Ethical considerations in the first American face transplant

Carmen Paradis, Maria Siemionow, Francis Papay, Robert Lohman, Eric Kodish, Chad R Gordon, Risal Djohan, Kathy Coffman, Steven Bernard, Daniel Alam

Research output: Contribution to journalArticle

Abstract

Background: Before performing the first face transplant in the United States, the authors addressed several ethical considerations: subject selection, adequacy of informed consent, and risk-to-benefit analysis. Methods: Destruction of the patient's midface, including its bony architecture, had impaired the ability of the authors' patient to speak, eat, smell, and socialize. These functional impairments and the inability of conventional reconstruction to reconstruct this deformity justified considering this patient for face transplantation. The patient's resilience in adapting to her injury, her conscientious self-care following her initial injury, and her ability to understand the risks and uncertainties of the proposed procedure were important factors in selecting her as a candidate for this innovation. To enhance our patient's understanding of this largely untried procedure, the informed consent process occurred over multiple encounters involving both information disclosure and assessment of comprehension of what the procedure involved, including its potential benefits and risks. The patient demonstrated not only understanding of the procedure, including its innovative nature and concomitant uncertainties, but also that its goals were consistent with her values. Results: Research risk-to-benefit analysis involved balancing societal and subject benefits against subject risks. The potential benefit to society and increased knowledge of the role of face transplantation in facial reconstruction were substantial. The subject's benefits had been maximized and harms minimized through subject selection, team expertise, and preparation. This produced a risk-to-benefit profile in which we considered that the benefits sufficiently outweighed the risks to proceed with transplantation in this patient. Conclusion: Ethical considerations were important determinants in the decision to proceed with facial transplantation in this woman.

Original languageEnglish (US)
Pages (from-to)896-901
Number of pages6
JournalPlastic and Reconstructive Surgery
Volume126
Issue number3
DOIs
StatePublished - Sep 2010
Externally publishedYes

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Facial Transplantation
Aptitude
Informed Consent
Patient Selection
Uncertainty
Smell
Wounds and Injuries
Disclosure
Self Care
Transplantation

ASJC Scopus subject areas

  • Surgery

Cite this

Paradis, C., Siemionow, M., Papay, F., Lohman, R., Kodish, E., Gordon, C. R., ... Alam, D. (2010). Ethical considerations in the first American face transplant. Plastic and Reconstructive Surgery, 126(3), 896-901. https://doi.org/10.1097/PRS.0b013e3181e3b63d

Ethical considerations in the first American face transplant. / Paradis, Carmen; Siemionow, Maria; Papay, Francis; Lohman, Robert; Kodish, Eric; Gordon, Chad R; Djohan, Risal; Coffman, Kathy; Bernard, Steven; Alam, Daniel.

In: Plastic and Reconstructive Surgery, Vol. 126, No. 3, 09.2010, p. 896-901.

Research output: Contribution to journalArticle

Paradis, C, Siemionow, M, Papay, F, Lohman, R, Kodish, E, Gordon, CR, Djohan, R, Coffman, K, Bernard, S & Alam, D 2010, 'Ethical considerations in the first American face transplant', Plastic and Reconstructive Surgery, vol. 126, no. 3, pp. 896-901. https://doi.org/10.1097/PRS.0b013e3181e3b63d
Paradis, Carmen ; Siemionow, Maria ; Papay, Francis ; Lohman, Robert ; Kodish, Eric ; Gordon, Chad R ; Djohan, Risal ; Coffman, Kathy ; Bernard, Steven ; Alam, Daniel. / Ethical considerations in the first American face transplant. In: Plastic and Reconstructive Surgery. 2010 ; Vol. 126, No. 3. pp. 896-901.
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