About face: The affective and cultural history of face transplants

Lead Research Organisation: King's College London
Department Name: History

Abstract

We are at a critical point in the UK where face transplants are technically viable, yet have not yet happened. Since 2005 there have been fewer than 50 face transplants across the world, yet their cultural impact outweighs their number. The face is a highly emotive, visible organ, connected to identity, inheritance, communication and perceptions of beauty (Bruce and Young 2012). No face transplant has yet happened in the UK for reasons that are financial as well as ethical; the Royal College of Surgeons placed a moratorium on them in 2004, though they have become increasingly common internationally, and the NHS views them as life-enhancing, rather than life-saving (and therefore not essential). But face transplants need to be viewed through a much longer lens that includes not only the history of psychological and social responses to disfigurement, including the horror and disgust shown towards disfigured people, but also the registers in which medical innovation have been framed (as 'Frankenstein science'), the emotional experiences of extended surgical teams, and the emotional experiences of face transplant recipients and recipient/donor families. By studying the history of face transplants in the US and the move towards face transplants in the UK, this project engages arts and humanities research with surgeons and their extended medical teams to create a revised psychological framework that can be used to support ethical policy and clinical practice.

This historical project therefore has key implications for human health and flourishing, and the ways surgical innovation is framed and understood. It will build an evidence base of historical analysis and qualitative interviews with surgeons and people affected by face transplants, to show how and why emotion and identity has historically become attached to the face. It will chart what cultural anxieties around face transplants reveal about anxieties over medical innovation as well the interaction of the individual with the social world. Using a framework of emotion history to think through the cultural presumptions associated with face transplants as an act of 'transformation', it will show how emotion language manipulates the framing of face transplants. In the process of making face transplants mainstream, for instance, families and friends of dead donors have been wheeled out on international television to respond to the re-purposing of their loved one's faces, with deliberate emotional impact on viewers and apparently no regard for the ethical responsibilities of producers or the psychological and social effects. The emotional consequences for transplant recipients, as well as donor families, and extended surgical teams who are undertaking challenging and life-changing surgeries, have been virtually ignored.

About Face will show that face transplants are inherently emotional procedures, and that their emotional impact needs to be incorporated into clinical and policy discussions. From their framing in popular media to films and books dealing with face transplants as a terrifying or freakish prospect, from the identification of a suitable donor to the rehabilitation of a post-operative patient, emotions impact on each stage of facial transplantation. The emotional and social effects on recipients and their families are clear in the secondary literature and implied in the emergence of psychological protocols since the 1950s. It is time to put these centre stage. Bringing together arts, humanities and social science researchers with extended surgical teams and people living with disfigurement, this project will create a framework by which clinicians and policy makers can engage with face transplants as an emotional and concern. It will thus contribute to the framing and practice of innovative surgical practice, and human health, in the 21st century.

Planned Impact

Beneficiaries of impact:

1. Extended surgical teams. Two major face transplants surgeons in the US and one facial reconstruction specialist in the UK, and teams of twenty who work with each (as physiotherapists, nurses and anaesthetists) will be directly benefitted by the evidence that face transplants are psychological and social processes, not merely medical events. The patients, researchers and clinicians working with these individuals will subsequently be benefitted by the ripple-effect by which an awareness of affective and cultural impact becomes embedded into clinical practice. This interdisciplinary knowledge exchange will be a goal in developing historically- and emotionally-informed protocols that guide innovative surgery. A rigorously researched emotional framework will also encourage and enable the UK to compete with and alongside other surgical innovators around the globe by supporting the development of the country's first face transplant. The project's knowledge-transfer practices between arts, humanities and social science and medical researchers will support this aim, as will the project's comparative focus on the UK and the US in the first four years, and the Anglo-American context and China in years 5-7.

2. The interested public, who will be encouraged to learn about, and contribute to, discussions about facial disfigurement and transplantation that are not shaped by the tabloids, or clinical literature, but through ongoing, open discussions that include policy-makers, surgical teams and disfigured people themselves. There are few spaces where public engagement in the meanings and practice of surgical innovation, or the impact on individual patients and their families, are discussed. This project provides these spaces through participation in the SGL Spare Parts season, a workshop around disfigurement, beauty and transplantation, an immersive surgical reenactment series, and a film evening tackling the stereotypes around transplantation. These events bring together surgeons, psychologists, ethicists and members of the public, targeted as noted in the Pathways to Impact: e.g. 18-25 year olds visiting SGL; older adults visiting Imperial War Museum; working with Changing Faces and other patient groups. The PI will work to engage with a wider variety of audiences through the project website and digital networks, seeking media coverage via BBC Radio 4 content providers, popular publications such as the Metro newspaper, and an active blogging network. Artists and writers connected to these events will benefit by having their work seen and discussed; disfigured people working with patient groups will benefit from having a voice and an outlet through which public perceptions of disfigurement and transplantation can be debated and challenged. This will, as the charity Changing Faces recognises, have a positive impact on the lives of those who live with stigma and create awareness of the emotional effects of disfigurement and surgery.

3. This project further seeks to influence policy around face transplants in the UK, and to benefit those who shape it. The creation of new and freely available data (e.g. 200 interviews from clinicians; 500 from public engagement events; 100 from patient groups and 200 from online questionnaires) will provide evidence on how the affective and cultural history of face transplants have influenced their ethical framing as problematic by the Royal College of Physicians, and the NHS's refusal to fund the procedure (largely because it is seen as life-enhancing rather than life-saving). The PI will collaborate with King's Policy Institute on three Policy Labs in years 1-3 to bring together stakeholders (disfigured people, surgeons, ethicists and policy makers) to identity key emotional and societal barriers to face transplants and to produce recommendations for the Royal College of Surgeons, the Nuffield Institute for Bioethics and the Parliamentary Office for Science and Technology

Publications

10 25 50

publication icon
Longo B (2024) International consensus recommendations on face transplantation: A 2-step Delphi study. in American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

Related Projects

Project Reference Relationship Related To Start End Award Value
MR/S017356/1 30/04/2019 08/01/2023 £1,111,519
MR/S017356/2 Transfer MR/S017356/1 09/01/2023 29/04/2024 £193,033
 
Description In this final year of FLF research for the first phase, the focus has been on the development of a documentary to meet the public engagement outcomes of the work. This film will enable us to communicate the stories of people involved in facial transplantation - as patients, family members, ethicists, psychologists, surgical specialists and nurses - and draw attention to the complexities and ethics of transplant surgery. Additionally, the PI established a Centre for Technology and the Body at King's College London, which acts as a focal point for continued study into the face, the body, and the rise of digital technologies, all of which have implications for how we live well with technology, past, present and future. https://www.kcl.ac.uk/research/centre-for-technology-and-the-body
Exploitation Route The Centre is already a hub for the integration of researchers from across the Faculties at King's and it is anticipated that the PI's leadership in this space will foster the research and engagement activities of other researchers. The work of the project into face transplant and the quality of life/ethics is continuing to make headway in medical spaces, though those outcomes have not yet been fully realised.
Sectors Digital/Communication/Information Technologies (including Software)

Healthcare

URL https://www.kcl.ac.uk/research/centre-for-technology-and-the-body
 
Description The project has continued to influence the work of medical professionals in the transplantation field. The PI is currently editing a Frontiers series on transplantation that compares transplantation and reconstruction surgery (which includes the field of face transplants), and her findings on qualitative research and how we evaluate the quality of life continues to shape medical practice and planning internationally. In addition to speaking at the Yale Schools of Medicine, and giving presentations at the International Society for Vascularised Composite Allograft (VCA) conferences in 2022 and 2023, the PI has been invited to contribute to the National Academy of Science Engineering and Medicine (NASEM) study on the development of protocols and SOPs for face and hand transplants in March 2024. This work builds on the project's International reputation for making a difference outside of the academic context. The PI is currently developing funding bids that bring together the work on aboutFace/Interface with major projects in the US and Europe around VCA reconstruction and transplantation. She is also working to support the voices of patients and the development of Patient Reported Outcome Measures (PROMS). This submission represents just over one year's work on the project Interface (previously AboutFace) as the award moved to King's College London on 9 January 2023. A full submission is being made for the earlier period (2019-2022) for the same research project.
First Year Of Impact 2022
Sector Digital/Communication/Information Technologies (including Software),Healthcare
Impact Types Cultural

Societal

Policy & public services

 
Description UKRI FLF Renewal funding for AboutFace, rebranded as Interface: Transplants, Aesthetics, Technology
Amount £567,000 (GBP)
Organisation United Kingdom Research and Innovation 
Sector Public
Country United Kingdom
Start 01/2023 
End 01/2025
 
Description 'Why History Matters to Medicine': RHS Lecture at the University of York 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Undergraduate students
Results and Impact Face transplants have been a surgical reality since 2005, but ideas about face transplants, and their surgical origins, have a much longer history. In this presentation Professor Fay Bound Alberti explored the history and practice of face transplants as a surgical approach to severe facial trauma.
Year(s) Of Engagement Activity 2024
URL https://www.google.com/search?q=%E2%80%98Why+History+Matters+to+Medicine%27%3A+RHS+Lecture+at+the+Un...
 
Description A Webinar for Patient Perspectives and Lived Experiences & International Perspectives on VCA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact An internationally online event intended to inform the work of face transplant strategy and policy.
Year(s) Of Engagement Activity 2024
URL https://www.nationalacademies.org/documents/embed/link/LF2255DA3DD1C41C0A42D3BEF0989ACAECE3053A6A9B/...
 
Description Centre For Technology & the Body Event Conceptualising "Posthuman Sexual Commerce" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact The Digital Futures Institute's Centre for Technology and the Body welcomed Chloé Locatelli from King's College London's Digital Humanities Department to discuss how heterosexual men's sextech developments replicated desirable aspects of post-industrial sexual commerce, heralding a transition into "posthuman sexual commerce." The event, held on December 8th, 2023, explored the burgeoning sex-tech industry's incorporation of digital technologies into various devices for sexual satisfaction and its potential implications, including the possibility of sex robots disrupting human sex work and other sectors of sexual commerce, while also examining broader intersections between existing sextech and the posthuman landscape.
Year(s) Of Engagement Activity 2023
URL https://www.kcl.ac.uk/events/conceptualising-posthuman-sexual-commerce#:~:text=The%20sex%2Dtech%20in...
 
Description Centre For Technology & the Body Event: AI and the Visual: Art, Science and Human Bias. King's Festival for Artificial Intelligence 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact This event convenes multidisciplinary experts specializing in visual culture and AI, spanning from artistic expression to facial recognition technology, to examine both the opportunities and challenges presented by the intersection of these fields, emphasizing questions surrounding coexistence with AI and visual media while addressing systemic inequalities related to race, gender, and ethnicity.
Year(s) Of Engagement Activity 2023
URL https://www.kcl.ac.uk/events/ai-and-the-visual
 
Description Centre For Technology & the Body Event: Consent in Digital Sexual Cultures 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Third sector organisations
Results and Impact Rikke Amundsen led an engaging workshop titled "Consent in Digital Sexual Cultures," bringing together guests and speakers from various sectors including charities, activists, academics, and professionals to address challenges in the field and formulate actionable recommendations, aiming to provide support and guidance for stakeholders working with adults on issues related to consent in digital sexual cultures. The workshop focused on collaborative problem-solving and reflection, with the main output being a comprehensive report outlining key insights and recommendations.
Year(s) Of Engagement Activity 2024
URL https://www.kcl.ac.uk/events/consent-in-digital-sexual-cultures-workshop
 
Description Centre For Technology & the Body Event: Technology and the Body - Book Launch 'The Digital Health Self' 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The Digital Futures Institute's Centre for Technology and the Body, in collaboration with Bristol University Press and the Department of Digital Humanities at King's College London, invited attendees to the Technology and the Body event celebrating the book launch of 'The Digital Health Self: Wellness, Tracking and Social Media' by Dr. Rachael Kent, held on Friday, June 16th, 2023, at the Strand Campus. The event featured a Q&A session with Dr. Kent, followed by a fireside conversation with Professor Fay Bound Alberti and Dr. Zeena Feldman, exploring themes from the book.
Year(s) Of Engagement Activity 2023
URL https://www.kcl.ac.uk/events/technology-and-the-body-book-launch-the-digital-health-self
 
Description Centre for Technology & the Body: Material Minds? The rise of Chat GPT and AI 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Undergraduate students
Results and Impact On March 27th, 2023, King's hosted a workshop titled Material Minds, in collaboration with the Centre for Technology and the Body and the Digital Future Institute, which gathered researchers and industry leaders to delve into understanding and utilizing Chat GPT and AI amidst the rapid evolution of language-learning models and AI technology.
Year(s) Of Engagement Activity 2023
URL https://www.kcl.ac.uk/news/material-minds-the-rise-of-chat-gpt-and-ai
 
Description Centre for Technology and the Body: Resisting Bodies: Technology and Race 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Undergraduate students
Results and Impact On April 26th, 2023, the Garden Cinema in Covent Garden hosted a morning event led by the Centre for Technology and the Body and the Digital Futures Institute, featuring the documentary 'Power to Heal' and a panel discussion focusing on healthcare and racial politics with three respondents.
Year(s) Of Engagement Activity 2023
URL https://www.kcl.ac.uk/events/resisting-bodies-technology-and-race
 
Description Consultant and interviewee for a documentary 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact Consultant and interviewee for a documentary, 'The Power of Friendship', directed by Adrian Tanner, Dartmouth Films.
Year(s) Of Engagement Activity 2024
 
Description Discovering our Digital Futures and exploring our Global Cultures 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact On April 27th, 2023, the Faculty of Arts and Humanities hosted the official launch of the new Digital Futures and Global Cultures Institutes, aiming to foster interdisciplinary engagement and understanding by reframing technical challenges as human and social ones, and exploring global impacts on arts, media, and culture through research, teaching, and impact activities across King's College London.
Year(s) Of Engagement Activity 2023
URL https://www.kcl.ac.uk/events/discovering-our-digital-futures-and-exploring-our-global-cultures
 
Description Feedback Loops Panelist 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact In January 2024, King's Chapel hosted a panel discussion titled "Feedback Loops," following a performance combining dance, music generated from live human body data, and personal narratives to explore the relationship between mind, body, and technology, fostering interdisciplinary collaboration between the Faculty of Arts & Humanities, the Digital Futures Institute, the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), and the NIHR Maudsley Biomedical Research Centre (BRC). Professor Fay Bound Alberti, Director of the Digital Futures Institute's Centre for Technology and the Body, emphasized the significance of such interdisciplinary endeavors in reshaping societal perceptions of health and disease by bridging the arts and sciences to offer new perspectives on the human experience and the role of technology throughout history.
Year(s) Of Engagement Activity 2024
URL https://www.kcl.ac.uk/events/feedback-loops
 
Description ISVCA 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact .
Year(s) Of Engagement Activity 2023
URL https://tts.org/isvca-about/isvca-presidents-message
 
Description Pari siamo: power and powerlessness in Rigoletto 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact On Wednesday, April 5th, 2023, Director Cecilia Stinton, John Allison, editor of Opera magazine, and cultural historian Fay Bound Alberti, author of "This Mortal Coil: The Human Body in History and Culture," joined Opera Holland Park's Anna Picard at the Italian Cultural Institute to delve into the themes of Verdi's compelling tragedy, featuring musical performances by Stephen Gadd and Fran Hills.
Year(s) Of Engagement Activity 2023
URL https://operahollandpark.com/events/power-and-powerlessness/
 
Description Participant in the DFI: Prospecting Symposium 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Speaking about loneliness and embodiment
Year(s) Of Engagement Activity 2023
 
Description Technologies of the Face talk at the Festival of Technology 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact At the Festival of Technology, Professor Fay Bound Alberti presented on "Technologies of the Face" via Microsoft Teams on Wednesday, June 7th, 2023, from 10:00 to 10:40, discussing the evolution of face transplants from science fiction to reality and examining their cultural significance and implications for the relationship between technology and the body. Drawing on her work with face transplant recipients and surgical teams worldwide, Professor Alberti explored the history, politics, and ethics of face transplants as part of the Interface project, situated within the History department and the Centre for Technology and the Body at King's College London.
Year(s) Of Engagement Activity 2023
URL https://emckclac.sharepoint.com/sites/ITdsh/SitePages/TechnologiesOfTheFace.aspx
 
Description UNAM/DIOMED Conference Presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Conference presentation: 'Sustainability of the face transplant in the short and long term' October 31, 2023, UNAM/DIOMED hospital.
Year(s) Of Engagement Activity 2023