Facial transplantation: a working party report from the Royal College of Surgeons of England.

At the winter meeting of the British Association of Plastic Surgeons in December 2002, Mr. Peter Butler presented a paper entitled “A Large Animal Model of Limb Transplantation without Long-Term Immunosuppression.” This led to widespread comment in the media about the possibility of facial transplantation. Three months later, press speculation had extended to trying to identify the possible recipient of the world’s first face transplant. The charity Changing Faces wrote to the Royal College of Surgeons of England, issuing a press release in March 2003 that called on the College to “attempt to create a moratorium on further media coverage of the issue.” This is something the College has never had the power to do. Both the College and the British Association of Plastic Surgeons, however, shared the concerns expressed by Changing Faces and others. Sensationalist coverage and a media hunt for the first patient could impinge on the privacy and well-being of any potential patients and their families. Any discussion of facial transplantation must also involve issues that are technical, psychologic, medical, and ethical. If such a procedure were to take place, it must be preceded by careful and open debate. In response to these concerns, the College set up a small working party to examine all aspects of the proposed procedure. This met three times between April and September 2003 and was also in contact by e-mail and fax. The relevant literature, both experimental and human, was reviewed. Members also met with Mr. Peter Butler to discuss his research. This article presents a review of the current situation in relation to facial transplantation as the working party members perceive it. It is published by the College to help inform and contribute to the ongoing debate about the ethics and practicalities of facial transplantation. The working party is interested in the opinions of the transplantation clinical community and therefore its reproduction as a special feature in this journal.