title: Ethical Issues in Pediatric Face Transplantation: Should We Perform Face Transplantation in Children?
abstract: BACKGROUND
  In 2005, face transplantation ceased to be fiction and became a scientific reality. Today, 10 teams from six different countries have performed 32 face transplantations. Immunosuppressive treatments are similar to other solid organ transplants, and patients have experienced a significant functional improvement. The authors are logically considering expanding face transplantation to children; however, children are not simply small adults.
  
  
  METHODS
  The authors searched for pediatric patients in need of restoration of fundamental functions of the face, such as orbicularis oris or oculi muscle closure by, first, selecting cases from a pediatric plastic surgery reference center and, second, analyzing the feasibility of face transplantation in those patients. The authors then identified the specific problems that they would encounter during a pediatric face transplant. The authors identified three potential candidates for pediatric face transplantation.
  
  
  RESULTS
  Children's youth imposes additional ethical and psychological considerations, such as the balance of risk to benefit when it is quality of life, not life itself, that is at stake; the process of informed consent; the selection process; and the protection of privacy against media exposure. The question becomes not whether children should be included as candidates for face transplantation but whether any ethical barriers should preclude children as candidates for a full face transplant.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Paris, France; San Francisco, Calif.; and Chestnut Hill, Mass.|From the Department of Plastic Surgery, Hopital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris; the Department of Pediatric Plastic Surgery, Hopital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris; the Program in Medicine and Human Values, California Pacific Medical Center; and the Department of Theology, Boston College.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Marchac
authors.affiliation: Paris, France; San Francisco, Calif.; and Chestnut Hill, Mass.|From the Department of Plastic Surgery, Hopital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris; the Department of Pediatric Plastic Surgery, Hopital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris; the Program in Medicine and Human Values, California Pacific Medical Center; and the Department of Theology, Boston College.
authors.forename: Tomasine
authors.initials: T
authors.lastname: Kuschner
authors.affiliation: Paris, France; San Francisco, Calif.; and Chestnut Hill, Mass.|From the Department of Plastic Surgery, Hopital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris; the Department of Pediatric Plastic Surgery, Hopital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris; the Program in Medicine and Human Values, California Pacific Medical Center; and the Department of Theology, Boston College.
authors.forename: John
authors.initials: J
authors.lastname: Paris
authors.affiliation: Paris, France; San Francisco, Calif.; and Chestnut Hill, Mass.|From the Department of Plastic Surgery, Hopital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris; the Department of Pediatric Plastic Surgery, Hopital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris; the Program in Medicine and Human Values, California Pacific Medical Center; and the Department of Theology, Boston College.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Picard
authors.affiliation: Paris, France; San Francisco, Calif.; and Chestnut Hill, Mass.|From the Department of Plastic Surgery, Hopital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris; the Department of Pediatric Plastic Surgery, Hopital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris; the Program in Medicine and Human Values, California Pacific Medical Center; and the Department of Theology, Boston College.
authors.forename: Marie Paule
authors.initials: MP
authors.lastname: Vazquez
authors.affiliation: Paris, France; San Francisco, Calif.; and Chestnut Hill, Mass.|From the Department of Plastic Surgery, Hopital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris; the Department of Pediatric Plastic Surgery, Hopital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris; the Program in Medicine and Human Values, California Pacific Medical Center; and the Department of Theology, Boston College.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D003657:Decision Making / Q000941:ethics*; D005145:Face / Q000601:surgery*; D054445:Facial Transplantation / Q000941:ethics* / Q000523:psychology; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D008297:Male; D011788:Quality of Life; D013518:Surgery, Plastic / Q000941:ethics*