The psychological management of facial transplantation.

Facial transplantation is a major advance in reconstructive surgery, providing enormous potential benefit in terms of improved function and cosmesis. Managing the challenges it brings depends on understanding both technical and psychological issues. Research on the psychological aspects of organ transplantation is a starting point; however, issues of altered appearance and identity, adjustment to change, the management of suboptimal adherence to immunosuppression, and how we present and understand risk, particularly related to immunosuppression and rejection, must all be addressed before the procedure becomes a clinical option. This review addresses the psychological issues highlighted in the Royal College of Surgeons Working Party Report on facial transplantation, describing how these have been addressed in the development of a clinical program.