Measuring utilities of severe facial disfigurement and composite tissue allotransplantation of the face in patients with severe face and neck burns from the perspectives of the general public, medical experts and patients

Background Facial composite tissue allotransplantation is a potential reconstructive option for severe facial disfigurement. The purpose of the present investigation was to use decision analysis modelling to ascertain the expected quality-adjusted life years (QALYs) gained with face transplantation (versus remaining in a disfigured state) in an effort to assist surgeons with the decision of whether to adopt this procedure. Study Design The probabilities of potential complications associated with facial allotransplantation were identified by a comprehensive review of kidney and hand transplant literature. A decision analysis tree illustrating possible health states for face allotransplantation was then constructed. Utilities were obtained from 30 participants, using the standard gamble and time trade-off measures. The utilities were then translated into QALYs, and the expected QALYs gained with transplantation were computed. Results Severe facial deformity was associated with an average of 7.34 QALYs. Allotransplantation of the face imparted an expected gain in QALYs of between 16.2 and 27.3 years. Conclusions The current debate within the medical community surrounding facial composite tissue allotransplantation has centred on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefits that transplantation would confer. As demonstrated by a gain of 26.9 QALYs, participants' valuation of quality of life is notably greater for face transplantation with its side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.

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Surgical Planning for Composite Tissue Allotransplantation of the Face Using 320-Detector Row Computed Tomography

Journal of Computer Assisted Tomography ◽

10.1097/rct.0b013e3181e9c133 ◽

2010 ◽

Vol 34 (5) ◽

pp. 766-769 ◽

Cited By ~ 11

Author(s):

Shigeyoshi Soga ◽

Hale Ersoy ◽

Dimitrios Mitsouras ◽

Kurt Schultz ◽

Amanda G. Whitmore ◽

...

Keyword(s):

Computed Tomography ◽

Surgical Planning ◽

Composite Tissue Allotransplantation ◽

Composite Tissue ◽

The Face

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Il “trapianto di faccia”

Medicina e Morale ◽

10.4081/mem.2010.203 ◽

2010 ◽

Vol 59 (4) ◽

Author(s):

Maria Luisa Di Pietro ◽

Barbara Corsano

Keyword(s):

United States ◽

Composite Tissue Allotransplantation ◽

Composite Tissue ◽

The Face ◽

Experimental Stage

L’allotrapianto di tessuto composito (CTA) nella forma di faccia viene proposto nel caso di gravi alterazioni della funzionalità e dell’estetica del volto e consente di sostituire tessuto facciale danneggiato e/o non-esistente con tessuto facciale sano, ben vascolarizzato, da donatore. Sebbene ancora in fase sperimentale, simile procedura – effettuata allo stato attuale nove volte in Francia, Cina, Stati Uniti e Spagna – pare mostrare risultati promettenti. Tuttavia, accanto alle difficoltà che come ogni procedura trapiantologica essa presenta dal punto di vista clinico, occorre considerare le problematiche economiche, organizzative e soprattutto etiche. ---------- Composite tissue allotransplantation (CTA) of the face is used for serious changes of the facial functionality and beauty and allows to replace facial tissue damaged or nonexistent by facial tissue sound, well vascularized, from donor. Although it is still at the experimental stage, this procedure – nine times realized in France, China, United States and Spain – seems to be promising. Neverthless, in addition to clinic issues, economic, organizational and above all ethical questions should be considered.

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