Marchac Alexandre, Kuschner Tomasine, Paris John, Picard Arnaud, Vazquez Marie Paule, Lantieri Laurent
Paris, France; San Francisco, Calif.; and Chestnut Hill, Mass.
From the Department of Plastic Surgery, Hopital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris; the Department of Pediatric Plastic Surgery, Hopital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris; the Program in Medicine and Human Values, California Pacific Medical Center; and the Department of Theology, Boston College.
Plast Reconstr Surg. 2016 Aug;138(2):449-454. doi: 10.1097/PRS.0000000000002387.
In 2005, face transplantation ceased to be fiction and became a scientific reality. Today, 10 teams from six different countries have performed 32 face transplantations. Immunosuppressive treatments are similar to other solid organ transplants, and patients have experienced a significant functional improvement. The authors are logically considering expanding face transplantation to children; however, children are not simply small adults.
The authors searched for pediatric patients in need of restoration of fundamental functions of the face, such as orbicularis oris or oculi muscle closure by, first, selecting cases from a pediatric plastic surgery reference center and, second, analyzing the feasibility of face transplantation in those patients. The authors then identified the specific problems that they would encounter during a pediatric face transplant. The authors identified three potential candidates for pediatric face transplantation.
Children's youth imposes additional ethical and psychological considerations, such as the balance of risk to benefit when it is quality of life, not life itself, that is at stake; the process of informed consent; the selection process; and the protection of privacy against media exposure. The question becomes not whether children should be included as candidates for face transplantation but whether any ethical barriers should preclude children as candidates for a full face transplant.
After careful consideration of the physical, psychological, and ethical aspects of such a procedure, the authors found no such barrier that would either disqualify such vulnerable subjects as profoundly disfigured children or conflict with their best interests.
2005年，面部移植不再是虚构之事，而成为了科学现实。如今，来自六个不同国家的10个团队已实施了32例面部移植手术。免疫抑制治疗与其他实体器官移植相似，患者的功能有了显著改善。作者们理所当然地在考虑将面部移植扩展至儿童；然而，儿童并非只是缩小版的成人。
作者们首先从一家小儿整形外科参考中心挑选病例，其次分析这些患者接受面部移植的可行性，以此寻找需要恢复面部基本功能（如口轮匝肌或眼轮匝肌闭合）的儿科患者。作者们随后确定了在小儿面部移植过程中会遇到的具体问题。作者们确定了三名小儿面部移植的潜在候选人。
儿童的年轻带来了额外的伦理和心理考量，比如当面临风险与获益的权衡时（此时关乎的是生活质量而非生命本身）、知情同意过程、选择过程以及针对媒体曝光保护隐私等问题。问题不再是儿童是否应被纳入面部移植候选人范围，而是是否存在任何伦理障碍会妨碍儿童成为全脸移植的候选人。
在仔细考虑了此类手术的生理、心理和伦理方面后，作者们发现不存在会使诸如严重毁容儿童这类脆弱受试者丧失资格或与其最大利益相冲突的障碍。
