Tuesday, December 16, 2008

Transplants and Ethical Complications

When 80 percent of a woman's face is replaced with the skin, nerves, and deep facial muscles of a cadaver donor, a host of ethical questions are raised in the aftermath of such a ground-breaking medical event.

In Cleveland, Ohio, Dr. Maria Siemionow and a enormous team of specialists have successfully completed just such a surgery, far surpassing the partial face transplants previously performed in France and China.

Performed not to extend life but to enhance quality of life, these types of surgeries carry a very high risk of rejection, a dangerous outcome that many ethicists feel may not warrant such extreme measures.

On the other side of the ethical debate, it is argued that those with major birth defects or other forms of disfigurement deserve a chance to live a normal life with near-normal facial physiognomy and expressive ability, despite the need for life-long immune suppressing medications and the risk of catastrophic rejection.

Meanwhile, some ethicists opine that facial transplant recipients should have the option of assisted suicide in the case of total rejection and transplant failure, an outcome that could lead to complete inability to breathe, eat or otherwise function normally. The removal of a rejected facial graft would leave a post-surgical patient with extreme disfigurement, risk of dangerous secondary infection, and potentially worse quality of life than prior to undergoing the surgery.

Advances in medicine and science often lead to ethical concerns that must be rigorously discussed and debated by interdisciplinary teams of surgeons, ethicists, nurses, laypersons, clergy, and other concerned individuals and groups. Decades ago, heart transplants and liver transplants sent shockwaves throughout the world as the ramifications of such advances became clear. Life support technologies, blood transfusions and advanced pharmacology have all become part and parcel of the medical world, sustaining and prolonging life while often simultaneously increasing quality of life as well.

Now, hand and face transplants once again push the envelope of what some feel is ethically and morally responsible as humans continue to dabble in the more esoteric reaches of medicine and surgery. And as much as brain or total head transplants may still seem like science fiction, I have no doubt that such emotionally charged and ethically challenging surgical events are most likely closer than we think to being reality.

As the 21st century continues to unfold, bioethics and the future of medical intervention are certain to challenge us as the edges of our comfort are once again breached. I am interested to see how the newest facial transplant recipient recovers from her surgery. I am equally interested in observing how the world continues to react and recover from the shock of yet another momentous milestone and its ethical aftermath.

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