One of the main areas of concern has been the risk to patients from the side effects of long term immunosuppression, say the authors. However, a patient having a facial transplant would probably require a similar level of immunosuppression to patient having a kidney transplant.

Given that one of the main justifications for kidney transplantation is improvement in quality of life, the same argument should apply to facial transplant, they write.

Concern over psychological effects is also misplaced, they say. They argue that a psychological change is not necessarily a psychological problem, and believe that the psychological impact of facial transplant can be anticipated, planned for and managed.

In terms of public fears over altered identity, the authors explain that modelling of the change in appearance, using laser scanning and photography, shows that this does not occur after facial transplantation. "Indeed, preoccupation with altered identity risks becoming too much of a distraction from the important issue of managing immunosuppression," they warn.

Although research has made the concept of facial transplant a reality, concerns about long term immunosuppression do remain. "But, instead of considering why facial transplantation cannot be justified, we may find it hard to justify why it should not be done," they conclude.

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Contact: Emma Dickinson
edickinson@bmj.com
44-020-738-36529
BMJ-British Medical Journal
8-Dec-2005