“Is it ethically legitimate to continue hand and face transplants? “. Authorised in France which performed world firsts for hand and face transplants in Lyon in 1998 and in Amiens in 2005, respectively, these transplants are still strictly defined.
Non-vital organs, they involve “chronic treatments”, which are “not without repercussions”. Indeed, “given the problem of chronic rejection, some patients will not keep the surgically transplanted hands and face for ever”. This situation came to light with the first double hand transplant where the patient was unable to continue anti-rejection therapy.
What is the benefit-risk ratio for non-vital organ transplants when alternative solutions exist albeit with a “less promising outcome than transplant surgery”? As regards facial transplants, the Ethics Committee noted in 2004 that “a patient’s quality of life gets worse before it can get better. Can we knowingly offer patients a therapeutic strategy that will relieve their disability but make them ill when they weren’t sick before? “.
For how long will patients retain the transplanted organs? Facial transplant patient with necrosis about to undergo a second transplant (see Following initial transplant rejection, man receives a second face and Second full face transplant following rejection: patient undergoes “tedious” rehabilitation). Rejection is a recurring problem amongst transplant patients and a new transplant isn’t always feasible. Repeat surgery has not been performed to date in any recipients who have experienced rejection following hand transplantation.
What is the impact on life expectancy? Six of the 37 face transplant patients have died.
For Professor Bernard Devauchelle, surgeon at Amiens University Hospital Centre, who has performed 3 face transplants, “these are the questions we should be asking”.
For further reading: ABM seminars, hand transplants, uterus transplants – an overview
La Croix, Pierre Bienvault (16/03/2018)