Dr. Plana and colleagues1 are to be congratulated for their important concept of promoting face donation and developing a very valid example of how to obtain an increased willingness to donate the face among the general population. The video produced is a brilliant way of informing the general public, in detail, of this developing topic, as it respects the sensitivities surrounding this subject.
We suggest that the donors should be carefully considered in the remarkable video created by Dr. Plana et al. We refer to the prosthetic reconstruction of the donor’s face (an important procedure that should be described and emphasized). The literature2,3 has already shown tremendous results in the recreation of the donor’s face with customized masks, resulting in a perfect replica of the original harvested part, in terms of color, complexion, and texture, in addition to integration within the context of the head.
We suggest that more emphasis should be placed on the possibility of reproducing the donor’s facial identity and the current ease of obtaining this result because of modern technological advancement in the field of rapid three-dimensional printing. The importance of this relates to the moral and ethical hesitation that religion and educational level place on willingness to donate. In the Mediterranean culture, for example, the appearance of the cadaver and its preservation are a tradition dating back, as is well known, to the Egyptians.
The extraordinary Cappuccini Catacombs of Palermo constitute clear evidence of how the body and even more so the face of the cadaver need to be protected and preserved in some traditional and/or religious niches of society, especially in the context of a Roman Catholic–pervasive context. The Cappuccini Catacombs are places where thousands of mummified bodies are exposed in their premortem work-related dress code, with some incredibly well-preserved faces, such as the famous deeply moving face of “sleeping” Rosalia, a 2-year-old baby (Fig. 1). Another aspect related to a more contemporary trend is the hope of returning dead bodies to life (e.g., the diffusion of postmortem hibernation).
Both traditional beliefs and novel, more or less sharable hopes should be taken into account when presenting educational material attempting to motivate potential donors on such a delicate issue. Not only the benefit to the recipient but also the absence of harm to the donor should be emphasized, even if a cadaver is scientifically no longer harmable; this belief is likely to not be shared by the less-scientific portion of the population.
The poor and less educated parts of society are often more influenced by traditional and religious beliefs, which have been ingrained for centuries or even millennia in the diffuse culture or are attracted by non–evidence-based hopes for an illusory postmortem resurrection or new life in the same body. Especially for recruitment of these specific parts of the population, educational tools should take more into account the emotional aspects related to the desire to preserve our bodies after death.
The authors have no financial information to disclose with regard to the content of this communication.
Filippo Boriani, M.D., Ph.D.Department of Plastic SurgeryVilla Regina HospitalLaboratory of Orthopaedic Pathophysiology andRegenerative MedicineUniversity of Bologna and Rizzoli InstituteBologna, Italy
Paolo G. Morselli, M.D., Ph.D.Department of Plastic SurgeryUniversity of Bologna and S. Orsola-Malpighi HospitalBologna, Italy
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. Grant GT, Liacouras P, Santiago GF, et al. Restoration of the donor face after facial allotransplantation: Digital manufacturing techniques. Ann Plast Surg. 2014;72:720724.
3. Mäkitie AA, Salmi M, Lindford A, Tuomi J, Lassus P. Three-dimensional printing for restoration of the donor face: A new digital technique tested and used in the first facial allotransplantation patient in Finland. J Plast Reconstr Aesthet Surg. 2016;69:16481652.