As late as last year, Brigham and Women's had publicly stated that it would not perform this kind of transplant because of ethics guidelines that it created when face transplants first became a viable option. Citing the rigors and side effects of immunosuppressant therapy to prevent organ rejection, the hospital's old rules, now changed, would only allow a patient to receive a face transplant procedure if he or she already was using these drugs after a procedure such as a heart or kidney transplant.
However, doctors and ethicists have subsequently agreed the move was likely justified.
"It is hard for us to imagine how difficult it was for Jim. He feared going outside," Pomahac said. "I feel that we are here on a mission, using cutting-edge technology to restore patients' lives."
While finding a family who is willing to donate the face of their deceased loved on is still a challenging prerequisite for face transplant surgery, the number of patients involved in these surgeries is still small enough that large-scale selection criteria probably do not come into play.
While face transplant recipient candidates remain scarce, as of May 21 there were 102,137 Americans on the UNOS organ transplant waiting list. The number of available organs is far fewer, and many patients die before an organ becomes available.
"Solid organs for transplantation are extraordinarily scarce resources," said Rosamond Rhodes, director of Bioethics Education at the Mount Sinai School of Medicine in New York City.
"When one person is allocated an organ, someone else may die for lack of an organ. Consequently, it is critical to allocate the short supply justly," she said. "Because face transplantation is so new, the just allocation issue is not yet critical."
But while today's face transplant recipients may face fewer selection criteria than those who need a liver, heart or kidney, Rhodes said this may not be the case in the future.
"As more face transplants are completed successfully, the demand for the treatment will increase and the available facial tissue will become a scarce resource," she said. "Then, principles of justice should be used to govern the allocation."
"I would predict that as facial transplantation becomes more popular, the selection criteria will evolve to insure the appropriate care and success of the composite tissue transplant," he said. "Although the face may not be a scarce or life-saving 'organ' in the same sense that solid organs are, the expense and investment in the procedure will require a similar selection process with the possible requirement of additional increased psychological scrutiny."
Meanwhile, Maki said that though he was aware the story has been the subject of much media attention, he wished to live quietly and privately.
"I just appreciate that I have the chance to start a new life, because the first part of my life was nothing but trouble," he said.