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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.
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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
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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.
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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
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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.
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Oser ML, Nizzi MC, Zinser JL, Turk M, Epstein R, Bueno E, Gitlin D, Pomahac B. Quality of Life and Psychosocial Functioning 2 Years Following Facial Transplantation. PSYCHOSOMATICS 2018; 59:591-600. [DOI: 10.1016/j.psym.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
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Fisher A, Andreasson A, Chrysos A, Lally J, Mamasoula C, Exley C, Wilkinson J, Qian J, Watson G, Lewington O, Chadwick T, McColl E, Pearce M, Mann K, McMeekin N, Vale L, Tsui S, Yonan N, Simon A, Marczin N, Mascaro J, Dark J. An observational study of Donor Ex Vivo Lung Perfusion in UK lung transplantation: DEVELOP-UK. Health Technol Assess 2018; 20:1-276. [PMID: 27897967 DOI: 10.3310/hta20850] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many patients awaiting lung transplantation die before a donor organ becomes available. Ex vivo lung perfusion (EVLP) allows initially unusable donor lungs to be assessed and reconditioned for clinical use. OBJECTIVE The objective of the Donor Ex Vivo Lung Perfusion in UK lung transplantation study was to evaluate the clinical effectiveness and cost-effectiveness of EVLP in increasing UK lung transplant activity. DESIGN A multicentre, unblinded, non-randomised, non-inferiority observational study to compare transplant outcomes between EVLP-assessed and standard donor lungs. SETTING Multicentre study involving all five UK officially designated NHS adult lung transplant centres. PARTICIPANTS Patients aged ≥ 18 years with advanced lung disease accepted onto the lung transplant waiting list. INTERVENTION The study intervention was EVLP assessment of donor lungs before determining suitability for transplantation. MAIN OUTCOME MEASURES The primary outcome measure was survival during the first 12 months following lung transplantation. Secondary outcome measures were patient-centred outcomes that are influenced by the effectiveness of lung transplantation and that contribute to the health-care costs. RESULTS Lungs from 53 donors unsuitable for standard transplant were assessed with EVLP, of which 18 (34%) were subsequently transplanted. A total of 184 participants received standard donor lungs. Owing to the early closure of the study, a non-inferiority analysis was not conducted. The Kaplan-Meier estimate of survival at 12 months was 0.67 [95% confidence interval (CI) 0.40 to 0.83] for the EVLP arm and 0.80 (95% CI 0.74 to 0.85) for the standard arm. The hazard ratio for overall 12-month survival in the EVLP arm relative to the standard arm was 1.96 (95% CI 0.83 to 4.67). Patients in the EVLP arm required ventilation for a longer period and stayed longer in an intensive therapy unit (ITU) than patients in the standard arm, but duration of overall hospital stay was similar in both groups. There was a higher rate of very early grade 3 primary graft dysfunction (PGD) in the EVLP arm, but rates of PGD did not differ between groups after 72 hours. The requirement for extracorporeal membrane oxygenation (ECMO) support was higher in the EVLP arm (7/18, 38.8%) than in the standard arm (6/184, 3.2%). There were no major differences in rates of chest radiograph abnormalities, infection, lung function or rejection by 12 months. The cost of EVLP transplants is approximately £35,000 higher than the cost of standard transplants, as a result of the cost of the EVLP procedure, and the increased ECMO use and ITU stay. Predictors of cost were quality of life on joining the waiting list, type of transplant and number of lungs transplanted. An exploratory model comparing a NHS lung transplant service that includes EVLP and standard lung transplants with one including only standard lung transplants resulted in an incremental cost-effectiveness ratio of £73,000. Interviews showed that patients had a good understanding of the need for, and the processes of, EVLP. If EVLP can increase the number of usable donor lungs and reduce waiting, it is likely to be acceptable to those waiting for lung transplantation. Study limitations include small numbers in the EVLP arm, limiting analysis to descriptive statistics and the EVLP protocol change during the study. CONCLUSIONS Overall, one-third of donor lungs subjected to EVLP were deemed suitable for transplant. Estimated survival over 12 months was lower than in the standard group, but the data were also consistent with no difference in survival between groups. Patients receiving these additional transplants experience a higher rate of early graft injury and need for unplanned ECMO support, at increased cost. The small number of participants in the EVLP arm because of early study termination limits the robustness of these conclusions. The reason for the increased PGD rates, high ECMO requirement and possible differences in lung injury between EVLP protocols needs evaluation. TRIAL REGISTRATION Current Controlled Trials ISRCTN44922411. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 85. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Andrew Fisher
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Anders Andreasson
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandros Chrysos
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Lally
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Catherine Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jessica Qian
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Watson
- Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Thomas Chadwick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kay Mann
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola McMeekin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Tsui
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nizar Yonan
- University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Andre Simon
- Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Nandor Marczin
- Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Jorge Mascaro
- Queen Elizabeth Hospital NHS Foundation Trust, Birmingham, UK
| | - John Dark
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Uluer MC, Brazio PS, Woodall JD, Nam AJ, Bartlett ST, Barth RN. Vascularized Composite Allotransplantation: Medical Complications. CURRENT TRANSPLANTATION REPORTS 2016; 3:395-403. [PMID: 32288984 PMCID: PMC7101879 DOI: 10.1007/s40472-016-0113-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objective of this review is to summarize the collective knowledge regarding the risks and complications in vascularized composite tissue allotransplantation (VCA), focusing on upper extremity and facial transplantation. The field of VCA has entered its second decade with an increasing experience in both the impressive good outcomes, as well as defining challenges, risks, and experienced poor results. The limited and selective publishing of negative outcomes in this relatively new field makes it difficult to conclusively evaluate outcomes of graft and patient survival and morbidities. Therefore, published data, conference proceedings, and communications were summarized in an attempt to provide a current outline of complications. These data on the medical complications of VCA should allow for precautions to avoid poor outcomes, data to better provide informed consent to potential recipients, and result in improvements in graft and patient outcomes as VCA finds a place as a therapeutic option for selected patients.
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Affiliation(s)
- Mehmet C. Uluer
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Philip S. Brazio
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Jhade D. Woodall
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Arthur J. Nam
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Stephen T. Bartlett
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Rolf N. Barth
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
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Abstract
AbstractObjective:To present the clinical outcomes obtained by the first facial transplant teams worldwide, reviewing current practice and addressing controversies.Methods:A bibliographic search of Medline and Embase databases was performed, and a comparative analysis of all articles published from 1980 to the present was conducted. Two independent investigators screened the manuscripts in accordance with pre-defined criteria.Results:A total of 12 partial and 5 full facial transplants were recorded in the literature. Procedures included partial and near-total facial myocutaneous flaps, and complex osteomyocutaneous grafts. Fifteen patients had fully vascularised grafts, and two patients died of transplant-related and infectious complications.Conclusion:Facial transplantation can restore quality of life and enable the social re-integration of recipients. Results published by the first facial transplant teams are promising. However, long-term reports of aesthetic and functional outcomes are needed to more precisely define outcomes. In addition, significant technical, medical and ethical issues remain to be solved.
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Paradis C. Moral Obligations in Head and Neck Allo-Transplantation Innovation. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Huh S. Ethical Issue in Preparing Manuscript on Esthetic Patients. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2014. [DOI: 10.14730/aaps.2014.20.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sun Huh
- Department of Parasitology and Institute of Medical Education, College of Medicine, Hallym University, Chuncheon, Korea
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Experiences of Healthcare Team Members Involved in Facial Transplant Surgery and Patient Care. Nurs Res 2013; 62:372-82. [DOI: 10.1097/01.nnr.0000434616.93493.e2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coffman KL, Siemionow MZ. Face transplantation: psychological outcomes at three-year follow-up. PSYCHOSOMATICS 2013; 54:372-8. [PMID: 23352049 DOI: 10.1016/j.psym.2012.10.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 10/12/2012] [Accepted: 10/22/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The advent of face transplantation has raised both ethical and psychological issues. Mortality of 18 existing face transplant recipients is 11.1% (2/18) through 2011. OBJECTIVE Psychological outcomes are as important in face transplantation as is restoring the face physically. Little quantitative information has been published this area. METHODS Data was systematically collected over 3 years with a face transplant recipient, including appearance self-rating, body image, mood changes, pain rating, perception of teasing, quality of life, self-esteem, and social reintegration. We identified a significant gap in rating instruments for use in the field, so we developed the Perception of Teasing-FACES, Facial Anxiety Scale-State, and the Cleveland Clinic FACES score, analogous to the model for end-stage liver disease (MELD) score for prioritizing patients for a face transplant registry. RESULTS Appearance self-rating rose from 3/10 prior to transplantation to 7/10 now. Anxiety about body image and the Facial Anxiety score were halved by the end of the third year. Beck Depression Inventory fell from 16 (prior to transplant) to 8. Chronic daily pain was 6-7/10 prior to transplant and 0/10 by day 50. Perception of Teasing-FACES scores fell from 25 to 9 by the end of year 3. Quality of life improved on the Social Environment Domain of the psychological adjustment to illness scale-self-rated (PAIS-SR), where the score dropped from 15 to 1 by the end of year 3, indicating marked improvement in social reintegration. CONCLUSIONS Standardized data collection may help quantify psychological outcomes with facial transplantation to determine whether the risks of immunosuppression over time are offset by improved quality of life for recipients.
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Affiliation(s)
- Kathy L Coffman
- Department of Psychiatry, Cleveland Clinic, Cleveland, OH 44195, USA.
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Evans LA. A historical, clinical, and ethical overview of the emerging science of facial transplantation. Plast Surg Nurs 2011; 31:151-157. [PMID: 22157604 DOI: 10.1097/psn.0b013e31822f6611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In the past 5 years, a total of 16 facial transplantation surgeries have been performed in France, China, Spain, and the United States. Facial transplantation has become a surgical option in clinical situations in which soft tissue and bone loss is accompanied by severe cosmetic, sensory, and functional deficiencies due to disease, trauma, or congenital malformations. With the introduction of facial tissue transplantation surgery came complex clinical, technological, and ethical patient care issues. These complex issues included determining patient selection criteria, refining donor tissue procurement techniques, predicting expected functional outcomes, appreciating the limitations of obtaining a fully informed consent for an innovative procedure, and deliberating the immunological response and postoperative immunosuppressant requirements of the recipient. In addition, psychological implications for the patient, societal consequences, and ethical concerns have been discussed. The short-term results have been positive. Results to date indicate that the clinical, technical, and immunological patient care issues in this emerging science appear to mirror those of other reconstructive and organ transplantation procedures. The long-term physical, emotional, and psychological effects on the recipient patient, as well as long-term consequences to the donor's family, are yet to be validated.
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Affiliation(s)
- Linda A Evans
- Burn and Trauma Program, Brigham and Women's Hospital, Boston, MA, USA.
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Psychological outcomes with face transplantation: overview and case report. Curr Opin Organ Transplant 2010; 15:236-40. [PMID: 20308897 DOI: 10.1097/mot.0b013e328337267d] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide guidance in a burgeoning new field of facial composite tissue transplantation. This review will contrast face transplant with solid organ transplantation, provide information to guide selection of face transplant candidates, and share information on psychological outcomes. RECENT FINDINGS Previously published face transplant reports have not investigated body image, mood changes, perception of teasing, quality of life, self-esteem, or social reintegration quantitatively. Face transplantation appears to decrease depression and verbal abuse, and improve quality of life and social reintegration, though may not alter anxiety or self-esteem. The Psychosocial Adjustment for Illness Scale-Self-Report scale may have advantages over the SF-36 and World Health Organization Quality of Life (WHOQOL)-BREF rating scales for measuring psychological distress and social reintegration. SUMMARY Face transplantation is currently a technique of last resort after traditional reconstructive techniques have failed, not for cosmesis alone. Mortality among eight existing face transplant patients is 25%, two of eight. Some consider blindness as an absolute contraindication; however, those who are legally blind but retain some vision may be appropriate candidates. Physical goals of transplantation include regaining movement of underlying structures and restoring the appearance of a normal face. However, psychological outcomes and quality of life are also important to the success of face transplantation and ultimately will determine the value of the procedure.
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BÅogowski W. Facial transplantation as an option in reconstructive surgery: no mountains too high? ANZ J Surg 2009; 79:892-7. [DOI: 10.1111/j.1445-2197.2009.05140.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Whitaker IS, Duggan EM, Alloway RR, Brown C, McGuire S, Woodle ES, Hsiao EC, Maldonado C, Banis JC, Barker JH. Composite tissue allotransplantation: a review of relevant immunological issues for plastic surgeons. J Plast Reconstr Aesthet Surg 2008; 61:481-92. [PMID: 18248779 DOI: 10.1016/j.bjps.2007.11.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 11/16/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Composite tissue allotransplantation of hand, facial and other tissues is now a clinical reality. The terminology, treatment principles, drug combinations, dosage schedules and mechanisms of the immunosuppression medications on which contemporary transplant surgery is based are unfamiliar to plastic surgeons and most healthcare providers outside the field of transplantation medicine. With this in mind, the purpose of this manuscript is to provide plastic surgeons with a comprehensive and understandable review of key immunological principles relevant to composite tissue allotransplantation. METHODS We present an overview of the immunological basis of composite tissue allotransplantation aimed at the plastic surgery readership, based on our own experience plus manuscripts sourced from MEDLINE, EMBASE, text books, ancient manuscripts and illustrations. RESULTS In this manuscript we provide the reader with a brief history of composite tissue allotransplantation (CTA), a concise description of the immunological terminology, treatment approaches, risks associated with immunosuppressive therapy, risk acceptance, and current research avenues relating to contemporary CTA. CONCLUSION Today, as transplant and reconstructive surgeons join forces to move hand and facial tissue allotransplantation into the clinical arena, it is important that plastic surgeons have an understanding of the major immunological principles upon which this new treatment is based.
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Affiliation(s)
- Iain S Whitaker
- Department of Surgery, University of Louisville, 511 South Floyd Street, 320 MDR Building, Louisville, KY 40202, USA
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