The English position: position paper of the Royal College of surgeons of England.

To the reconstructive surgeon, facial transplantation would constitute a major breakthrough in restoration of a quality of life to those whose faces have been destroyed by accident or tumour. It is therefore worthy of study.

The microsurgical skills and anatomic knowledge required for this procedure are already well-established and well-known. However, at present, this is not only a question of technical achievement. The immunosuppression needed, the psychological impact on the recipient and on the donor family, and the ethical concerns are the issues which must be considered. The need for lifetime immunosuppression carries considerable long-term risks which appear to outweigh any premature attempt to open the gates to facial transplantation. It remains unclear how acceptable and valid consent can be obtained from potential recipients, given the uncertainties about the risks and benefits that accompany the highly experimental character of the procedure.

The working party believes that until there is further research and the prospect of better control of these complications, it would be unwise to proceed with human facial transplantation. Equally, this conclusion does not underestimate the suffering of those patients who might be tempted by the prospect of facial transplantation. This conclusion is not adverse to facial transplantation. Indeed, it acknowledges the need to recognize it as a possible future treatment. It simply means that the work should take a much more incremental approach than some of the current hype surrounding it has suggested. The working party has only considered the question of facial transplantation and has not considered any other transplant surgery to improve quality of life, for example, hand transplantation. Such surgery would itself be subject to detailed consideration and research ethics committee approval.