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Ethical Issues in Pediatric Face Transplantation: Should We Perform Face Transplantation in Children?

Marchac, Alexandre, M.D.; Kuschner, Tomasine, Ph.D.; Paris, John, S.J., Ph.D.; Picard, Arnaud, M.D., Ph.D.; Vazquez, Marie Paule, M.D., Ph.D.; Lantieri, Laurent, M.D., Ph.D.

Plastic and Reconstructive Surgery: August 2016 - Volume 138 - Issue 2 - p 449–454
doi: 10.1097/PRS.0000000000002387
Pediatric/Craniofacial: Special Topic
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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.

Conclusion: 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.

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.

Received for publication September 20, 2015; accepted March 22, 2016.

Presented at the 23rd Annual Meeting of the European Association of Plastic Surgeons, in Munich, Germany, May 24 through 26, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Alexandre Marchac, M.D., Department of Plastic and Reconstructive Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris 75015, France, alexandremarchac@gmail.com

©2016American Society of Plastic Surgeons