Médiatisation et «greffe de visage» ou «à qui appartient la greffe de visage»?

Ethical questions raised by the first allotransplantations of the face: a survey of French surgeons

INTRODUCTION

More than any other allograft, the allotransplantation of the face has a symbolic character, which raises a large number of questions. The objective of this article is to make an analysis through a survey carried out among French surgeons.

METHODS

A file of 909 e-mail addresses of surgeons was created so as to send out a questionnaire regarding 10 ethical issues.

RESULTS

Beyond the technical prowess, the surgeons ethical reflection initially focused on the notion of consent to donation and care. They attached equal importance to all ethical questions. They spontaneously raised the issue of over-mediatization of these first transplants and the place of the transplant surgeons and their patients in the medical information.

CONCLUSION

Over two thirds of the surgeons attached importance to ethical issues regarding the donor and recipient of a facial allograft. Some of the principal questions facing facial transplantation is of an ethical nature as it is an unprecedented procedure that is challenged by the axiom to first do no harm and the need of modern medicine to limit risk to as close to zero as possible. For the non-specialist, accepting psychologically the face of another individual appears to be a real issue. Contrary to that, the main demand expressed by the facial transplant recipients appears to be related to facial functions rather than appearance.

The role of indoleamine 2,3 dioxygenase in the induction of immune tolerance in organ transplantation

The aim of this review is to present current information on transplantation research regarding the role of indoleamine 2,3 dioxygenase in immune regulation. We present the basic mechanisms by which the enzyme is expressed, followed by tryptophan catabolism that leads to midg1 phase arrest and apoptosis. Other effects proposed, although not yet completely proven and generally accepted, include T-cell development suppression, secretion of regulatory cytokines such as IL10, and generation of new T regulatory cells. Clinical studies are being performed worldwide; thus, our goal is to focus on the clinical potential relevance of the enzyme rather than a presentation on a molecular basis so that health care providers concerning transplantation are aware of this promising field in immunology and therapeutics. We do emphasize the fact that information regarding the role of indoleamine 2,3 dioxygenase in human beings is still scarce.