Facial transplantation in emerging adulthood: characterizing challenges and opportunities to support optimal outcomes

Ethical considerations in facial transplantation have been widely discussed for more than twenty years, preceding the technical realization of the procedure in 2005. With more than 50 face transplants performed to date in adults worldwide, considerations are evolving beyond risks and benefits toward questions of equity and sustainability. Yet, issues of informed consent, the risk of lifelong immunosuppression, graft lifespan, and metrics for success continue to prompt dialogue, especially for certain patient populations. In this Perspective, we combine our clinical experience with a synthesis of the existing evidence and propose that emerging adults, characterized as individuals aged 18-25, be given particular consideration. Emerging adults occupy a middle ground between adolescence and established adulthood. This formative life stage has a profound impact on an individual's sense of identity and social integration. Emerging adults stand to benefit significantly from facial transplantation precisely because of the key developmental nature of this stage, yet ongoing cognitive development presents challenges for judgement and decision-making that can complicate care for this population and impact outcomes. Given the complexity of facial transplantation and lifelong commitment to follow up required for face transplant recipients, it is critical to understand potential challenges for decision-making and obstacles to adherence that individuals may face in this developmental life stage. Recognizing emerging adults as a patient population with specific support needs will enable face transplant programs to offer tailored supports to improve outcomes for this transformative procedure in emerging adulthood.