Facial transplantation: a review of ethics, progress, and future targets

Correspondence: David w Mathes Chief, Seattle veterans Affairs Hospital, University of washington Medical Center, 1959 NE Pacific Street, Box 356410, Seattle, wA 98115, USA Tel +1 206 543-5516 Fax +1 206 543-8136 Email dwmathes@u.washington.edu Abstract: The surgical history of transplantation in the modern era begins in 1956 with the successful transplantation of a kidney between identical twins. Since then the field of transplantation has seen remarkable advancements in both surgical techniques and our understanding and ability to manipulate the immune response. Composite tissue allotransplantation involves the transplantation of any combination of vascularized skin, subcutaneous tissue, blood vessels, nerves, muscle, and bone. Orthotopic hand transplantation is considered the first clinical example of CTA and has seen success at many different centers worldwide. Facial allotransplantation is a recent development in the field of CTA and the first successful case was performed as recently as November 2005. Since then there have been a number of successful facial transplants. The purpose of this paper is to examine some of the issues surrounding facial transplantation including the complex ethical issues, the surgical and clinical issues, cost and administrative issues, and future directions for this new, exciting, and controversial field.