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

DOI

10.1016/j.ajt.2023.08.023

Document Type

Journal Article

Publication Date

1-1-2024

Publication Title

American Journal of Transplantation

Volume

24

Issue

1

First Page

104

Last Page

114

ISSN

16006135

Keywords

consensus recommendations, face transplantation, vascularized composite allotransplantation

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.

Open Access

Hybrid_Gold

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