Would you give away your face? The emotional challenges of face transplants

Would you give away your face? The emotional challenges of face transplants

A recent article by leading facial transplantation surgeon Eduardo Rodriguez and others highlights the importance of donor education in transplantation. Motivated by the continual lack of organ donors, researchers argued that educational health campaigns can inform the public and inspire them to act differently. Educating the public might mean that more faces are available for transplant.

It’s an incredibly important issue, and not one restricted to face transplants. There are religious and ethical reasons why some people don’t become organ donors, but how many others decline out of fear or ignorance? Different countries have their own laws on organ donation. Yet there is no doubt that faces make people nervous.

Fifty years ago, when the first successful heart transplant was performed, there was a cultural fear that black people would become spare parts for whites. This was South Africa after all, at the time of Apartheid. Today, there is a cultural fear that old rich people will one day acquire the faces of the young and poor. Like many dystopic fantasies about transplantation, fears of the limits and ethics of science tap into broader concerns about power, the body and identity.

Faces, for good or ill, are supposed to represent the essence of who we are. Stamped on our passports, they define our identity. Consider the political debates about the veil in much of Europe and conflicts in the UK about wearing a veil in court. Smuggled into these debates are anecdotal discussions about honesty, trust, and the importance of faces for social communication. Faces are also visible indicators of our health, wealth, ethnicity, heredity, gender and age. How often do visitors of a newborn declare 'Oh, s/he looks exactly like you!' to titters of delight from the parents? 

It is perhaps understandable, given the varied meanings of the face, that many people would not want to give up the face of a loved one to another, especially since so much misinformation abounds about face transplants, like the myth that a donor would immediately look like the recipient (a myth, no doubt, influenced by John Woo’s movie Face/Off. If John Travolta can become Nicholas Cage in a matter of hours, might somebody else become your beloved husband? 

Would public education help put people's minds at rest? We certainly need to talk about transplantation more than we do. And we need to talk about it earlier; it is traumatic for anyone to be met in the hospital not only with the death of a loved one but also with a request for organs. And yet that it is the burden placed on medical staff. How much more traumatic is it to give up the face of a child, a wife, a brother? To imagine them being buried faceless? Extraordinarily, 3D printers have come to the rescue and donors can now be buried with an almost identical plastic replica of their own face.

The article by Rodriguez et al found that only 52 per cent of people surveyed were willing to donate their own face. After they had watched an educational video, that increased by 18 per cent. Those who changed their minds were influenced not only by learning how the procedure is carried out, but also by understanding the devastating emotional and physical impact of the kind of facial trauma that requires transplantation.

But  - as the considerable proportion of resisters suggests -  people are not only unwilling to give up faces because of a lack of education. It’s also because of what faces mean. It’s also a difficult burden to take on as a recipient. In addition to the pain of surgery, or multiple surgeries, and the need to take dangerous immuno-suppressant drugs for life, acquiring the face of someone else means presuming another, visible, identity of sorts. Not all people are able to cope emotionally with the impact of receiving another person’s face. This is apparent in the story of Isabelle Dinoire, the world’s first face transplant recipient in 2005, as I have written about elsewhere.

More than 40 people have received face transplants since Dinoire’s time, and the number is growing. It is only a matter of time before we have the UK's first. How future generations of face transplant recipients will cope with their inheritance – and how the families of donors will adjust to their complex loss – remains to be seen.

Crucially, there are not yet enough faces to go around. If donor education changes this, what does it mean for the future of the face transplant? Or for the people who acquire a new face?

I am seeking to answer these and related questions through the first major interdisciplinary project into the emotional history and impact of the face transplant. 

Would you give away your face? And would you accept one? What do you imagine the major difficulties might be? Please get in touch through the Contact Me page. Or come to my public lecture at the University of York on 22 January and join in the conversation.