Face transplantation: psychological assessment and preparation for surgery

Abstract

Face transplantation is emerging as the next logical step in the reconstructive ladder for patients with severe facial injuries. However, this is a procedure which presents major challenges, not only in terms of public acceptance, but particularly in terms of the appropriate selection and preparation of patients. Unlike solid organ transplantation, the likely benefits are life enhancing rather than life saving, and since the face is highly allergenic, the immunosuppressive regimen will be rigorous. Managing patients' expectations of outcome is vital both in ensuring post-operative satisfaction and in maximizing adherence with the immunosuppressive regime. Whilst more research in this area is clearly needed before this procedure becomes available, it is important to anticipate surgical advance and to develop a process of psychological assessment with a sound empirical base. This paper therefore addresses the problems of selection and preparation for surgery using a model of informed choice. Issues of altered identity and adherence with the therapeutic regimen are discussed with reference to research in analogous populations, including patients with facial disfigurement, those undergoing facial reconstruction, solid organ and hand transplantation. This paper therefore proposes an empirical approach to the planning of future research and the development of clinical tools for assessment and preparation of potential patients.