We would like to thank Drs. Boriani and Morselli for their insightful comments highlighting the importance of preserving donor integrity during facial transplantation, and the cultural nuances that should be considered when directing educational efforts toward improving rates of facial allograft donation.1 This study (educational video) was expressly designed as a pilot, and the short duration of the educational video was among the main priorities during conceptualization and production. However, in future, large-scale studies, the possibility of a longer video, printed materials, or even educational lectures may allow us to expand on several topics that are so briefly explained in the current video.
Fabrication of a facial mask to dress a donor’s remains after procurement has been repeatedly presented as an ethical obligation for facial transplantation teams, and remains a priority across institutional protocols at most centers. Devauchelle et al. set the precedent after the first successful facial transplantation was performed, and to date, constructing a mask in the donor’s likeness has been performed in 55 percent of facial transplantations.2 Growing experience has invited sophisticated techniques to efficiently generate a lifelike prosthetic while maintaining low production costs.3 We agree that the restoration of donor likeness with a prefabricated mask is certainly among the more interesting topics to the general public, precisely because of the cultural/religious connection with the face and the concept of self.4 We also agree that an in-depth explanation of the ethics behind this practice may effectively determine an individual’s (or their family member’s) willingness to donate a facial allograft for transplantation.
Individuals disinclined to participate in facial donation have indeed reported concern over passing their identity to a stranger and the resulting disfigurement inherent in the donation process,5 which the discussants suggest is heightened among the Mediterranean population. Although only a small number of study participants belong to this specific demographic, the positive impact that our educational intervention was able to achieve across religious groups allows us to hypothesize that similar studies among Mediterranean populations may also yield favorable results. Moreover, as many face transplants have been performed in countries bordering the Mediterranean (i.e., France, Spain, and Turkey), awareness among the general public in this area may be increased. Although conflicting opinions and cultural preconceptions may be encountered in different sectors of the population, studies such as these provide an opportunity to accurately inform individuals and dispel misconceptions about the facial transplantation process.
The authors do not have any commercial associations or financial disclosures that might pose or create a conflict of interested with information presented in this communication.
Natalie M. Plana, B.A.J. Rodrigo Diaz-Siso, M.D.Eduardo D. Rodriguez, M.D., D.D.S.Hansjörg Wyss Department of Plastic SurgeryNew York University Langone Medical CenterNew York, N.Y.
1. Plana NM, Kimberly LL, Parent B, et al. The public face of transplantation: The potential of education to expand the face donor pool. Plast Reconstr Surg. 2018;141:176185.
2. Plana NM, Malta Barbosa J, Diaz-Siso JR, Brecht LE, Rodriguez ED. Dental considerations and the role of prosthodontics and maxillofacial prosthetics in facial transplantation. J Am Dent Assoc. 2018;149:9099.
3. Cammarata MJ, Wake N, Kantar RS, et al. Three-dimensional analysis of donor masks for facial transplantation. Plast Reconstr Surg. (in preparation).
4. Rifkin WJ, Kantar RS, Ali-Khan S, et al. Facial disfigurement and identity: A review of the literature and implications for facial transplantation. AMA J Ethics 2018;20:309323.
5. Sarwer DB, Ritter S, Reiser K, et al. Attitudes toward vascularized composite allotransplantation of the hands and face in an urban population. VCA 2014;1:2230.