kon
Moshe
M
Banis
Joseph C
JC
D003657:Decision Making; D005145:Face / Q000601:surgery*; D005151:Facial Injuries / Q000523:psychology / Q000601:surgery*; D005528:Foot / Q000637:transplantation; D006084:Graft Rejection / Q000523:psychology; D063987:Hand Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000523:psychology; D016030:Kidney Transplantation / Q000523:psychology; D007830:Larynx / Q000637:transplantation; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016378:Tissue Transplantation / Q000523:psychology*; D014184:Transplantation, Homologous / Q000523:psychology