Face Transplant Patient Recovering Well, Surgeon Says

"The patient is now expected to take immunosuppressant medication for the rest of his life," he said. "There is nothing on the horizon, no major medical breakthrough that would suggest otherwise."

But he noted that the doses would likely be reduced as time progresses, which would likely come hand-in-hand with a reduction in side effects.

Implications of Immunosuppression After Face Transplant

The importance of such side effects was not lost on Brigham and Women's. A 2007 article in a hospital newsletter and a 2008 article in the journal Transplantation suggest that Brigham and Women's had a policy in place not to perform such a surgery on any patient who did not already have a suppressed immune system.

"The BWH team recognizes the ethical concerns and tailored BWH's programs to address them," reads the article in a 2007 issue of BWH Bulletin. "One concern is that transplant patients spend the rest of their lives taking immunosuppressant drugs to keep the body from rejecting the organ. BWH will only perform facial transplants on those who already are on these drugs, most likely from a previous transplant."

Pomahac is quoted in the article as saying that patients already on immunosuppressants "know what it's like to live on these drugs, which can have debilitating effects on the body."

And in the 2008 Transplantation article, Pomahac wrote:

"We currently share the concern that life-long immunosuppression associated with facial transplantation may not outweigh its benefits as compared to the alternative reconstructive methods. We asked ourselves the question of which patient population would risk less and overall benefit more from undergoing face transplantation, and identified those currently on immunosuppressive therapy the most suitable candidates."

The hospital newsletter article further suggested that Brigham and Women's would only perform partial face transplants, chiefly in response to critics' concerns over "the ethics of changing a person's identity."

Position Shift on Face Tranplant Ethically Justified

Still, surgeons and ethicists alike appear to agree that shifting away from a policy limiting the patient pool for face transplants may not be such a bad thing -- particularly considering the horrific injuries that candidates for this surgery possess.

"I don't think that it makes sense to try and limit face transplantation to those already on immunosuppression," said Arthur Caplan, head of the bioethics center at the University of Pennsylvania. "That might be preferable, other things being equal, but the number of persons who will fit that selection standard is tiny."

Rosamond Rhodes, director of bioethics education at Mount Sinai School of Medicine, agreed. "When the facial disfigurement is so severe as to merit the risks of transplantation, the extra burdens of immunosuppression hardly adds to the burden.

"In that light, the BWH policy seems designed to spare the surgeons and institution from guilt or public criticism, rather than to serve the interests of patients in need of a face transplant," she added.

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