Thursday, December 18, 2008

Is Face Transplant an Identity Transplant?

The face is visible in a way that internal organs are not. Further, it is visible in a way that is highly associated with one’s individual identity. If we have someone else’s face, are we really and truly our self?

John Lantos, MD
December 18, 2008

A few weeks ago, surgeons at The Cleveland Clinic performed “a face transplant.” News reports of this remarkable technological achievement almost always include comments from bioethicists who, as bioethicists tend to do, urge caution, worry about consequences, and wonder about the patient’s autonomy.

Perhaps it might be more appropriate to urge awe and wonder about our interconnectedness.

Certain ethical issues accompany all medical innovations. Nobody really knows the long term risks or benefits. Great hopes might be dashed by unforeseen complications. Progress has inherent perils. The first patients can be harmed rather than helped. All this has been true for prior pioneering transplantations of heart, liver, kidney, and intestine.

It has also been true for cancer chemotherapy, immunizations, and other medications. What, then, is really new and different about face transplantation?

The face is visible in a way that internal organs are not. Further, it is visible in a way that is highly associated with one’s individual identity. If we have someone else’s face, are we really and truly our self? Do we become, in some weird way, the donor? Is a face transplant really an identity transplant?

The relationship between transplanted body parts and transplanted identities has always been a concern. Fiction writers have explored this territory more than have scientists.

John Irving’s novel, The Fourth Hand, imagines a hand transplant in which the recipient gets not only the physical hand but much of the life of the donor. Robert Heinlein’s I Will Fear No Evil imagines a brain transplant, and one in which the brain of an old man is transplanted into the body of a young woman.

Both novels deal with the scintillating concerns that a transplant can never be simply of tissue, that when we put bodies together, we also put souls and psyches together. Tabloid newspapers get it. (The Daily Mail, in the UK, had a recent headline, “I was given a young man’s heart – and started craving beer and Kentucky Fried Chicken.”)

Even transplant surgeons themselves worry. Anthropologist Margaret Lock quotes a surgeon who was a little queasy about the possibility of obtaining organs from death row prisoners, “I wouldn’t like to have a murderer’s heart put into my body. I might find myself starting to change.”

The fact is that transplantation of body parts creates a strange and unique bond between donor and recipient. A gift has been given that is like no other – a gift of self that crosses the boundary between life and death. The families of donors often cling to a belief that their loved on “lives on” because a body part is still alive. Recipients often talk of being reborn, or of not being the same person that they were before.

Face transplants differ from other transplants in degree, not kind. All transplants, all use of the body parts of other people, reflect the subtle ways in which we are interconnected and almost interchangeable with one another.

There is beauty in that, as well as fear and trembling. We shouldn’t shrink from the new responsibilities that our new powers foist upon us. But we shouldn’t minimize or simplify those responsibilities, either. We should never do things simply because we can, but neither should we avoid doing things simply because they raise frightening new ways to think about who we are or who we might become.

We are blessed by scientific breakthroughs that enable us to take care of each other in new, spooky, and miraculous ways. Our interconnectedness should generate in us a sense of awe, wonder, and, ultimately, responsibility.

We can harm each other. We can take care of each other. We can choose. The surgeons, the bioethicists, the patient and the families of the donor and recipient all chose to improve life in a way that was only possible through extraordinary human interconnectedness. They have taken risks for us.

They have done a brave and good thing.

What do you think? Click here to view and leave your comments.


First U.S. face transplant completed at Cleveland Clinic, USA Today, December 16

Transplanting a Face: The Ethical Issues, New York Times, December 17

Is face transplant worth risking patient's life?, Arthur Caplan, Ph.D., December 17


Blogger Tarris Rosell said...

Dr. Lantos, while I share much of your sense of appreciation for medical innovation, including this one, I wonder also what could mitigate your response and mine of “awe and wonder.” Under what conditions might a face transplant not be a “brave and good thing”—in this case or some other? What degree of risk could be clearly unacceptable regardless of good intentions, given that the risks of this procedure currently are very considerable? What level of (increasingly scarce, let’s say) medical resources ought to be expended on this sort of surgical innovation relative to other healthcare needs and in light of disparities?

Tarris Rosell

Monday, December 22, 2008  
Anonymous Anonymous said...

Certainly a face transplant is not an identity transplant, in the sense that the patient who undergoes the procedure is presumably choosing to have the transplant. It is safe to conclude that the patient's self-conception, or identity, includes the ability to consider the risks and to contemplate some of the possible outcomes of the surgery, insofar as they can be known. Dramatic circumstantial and internalized changes are part and parcel of each individual's life history, as is the individual's learned capacity and predisposition to deal with such changes, whether sudden or gradual, wanted or not. The transplant operation is merely a newly-available option which increases the scope of an individual's possible actions as a product of individual identity.
Martin Zehr

Tuesday, December 23, 2008  
Anonymous John Lantos said...

Thanks for those comments.

Some surgical innovation is neither brave nor good. I think that, in this case, the surgeons, the institution, and the bioethicists were very responsible in their evaluation of the ethical implications of their work. They even held a conference about the ethics of innovative surgery, and published the proceedings for the world to see and scrutinize. (

And they have their own blog. (
medical/2008/08/ live_blog_surgical_innovation.html)
As best I can tell (it is always hard to know for sure), the preliminary research had been exhaustive. The surgeon who did the operation has been working on "composite" transplants for over 20 years. And the consent process was, apparently, thorough and meticulous. Had those preparations not been done, I'd have been less laudatory.

As far as identity goes, I agree with most of what Martin Zehr says. But I do think that face transplants raise issues that are different from, say, kidney transplants or heart transplants (both of which have raised questions about identity - with some recipients reporting feelings of having taken on some characteristics of the donors. It seems like this is even more likely with a face transplant. Perhaps "identity transplant" is too flamboyant a term for this - but it would have to be a strange feeling to look in the mirror and see -- someone else.

Again, thanks for your comments.


Thursday, December 25, 2008  
Anonymous medifast diet plan said...

Greetings so people think that the face change is a identity change but is not right cause the transplant not going to change you re fingerprints so you will be the same person and also you re documents will reflect the same so in my personal opinion is not a change of identity .

Thursday, June 24, 2010  
Anonymous Buy Generic Viagra said...

I don't think that the only way that it can be an identity transplant it is like surgeries that drug dealers make and they don't be catch by the police but after that it is necessary to people that really need it when they suffer accidents.

Thursday, September 30, 2010  
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