International consensus recommendations on face transplantation: A 2-step Delphi study

Benedetto Longo¹, Fay Bound Alberti², Bohdan Pomahac³, Julian Joseph Pribaz⁴, Jean-Paul Meningaud⁵, Benoît Lengelé⁶, Ömer Özkan⁷, Özlenen Özkan⁷, Juan Pere Barret⁸, Patrik Lassus⁹, Phillip Blondeel¹⁰, Nathalie Roche¹⁰, Raffi Gurunian¹¹, Pedro Infante-Cossio¹², Andrew Lindford⁹, Gerald Brandacher¹³, Pietro Giovanoli¹⁴, Jan Plock¹⁴, Vijay S Gorantla¹⁵, Emily Ruppel Herrington¹⁶, Daniel Saleh¹⁷, Ibrahim Natalwala¹⁸, Massimo Cardillo¹⁹, Sheila Jowsey-Gregoire²⁰, Simone La Padula²¹, Derek Manas²², James Benedict²³, Gloria Nuccitelli²⁴, Romain Bosc⁵, Roberto Morello²⁵, Anneke Farías-Yapur²⁶, Martina Giacalone²⁷, Sarah Hall²⁸, Gennaro D'Orsi²⁷, Valerio Cervelli²⁷

Affiliations

¹ Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy. Electronic address: benedetto.longo@uniroma2.it.
² Director of Interface and Director of the Centre for Technology and the Body, King's College London.
³ Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.
⁴ Department of Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
⁵ Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University of Paris, Créteil, France.
⁶ Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
⁷ Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
⁸ Department of Plastic Surgery and Burns, Vall d'Hebron Barcelona Hospital Campus, Universidad Autònoma de Barcelona, Barcelona, Spain.
⁹ Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹⁰ Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium.
¹¹ Department of Plastic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹² Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, University of Seville, Seville, Spain.
¹³ Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁴ Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
¹⁵ Department of Surgery, Wake Forest School of Medicine, Wake Forest Institute of Regenerative Medicine, Winston Salem, North Carolina, USA.
¹⁶ Department of Communication, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁷ Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹⁸ Department of Plastic Surgery, Leeds Teaching Hospitals, Leeds, UK.
¹⁹ Director of National Transplants Center, National Institute of Health, Italian Ministry of Health, Rome, Italy.
²⁰ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
²¹ Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University of Paris, Créteil, France; Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Napoli, Italy.
²² NHS Blood and Transplant, Stoke Gifford, Bristol, UK; Liver Transplant Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle University, Newcastle, UK.
²³ Center for Global Health Ethics, Duquesne University, Pittsburgh, Pennsylvania, USA.
²⁴ Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
²⁵ Department of Maxillofacial Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
²⁶ School of Psychology, Universidad Panamericana, Benito Juárez, Mexico City, Mexico.
²⁷ Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy.
²⁸ AboutFace, University of York, UK.

PMID: 37666457
PMCID: PMC10881406
DOI: 10.1016/j.ajt.2023.08.023

International consensus recommendations on face transplantation: A 2-step Delphi study

Benedetto Longo et al. Am J Transplant. 2024 Jan.

. 2024 Jan;24(1):104-114.

doi: 10.1016/j.ajt.2023.08.023. Epub 2023 Sep 2.

Authors

Affiliations

¹ Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy. Electronic address: benedetto.longo@uniroma2.it.
² Director of Interface and Director of the Centre for Technology and the Body, King's College London.
³ Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.
⁴ Department of Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
⁵ Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University of Paris, Créteil, France.
⁶ Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
⁷ Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
⁸ Department of Plastic Surgery and Burns, Vall d'Hebron Barcelona Hospital Campus, Universidad Autònoma de Barcelona, Barcelona, Spain.
⁹ Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
¹⁰ Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium.
¹¹ Department of Plastic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹² Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, University of Seville, Seville, Spain.
¹³ Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁴ Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
¹⁵ Department of Surgery, Wake Forest School of Medicine, Wake Forest Institute of Regenerative Medicine, Winston Salem, North Carolina, USA.
¹⁶ Department of Communication, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁷ Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
¹⁸ Department of Plastic Surgery, Leeds Teaching Hospitals, Leeds, UK.
¹⁹ Director of National Transplants Center, National Institute of Health, Italian Ministry of Health, Rome, Italy.
²⁰ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.
²¹ Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University of Paris, Créteil, France; Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Napoli, Italy.
²² NHS Blood and Transplant, Stoke Gifford, Bristol, UK; Liver Transplant Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle University, Newcastle, UK.
²³ Center for Global Health Ethics, Duquesne University, Pittsburgh, Pennsylvania, USA.
²⁴ Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
²⁵ Department of Maxillofacial Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
²⁶ School of Psychology, Universidad Panamericana, Benito Juárez, Mexico City, Mexico.
²⁷ Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy.
²⁸ AboutFace, University of York, UK.

PMID: 37666457
PMCID: PMC10881406
DOI: 10.1016/j.ajt.2023.08.023

Abstract

Face transplantation is a viable reconstructive approach for severe craniofacial defects. Despite the evolution witnessed in the field, ethical aspects, clinical and psychosocial implications, public perception, and economic sustainability remain the subject of debate and unanswered questions. Furthermore, poor data reporting and sharing, the absence of standardized metrics for outcome evaluation, and the lack of consensus definitions of success and failure have hampered the development of a "transplantation culture" on a global scale. We completed a 2-round online modified Delphi process with 35 international face transplant stakeholders, including surgeons, clinicians, psychologists, psychiatrists, ethicists, policymakers, and researchers, with a representation of 10 of the 19 face transplant teams that had already performed the procedure and 73% of face transplants. Themes addressed included patient assessment and selection, indications, social support networks, clinical framework, surgical considerations, data on patient progress and outcomes, definitions of success and failure, public image and perception, and financial sustainability. The presented recommendations are the product of a shared commitment of face transplant teams to foster the development of face transplantation and are aimed at providing a gold standard of practice and policy.

Keywords: consensus recommendations; face transplantation; vascularized composite allotransplantation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Daniel Saleh reports a relationship with Stryker UK Ltd that includes: speaking and lecture fees. Daniel Saleh reports a relationship with Sanofi Genzyme that includes: speaking and lecture fees. Romain Bosc reports a relationship with Alexion Pharma France SAS that includes: consulting or advisory. Romain Bosc reports a relationship with AstraZeneca SAS that includes: consulting or advisory. Sheila Jowsey-Gregoire reports a relationship with US Department of Defense that includes: funding grants. Sheila Jowsey-Gregoire reports a relationship with Mayo Clinic that includes: travel reimbursement.

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References

1. Alberti F.B., Hoyle V. Face transplants: an international history. J Hist Med Allied Sci. 2020;76(3):319–345. - PMC - PubMed
1. Devauchelle B., Badet L., Lengelé B., et al. First human face allograft: early report. Lancet. 2006;368(9531):203–209. - PubMed
1. La Padula S., Pensato R., Pizza C., et al. Face transplant: indications, outcomes, and ethical issues-where do we stand? J Clin Med. 2022;11(19):5750. doi: 10.3390/jcm11195750. Published 2022 Sep 28. - DOI - PMC - PubMed
1. Alberti F.B. Face transplants as surgical acts and psychosocial processes. Lancet. 2020;395(10230):1106–1107. doi: 10.1016/S0140-6736(20)30684-X. - DOI - PubMed
1. https://aboutface.uk/research-info/a-blueprint-for-sustainable-face-tran.... Accessed June 1, 2022.

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International consensus recommendations on face transplantation: A 2-step Delphi study

Affiliations

International consensus recommendations on face transplantation: A 2-step Delphi study

Authors

Affiliations

Abstract

Conflict of interest statement

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References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources