While other types of transplants are conducted to save lives, treat disease or improve body function, face transplants for aesthetic reasons are no less important to the person who seeks one, said ethicist Trump, who received a kidney transplant five years ago.
A face transplant, even with its risks, might be more appealing than the alternatives, said burn survivor Barbara Kammerer Quayle. After surviving a rear-end car crash in 1977, Quayle underwent approximately 20 operations over four years to reconstruct her face.
Reconstruction strategies include skin and muscle grafts and prosthetic implants; someone with a severe injury could need a dozen or more surgeries over the course of many years.
"While there are many possibilities for people with reconstructive surgery, sometimes people have to come to the conclusion that there is just so much that can be done," said Quayle, who works at UCI Medical Center in Orange, counseling other burn patients on recovery and image enhancement. "If it's a serious burn, and face transplantation is an option, I say hallelujah."
Dennis Gardin, 47, could have been a candidate for facial transplant. He was 14 when he was burned over 70% of his body in a motorcycle accident. He had more than 50 operations while spending eight months in a hospital. When he was released, he wouldn't leave his house for two years. "I was so ashamed with my appearance and so afraid that no one would accept me the way I looked," he said.
Gardin, now a motivational speaker who lives in Detroit, began having reconstructive surgery but, after four years, reached a breaking point.
"I never forgot that day," he said. "I was to be admitted for another surgery and when I got my overnight bag to pack I realized I hadn't unpacked my bag from the last operation. I broke down and cried. That was all I was doing, having surgery. I asked my mom, 'Please don't make me go back again.' I was so tired of the hospital, surgery and pain."
He chose to live with his appearance and, many years later, said he was comfortable with it. Gardin said he wouldn't want a face transplant now, but added: "I think we are fortunate to be in a time where there are these options."
Not a quick fix
A face transplant would not be an easy fix, even for severely burned patients. They would still have some scarring and would require extensive psychological adjustment.
The first candidate for a face transplant would be someone who has been disfigured for some time and has the emotional wherewithal to deal with the transplant, Barker said. There is no way to predict how the recipient might feel with a new face, he added.
Psychological hurdles exist on the other end of the transplant as well, experts noted. Who would donate their loved one's face?
"Would parents, for example, be willing to have their brain-dead child's face excised?" said Trump. "Would anyone want a loved one's face removed after death? I think this is a major obstacle to the procedure becoming routine."
Donor organs and tissues already are in short supply, said Wells, the Long Beach plastic surgeon. Finding appropriate face donors and recipients will be even more difficult.
"Your donor pool is going to get extremely narrow if you consider race and ethnicities," said Wells. "If the donor pool is as narrow as I've suggested, I don't see [face transplantation] happening any time quickly. I think it will be very difficult."