“These guidelines are aimed at stimulating professional discussion and debate,” said John Barker, M.D., team leader and director of plastic surgery research at the University of Louisville. “We feel the ethics of a face transplant need to be openly discussed before it is performed.”

Although the hopes, anxieties and emotional stability of transplant recipients have always posed ethical concerns, such issues are even more critical in face transplants, said Osborne Wiggins, Ph.D., a philosophy professor and epidemiology and clinical investigation science associate at U of L who was lead author on the article.

“What is at stake is a person’s self-image, social acceptability and sense of normalcy,” Wiggins says.

The team’s article, “On the Ethics of Facial Transplantation Research,” is accompanied by critiques from more than a dozen leading bioethicists, psychologists, reconstructive surgeons and others.

“The risks involved in undertaking the first clinical face transplant are staggering,” writes respondent Arthur Caplan, Ph.D., Professor and Director of the Center for Bioethics at the University of Pennsylvania. “It is not certain that the transplant will provide a functioning or even partially functional face. The drugs required to maintain a transplanted face are powerful, noxious, and potentially life-threatening.”

Face transplants would be offered to those disfigured by trauma, burns, tumors, infections, or congenital defects, the authors say. Currently, surgeons try to reconstruct these patients’ faces by transplanting tissue from other sites on their bodies or by implanting prosthetic devices.

Face transplants may actually pose fewer surgical complications than existing methods used to repair severe facial disfigurement, and recipients would be less likely than organ transplant recipients to develop organ toxicity from anti-rejection drugs, the team suggests.

However, because facial appearance is so closely associated with one’s sense of personal identity, the recipient of a face “must adapt ... to this new ‘identity,’ as well to other people’s responses to it.”

It is also vital that the institution performing a face transplant be free of possible conflicts of interest, such as financial reward or professional gain, the team concluded.