title: Investigation of risk acceptance in facial transplantation.
abstract: 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.
authors.affiliation: Department of Surgery, University of Louisville, KY 40202, USA. jhbark01@louisville.edu
authors.forename: John H
authors.initials: JH
authors.lastname: Barker
authors.forename: Allen
authors.initials: A
authors.lastname: Furr
authors.forename: Michael
authors.initials: M
authors.lastname: Cunningham
authors.forename: Federico
authors.initials: F
authors.lastname: Grossi
authors.forename: Dalibor
authors.initials: D
authors.lastname: Vasilic
authors.forename: Barckley
authors.initials: B
authors.lastname: Storey
authors.forename: Osborne
authors.initials: O
authors.lastname: Wiggins
authors.forename: Ramsey
authors.initials: R
authors.lastname: Majzoub
authors.forename: Marieke
authors.initials: M
authors.lastname: Vossen
authors.forename: Pascal
authors.initials: P
authors.lastname: Brouha
authors.forename: Claudio
authors.initials: C
authors.lastname: Maldonado
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Reynolds
authors.forename: Cedric
authors.initials: C
authors.lastname: Francois
authors.forename: Gustavo
authors.initials: G
authors.lastname: Perez-Abadia
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Frank
authors.forename: Moshe
authors.initials: M
authors.lastname: Kon
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Banis
mesh_terms: 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