Attitudes toward face transplantation in Asia: A survey of Taiwanese population

Abstract

Severe facial disfigurement caused by major burn, trauma, gunshot, or even tumor ablation is particularly challenging for reconstructive surgeons (Pomahac et al., 2011; Siemionow, 2017). These patients usually have suboptimal functional and aesthetic results even after multiple reconstructive procedures (Siemionow & Ozturk, 2012; Sosin & Rodriguez, 2016). Advances in transplant immunology and surgical techniques have made face transplantation become a clinical reality in recent years (Siemionow, 2017; Siemionow & Ozturk, 2012; Sosin & Rodriguez, 2016). To date, more than 40 face transplantations have been accomplished worldwide since the first face transplantation performed in 2005 (Devauchelle et al., 2006; Sosin & Rodriguez, 2016). Most reports demonstrated satisfactory aesthetic outcomes with an enhanced quality of life and social reintegration postoperatively (Aycart et al., 2017; Fischer et al., 2015; Roche et al., 2015; Siemionow, 2017; Siemionow & Ozturk, 2012; Sosin & Rodriguez, 2016). Though significant outcomes are evident, the concomitant ethical and moral arguments from medical communities and the general public alike have been fiercely debated (Kiwanuka et al., 2013; Theodorakopoulou et al., 2017; Vercler, 2010). However, most surveys on the attitudes toward face transplantation have been conducted in the Western population. Due to the paucity of the literature on the opinions and concerns of Asian people, these have motivated us to assess the attitude of the Taiwanese toward face transplantation. This study was approved and supported by the Institutional Review Board and Ethics Committee (KMUHIRB-E(I)-20190279). A survey was conducted between November 2019 and November 2020 and involved 1020 adult volunteers selected randomly from the general public in Taiwan. One volunteer was excluded due to incomplete answers. The volunteers completed a self-administered anonymous questionnaire consisting of 20 questions and covering three parts: (1) sociodemographic information, including gender, age, education, religion, organ, and blood donor status; (2) knowledge about face transplantation such as the source of information about face transplantation, understanding of the risks and benefits of face transplantation; (3) willingness to support face transplantation, including the indication for face transplantation, number of procedures before receiving face transplantation, willingness to be a donor/recipient of face transplantation. Statistical analysis was performed by using SPSS (SPSS Inc., Chicago, IL). Chi-square test was applied to compare each category. P < .05 was considered statistically significant. The demographic and background profiles showed that, out of 1019 respondents, 515 (50.54%) were men and 504 (49.46%) were women. The mean age was 39.66 years, ranging from 20 to 75 years. Among the respondents, 55.54% were college-educated. The distribution of religion was 37% Buddhism, 36.31% Taoism, 10.30% Christian, and 8.15% were atheists. Medical professional, which was defined as a person with a medical education background and has medical practicing experience, constituted 43.57% of all respondents. Among the respondents, 47.11% had a history of being a blood donor and 20.61% were registered as an organ donor. Of all respondents, 70.26% of them would be willing to receive face transplantation if it was indicated, while 56.23% of them agreed to be face transplantation donors. Factors associated with willingness to undergo face transplantation were analyzed. The respondents who were either medical professionals (p = .003), blood donors (p = .002), organ donor registrants (p < .001), willing to be recipients (p < .001), and had knowledge about face transplantation (p < .001) were more willing to accept face transplantation (Table 1). The primary reasons for refusing face transplantation were high risks of the operation (63.37%), family opinion (31.68%), and ethical concern (28.38%). For face donation, respondents who were medical professionals (p < .001), blood donors (p < .001), organ donor registrants (p < .001), participants who had willingness to be an organ transplant recipient (p < .001), or knowledge about face transplantation (p = .008) were more agreeable to be face donors (Table 2). The reasons for refusing face donation were mainly due to family opinion (66.14%) and religious concern (42.38%). To investigate the knowledge about face transplantation, among the medical professionals, mass media (70.96%) and scientific journals (55.30%) were their main sources of knowledge about face transplantation. Nonmedical professional respondents garnered much of their understanding about face transplants from the mass media (71.69%). Among medical professional respondents, 90.99% agreed that face transplantation is indicated for severe facial deformities and functional defects. Meanwhile, 76.17% of the nonmedical professional respondents agreed on this statement. In terms of the indications, most medical professionals considered the absence of autologous tissue (97.03%) and facial burn (93.81%) as the two major indications for face transplantation. However, among the nonmedical professionals group, the primary indication for face transplantation was facial burn (85.62%). Other clinical scenarios, such as oral and lip defects, and nasal defects showed a similar distribution between the two groups. According to reconstructive procedures that are reasonable before Received: 30 January 2021 Revised: 7 April 2021 Accepted: 6 May 2021