Bioethical considerations.

The clinical literature notes that pregnancy has become an expected benefit of solid organ transplant. Establishing "best practices" in the management of this particular transplant population requires careful consideration of the ethical dimensions, broadly speaking, of posttransplant pregnancies and these women's lived experiences. In this article, we present the current clinical and social science posttransplant pregnancy research. We specifically address the psychosocial and ethical issues surrounding preconception counseling and posttransplant health quality of life and mothering and suggest areas for future research.

Ethical questions raised by the first allotransplantations of the face: a survey of French surgeons.

INTRODUCTION: More than any other allograft, the allotransplantation of the face has a symbolic character, which raises a large number of questions. The objective of this article is to make an analysis through a survey carried out among French surgeons. METHODS: A file of 909 e-mail addresses of surgeons was created so as to send out a questionnaire regarding 10 ethical issues. RESULTS: Beyond the technical prowess, the surgeons ethical reflection initially focused on the notion of consent to donation and care. They attached equal importance to all ethical questions. They spontaneously raised the issue of over-mediatization of these first transplants and the place of the transplant surgeons and their patients in the medical information. CONCLUSION: Over two thirds of the surgeons attached importance to ethical issues regarding the donor and recipient of a facial allograft. Some of the principal questions facing facial transplantation is of an ethical nature as it is an unprecedented procedure that is challenged by the axiom to first do no harm and the need of modern medicine to limit risk to as close to zero as possible. For the non-specialist, accepting psychologically the face of another individual appears to be a real issue. Contrary to that, the main demand expressed by the facial transplant recipients appears to be related to facial functions rather than appearance.

Hand transplantation.

The first successful hand transplant was performed in 1998, opening up a new possibility for patients who have suffered mutilating hand injuries. Since then, more than 60 such procedures have been performed throughout the world. This article describes the evolution of hand transplantation, outcomes of patients listed in the International Registry of Hand and Composite Tissue Transplantation, and ethical issues involved in hand transplantation. It also describes the hand transplantation program at Mayo Clinic, which was established in 2010.

Ethical issues of facial transplantation.

The transplantation of tissue from one human to another has always been contentious, and transplantation of facial tissue creates an additional ethical dimension that seems to give it special status. This paper reviews the ethical debate and concludes that it is the practical limitations of the procedure that should regulate its use, and not the special status of the face.

Facial transplantation: adding to the reconstructive options after severe facial injury and disease.

The ability to reconstruct complex facial injuries is still a considerable challenge despite the development of microsurgical techniques. The reconstructive options for conditions such as panfacial burns are severely limited. The result after multiple surgical procedures in this group is often poor in terms of function and cosmesis. Facial transplantation provides a potential solution, but opinion is currently divided about the extent to which the potential benefits to the quality of life can be justified when weighed against the technical, psychological and immunological risks. This paper reviews the current status of the debate and argues that a rigorous research strategy is the only logical basis for countering the ethical objections to a procedure that offers considerable benefits over existing reconstructive options.

Extension of organ transplantation: some ethical considerations.

The concept of vital organ transplantation is critically analyzed by considering how traditional transplantation modifies the commitment to saving lives. Problems such as those associated with immunosuppression might seem to provide a compelling reason to oppose extension of transplantation to non-lifesaving situations. A closer examination, however, shows that immunosuppression does not present an intractable objection. For some organ transplants, such as the uterus, use of immunosuppression could be limited to the childbearing years. Complexities associated with assessment of quality of life are discussed using the example of hand transplantation. Assessment of success and functionality in a hand transplant is more complicated than it might appear at first. These complications suggest that monitoring and assessment should be a part of any extension of organ transplantation. Informed consent provides a limited, but important, component in justifying extended transplantation. Such justification, however, does not rest on patient autonomy, but on the reasonable prospect of benefit. Transplant programs considering an extension of traditional transplantation should develop formal protocols that include assessment of costs, benefits, quality of life, and the adequacy of informed consent.

Hand transplantation: current status.

The hand is a very special organ, with unique functions and versatility in the human body. Our hands are pivotal in manipulating our environment, receiving feedback from our surroundings and communicating our unspoken words by gestures. Thus, the loss of a hand is a tragic, disfiguring event with profound personal, vocational, financial and social implications. Transplantation of life-saving solid organs is now widely accepted in both the medical and lay communities. The technical skills and prerequisites for hand transplantation have been honed over recent decades, culminating in the recent commencement of hand transplantation in several centers around the world. However, unlike life-saving solid organ transplantation, hand transplantation has been greeted with less enthusiasm in the professional community because it is not yet clear what the long-term risks-to-benefits ratio is. The scientific background, and the potential risks, benefits, and ethical aspects of this procedure are discussed. Successful transplantation to amputees of fully integrated and functional hands is a worthy goal. Hopefully, at some point in the future, hand transplantation will become another safe and viable option for amputees to consider.