First-in-Human Whole-Eye Transplantation: Ensuring an Ethical Approach to Surgical Innovation

Abstract

As innovations in the field of vascular composite allotransplantation (VCA) progress, whole-eye transplantation (WET) is poised to transition from non-human mammalian models to living human recipients. Present treatment options for vision loss are generally considered suboptimal, and attendant concerns ranging from aesthetics and prosthesis maintenance to social stigma may be mitigated by WET. Potential benefits to WET recipients may also include partial vision restoration, psychosocial benefits related to identity and social integration, improvements in physical comfort and function, and reduced surgical risk associated with a biologic eye compared to a prosthesis. Perioperative and postoperative risks of WET are expected to be comparable to those of facial transplantation (FT), and may be similarly mitigated by immunosuppressive protocols, adequate psychosocial support, and a thorough selection process for both the recipient and donor. To minimize the risks associated with immunosuppressive medications, the first attempts in human recipients will likely be performed in conjunction with a FT. If first-in-human attempts at combined FT-WET prove successful and the biologic eye survives, this opens the door for further advancement in the field of vision restoration by means of a viable surgical option. This analysis integrates recent innovations in WET research with the existing discourse on the ethics of surgical innovation and offers preliminary guidance to VCA programs considering undertaking WET in human recipients.

Keywords:

• Vascularized composite allotransplantation
• quality-of-life
• research ethics
• surgical innovation
• eye transplant
• patient selection

This article is referred to by:

Disability Bioethics, Social Inclusion, and Whole-Eye Transplantation

Whether Whole Eye Transplant is a Benefit or Harm Depends on More Than the Observer

Reopening the ‘Window to the Soul’?: The Ethics of Eye Transplantation Now and in the Future

An Eye for an Eye?: Problematic Risk–Benefit Trade-Offs in Whole Eye Transplantation

Equitable Participant Selection Concerns for First-In-Human Whole-Eye Transplantation

Ophthalmic Research’s Unique Challenges: Not All First-in-Human Surgeries Are the Same

Current Ethical Considerations of Human Whole Eye Transplantation is Short-Sighted

A Surgeon’s Perspective From the Sharp End of Surgical Innovation

Putting a Face on WET Recipients

The Ethical Challenges of Whole-Eye Transplantation: Is Recipient Informed Consent Enough?

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.