Morris Peter, Bradley Andrew, Doyal Len, Earley Michael, Hagen Patricia, Milling Martin, Rumsey Nichola
Centre for Evidence in Transplantation, Royal College of Surgeons of England and London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom.
Transplantation. 2007 Jan 27;83(2):109-28. doi: 10.1097/01.tp.0000254201.89012.ae.
Three years ago, the Working Party on Facial Transplantation concluded that until there was more information available about risks any potential patient would be exposed to, it would be unwise to proceed with transplantation of the human face. Over the last three years, there has been a deepening understanding of the potential psychological problems of facial transplantation as well as a very considerable debate on the ethical aspects of the procedure. Further data on experimental work in animal models of facial transplantation as well as medium-term follow-up data from 24 hand and forearm transplants in 18 patients has now become available. Furthermore, a partial facial transplantation has been performed in France and a second one in China. In this second edition of the report, the technical, immunological, psychological, and ethical issues are discussed again in the light of this developing knowledge. In particular, there has been a major expansion of the sections on the psychological and societal issues, as well as the ethical and legal problems of facial transplantation. The working party still has considerable reservations about facial transplantation. Although it accepts that on balance the risks cannot be precisely quantified, they remain substantial. Therefore, if patients are allowed to make an informed choice to proceed, they must be very carefully selected and protected in the process, along with the families of both the donors and the recipients. To achieve this, the working party insists that 15 minimum requirements, described at the end of this report, must be fulfilled before it would be appropriate for a research ethics committee/institutional review board to approve of a proposal to undertake facial transplantation.
三年前，面部移植工作小组得出结论：在获得更多关于任何潜在患者可能面临的风险的信息之前，进行人脸移植是不明智的。在过去三年里，人们对面部移植潜在的心理问题有了更深入的理解，同时也对该手术的伦理方面展开了非常激烈的辩论。现在已经有了关于面部移植动物模型实验工作的进一步数据，以及18名患者24例手部和前臂移植的中期随访数据。此外，法国进行了一例部分面部移植手术，中国进行了第二例。在本报告的第二版中，根据这些不断发展的知识，再次讨论了技术、免疫、心理和伦理问题。特别是，关于心理和社会问题以及面部移植的伦理和法律问题的章节有了大幅扩充。工作小组对面部移植仍有相当大的保留意见。尽管它承认总体而言风险无法精确量化，但风险仍然很大。因此，如果允许患者做出明智的选择继续进行手术，那么在这个过程中必须非常谨慎地挑选和保护他们，同时也要保护供体和受体的家属。为了实现这一点，工作小组坚持认为，在研究伦理委员会/机构审查委员会批准进行面部移植的提议之前，必须满足本报告末尾所述的15项最低要求。
