1
|
de Haseth KB, Gehrels AM, Widdershoven G, Bouman MB, van de Grift TC. Ethical considerations regarding penis transplantation surgery in transgender men-an empirical ethics study. Sex Med 2023; 11:qfad041. [PMID: 37720817 PMCID: PMC10501463 DOI: 10.1093/sexmed/qfad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 09/19/2023] Open
Abstract
Background The ongoing quest to surgically create the (nearly) ideal neophallus in transgender men has led to the continuous development of transgender medicine and the proposed introduction of penis transplantation. However, both technical and ethical issues arise when developing this treatment. Aim We sought to extract ethical considerations among different stakeholder groups regarding penile transplantation surgery in transgender men and to define preliminary clinical recommendations. Methods Three semistructured focus groups, consisting of different stakeholders, were organized to participate in discussions of ethical considerations retrieved from the ethics literature of transplantation and transgender medicine. Analysis of the results was performed according to empirical ethics. Outcomes Study outcomes were the identification of qualitative themes describing ethical considerations pertaining to penile transplantation in transgender men. Results Nineteen people participated in this qualitative study. The main domains that emerged included arguments in favor of and arguments against penile transplantation. Although the participants expressed positive attitudes toward developing this care, with acknowledgement of the current limitations stakeholders of all groups were reluctant to endorse the introduction of penile transplantation for transgender men at this point. Clinical Implications Under the present circumstances, all groups expressed both a wide variety of ethical considerations as well as a tendency to prefer developing alternative treatment options or improving the results of currently available treatments in relation to penile transplantation for transgender men. Strengths and Limitations This study was the first (empirical) study to focus on this topic and included a diversity of stakeholder perspectives. Limitations included the hypothetical nature of the discussion as well as the clinical setting in which the topic has been studied. Conclusion Introducing penile transplantation for transgender men, under the current circumstances, comes with a wide range of ethical considerations, which deal with personal identity, autonomy, medical risks, risk for transgender support and donor willingness, and issues regarding equality. Despite the present hesitancy to use penile transplantation, should the technical side of this treatment option develop, further research in the ethical field of penile transplantation for transgender men is recommended.
Collapse
Affiliation(s)
- Kristin B de Haseth
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Anne M Gehrels
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Guy Widdershoven
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Azher S. Facial Transplantation: An Ethical Debate. THE JOURNAL OF CLINICAL ETHICS 2021. [DOI: 10.1086/jce2021323256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
3
|
Shokri T, Saadi R, Wang W, Reddy L, Ducic Y. Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies. Semin Plast Surg 2020; 34:245-253. [PMID: 33380909 DOI: 10.1055/s-0040-1721760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
Collapse
Affiliation(s)
- Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Robert Saadi
- Department of Otolaryngology - Head & Neck Surgery, Penn State Health, Hershey, Pennsylvania
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Likith Reddy
- Department of Oral and Maxillofacial Surgery, Texas A&M College of Dentistry, Dallas, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| |
Collapse
|
4
|
Before and After: What Has Changed in the Attitude of Turkish Society Regarding Face Transplantations? Ann Plast Surg 2020; 82:692-699. [PMID: 31021843 DOI: 10.1097/sap.0000000000001877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Face transplantation is one of the most popular and controversial subjects of plastic surgery today. Although there are various surveys on the subject, there is no study comparing the past and the present social viewpoint and behavioral preferences for face transplantations across the world. In this study, we aimed to investigate the changes in the views of the Turkish society with respect to face transplantation from past to present. For this purpose, 1000 volunteer participants were questioned in terms of demographics and their perspective and preferences on organ and face transplantation. The results of the study were compared with the past data, and based on the results, the level of consciousness and awareness of the Turkish society about the subject has increased; the rate risk taking for immunosuppression has decreased, and instead, the rate of having an undecided stance has increased, and this attitude continues even if the risk is resolved. With these results, we can conclude that the greatest handicap for face transplantation in the Turkish society today is immunosuppression and the associated risks. We believe that new drug protocols and monitoring of patient outcomes for longer periods as well as more extensive clinical applications may be beneficial in addressing this issue.
Collapse
|
5
|
The Ethics of Facial Allotransplantation: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2425. [PMID: 31772878 PMCID: PMC6846319 DOI: 10.1097/gox.0000000000002425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text. Currently, there are more than 40 cases of facial allotransplantation performed by 13 different groups in 10 countries. Although it has become a potential option to reconstruct and restore the function and appearance of severely facially disfigured individuals, the ethical concerns of facial allotransplantation remain unsolved. We conducted a systematic review to better understand the ethical concerns on facial allotransplantation and the changing trends of the ethical debate over time.
Collapse
|
6
|
|
7
|
Sarwer DB, Ritter S, Reiser K, Spitzer JC, Baumann BM, Patel SN, Mazzarelli AJ, Levin LS, Doll S, Caplan AL. Attitudes Toward Vascularized Composite Allotransplantation of the Hands and Face in an Urban Population. ACTA ACUST UNITED AC 2014. [DOI: 10.4161/23723505.2014.975021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
8
|
|
9
|
Kay S, Wilks D. Invited Comment: Vascularized composite allotransplantation: An update on medical and surgical progress and remaining challenges. J Plast Reconstr Aesthet Surg 2013; 66:1456-7. [DOI: 10.1016/j.bjps.2013.04.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
|
10
|
Edison E, Camm CF, Agha R. Commentary on: “Facial transplantation revisited: Findings from the very first public engagement exercise”. Int J Surg 2011; 9:488-9. [DOI: 10.1016/j.ijsu.2011.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 07/04/2011] [Indexed: 11/27/2022]
|
11
|
Abstract
This article in the series describes how UK law and medical ethics have evolved to accommodate developments in organ transplantation surgery. August committees have formulated definitions of the point of death of the person which are compatible with the lawful procurement of functioning vital organs from cadavers. Some of the complexities of dead donor rules are examined. Live donors are a major source of kidneys and the laws that protect them are considered. Financial inducements and other incentives to donate erode the noble concept of altruism, but should they be unlawful?
Collapse
Affiliation(s)
- Tom Woodcock
- Department of Anaesthetics, Southampton General Hospital, Southampton, UK
| | | |
Collapse
|
12
|
|
13
|
Facial transplantation in a new era: what are the ethical implications? Curr Opin Otolaryngol Head Neck Surg 2009; 17:274-8. [DOI: 10.1097/moo.0b013e32832cba57] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Hom DB, Sun GH, Elluru RG. A contemporary review of wound healing in otolaryngology: Current state and future promise. Laryngoscope 2009; 119:2099-110. [DOI: 10.1002/lary.20561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
15
|
Mathes DW, Kumar N, Ploplys E. A survey of North American burn and plastic surgeons on their current attitudes toward facial transplantation. J Am Coll Surg 2009; 208:1051-8.e3. [PMID: 19476891 DOI: 10.1016/j.jamcollsurg.2009.01.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 12/07/2008] [Accepted: 01/20/2009] [Indexed: 01/20/2023]
Abstract
BACKGROUND Feasibility of composite tissue allotransplantation (CTA) has been substantiated by transplantations of the hand, abdominal wall, and face. CTA has the potential to reconstruct "like with like," but the risk-to-benefit ratio and clinical indications have yet to be determined. We sought to examine the current attitudes about the emerging field of CTA from those who treat complex facial injuries. STUDY DESIGN In 2007, a Web-based blinded survey was sent to both burn and plastic surgeons involved in facial reconstruction. We examined the practice profile with regard to complex facial injuries and asked respondents to assess the level of risk in CTA and indications for facial transplantation. Surgeons were asked to evaluate three clinical cases (two closely mirroring clinical face transplantations) for suitability for treatment with CTA. RESULTS One hundred sixty-four surgeons responded (54% response rate) and averaged 17.3 years in practice. They saw 12.1 severe facial-injury patients per year. A total of 78.7% agreed that current techniques do not provide adequate reconstruction for severe facial injuries, and 26.2% were in favor of performing CTA on immunosuppression. Acceptable indications for CTA were multiple failed reconstructions (70%), total facial burn (59%), and absence of remote tissue (55%). Ten percent saw no acceptable indication for CTA. The scenarios that mimicked recent transplantations had moderate support in favor of CTA (20.7% for the Chinese patient and 29.3% for the French patient). CONCLUSIONS This survey demonstrates support for use of CTA to reconstruct complex facial deformities. Surgeons continue to be wary of immunosuppression and chronic rejection, and many want to wait for better immunologic treatment options.
Collapse
Affiliation(s)
- David W Mathes
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA.
| | | | | |
Collapse
|
16
|
Chenggang Y, Yan H, Xudong Z, Binglun L, Hui Z, Xianjie M, Li Y, Xing F, Yunjing L, Kaihua L, Huiyuan L, Yan Z, Guoyou Z, Shuzhong G. Some issues in facial transplantation. Am J Transplant 2008; 8:2169-72. [PMID: 18828775 DOI: 10.1111/j.1600-6143.2008.02352.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Human facial transplantation, a form of composite tissue allotransplantation, has now become a clinical reality. We carried out the world's second partial facial transplantation in April 2006. We reviewed some issues associated with facial transplantation, especially focusing on the individual who underwent the transplant in our department. We discussed surgical indications, techniques, risks versus benefits, informed consent and psychosocial, societal and financial issues of facial transplantation. In our opinion, with the progresses in composite tissue allotransplantation, partial or full facial transplantation is becoming a timely and effective remedy for the significantly disfigured patients. However, there are a lot of problems unsolved, and as we have performed the transplant on only three individuals, no long-term outcome data are available. Facial transplantation needs further research.
Collapse
Affiliation(s)
- Y Chenggang
- Institute of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Guo S, Han Y, Zhang X, Lu B, Yi C, Zhang H, Ma X, Wang D, Yang L, Fan X, Liu Y, Lu K, Li H. Human facial allotransplantation: a 2-year follow-up study. Lancet 2008; 372:631-8. [PMID: 18722867 DOI: 10.1016/s0140-6736(08)61276-3] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Progress in composite tissue allotransplantation could provide a new treatment for patients with severe facial disfigurements. We did a partial facial allotransplantation in 2006, and report here the 2 year follow-up of the patient. METHODS The recipient, a 30-year-old man from China, had his face severely injured by a bear in October, 2004. Allograft composite tissue transplantation was done in April, 2006, after careful systemic preparation. The surgery included anastomosis of the right mandibular artery and anterior facial vein, whole repair of total nose, upper lip, parotid gland, front wall of the maxillary sinus, part of the infraorbital wall, and zygomatic bone. Facial nerve anastomosis was done during the surgery. Quadruple immunomodulatory therapy was used, containing tacrolimus, mycophenolate mofetil, corticosteroids, and humanised IL-2 receptor monoclonal antibody. Follow-up included T lymphocyte subgroups in peripheral blood, pathological and immunohistochemical examinations, functional progress, and psychological support. FINDINGS Composite tissue flap survived well. There were three acute rejection episodes at 3, 5, and 17 months after transplantation, but these were controlled by adjustment of the tacrolimus dose or the application of methylprednisolone pulse therapy. Hepatic and renal functions were normal, and there was no infection. The patient developed hyperglycaemia on day 3 after transplantation, which was controlled by medication. INTERPRETATION Facial transplantation could be successful in the short term, but the procedure was not without complications. However, promising results could mean that this procedure might be an option for long-term restoration of severe facial disfigurement.
Collapse
Affiliation(s)
- Shuzhong Guo
- Institute of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|