{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:16:34Z","timestamp":1783577794668,"version":"3.55.0"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:p>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\u201325, 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.<\/jats:p>","DOI":"10.3389\/frtra.2026.1880820","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:34:05Z","timestamp":1783575245000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Facial transplantation in emerging adulthood: characterizing challenges and opportunities to support optimal outcomes"],"prefix":"10.3389","volume":"5","author":[{"given":"Michael E.","family":"McKenna","sequence":"first","affiliation":[{"name":"Hansj\u00f6rg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailey P.","family":"Wyatt","sequence":"additional","affiliation":[{"name":"Hansj\u00f6rg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis K.","family":"Gursky","sequence":"additional","affiliation":[{"name":"Hansj\u00f6rg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo D.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Hansj\u00f6rg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura L.","family":"Kimberly","sequence":"additional","affiliation":[{"name":"Hansj\u00f6rg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine","place":["New York, NY, United States"]},{"name":"Department of Population Health, NYU Grossman School of Medicine","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s40472-014-0025-6","article-title":"Vascularized composite allografts: procurement, allocation, and implementation","volume":"1","author":"Rahmel","year":"2014","journal-title":"Curr Transplant Rep"},{"key":"B2","doi-asserted-by":"crossref","first-page":"388","DOI":"10.17226\/28580","volume-title":"Advancing Face and Hand Transplantation: Principles and Framework for Developing Standardized Protocols","author":"Kizer","year":"2025"},{"key":"B3","article-title":"Man undergoes World's first successful face & double hand transplant","author":"Mazziotta","year":"2021","journal-title":"People Magazine"},{"key":"B4","article-title":"The story of a face","volume":"234","author":"Connors","year":"2018","journal-title":"Natl Geogr Mag"},{"key":"B5","article-title":"Connie Culp, the first person to receive a near-total face transplant in the US, has died","author":"Moshtaghian","year":"2020","journal-title":"CNN"},{"key":"B6","article-title":"World's third full face transplant patient says operation \u2018best decision I ever made","author":"Hunter","year":"2022","journal-title":"The Independent"},{"key":"B7","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0140-6736(06)68935-6","article-title":"First human face allograft: early report","volume":"368","author":"Devauchelle","year":"2006","journal-title":"Lancet"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1001\/jamasurg.2024.3748","article-title":"An update on the survival of the first 50 face transplants worldwide","volume":"159","author":"Homsy","year":"2024","journal-title":"JAMA Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1001\/jama.2024.12601","article-title":"Combined whole eye and face transplant: microsurgical strategy and 1-year clinical course","volume":"332","author":"Ceradini","year":"2024","journal-title":"Jama"},{"key":"B10","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1097\/SCS.0b013e31827104ab","article-title":"Evolution and limitations of conventional autologous reconstruction of the head and neck","volume":"24","author":"Pribaz","year":"2013","journal-title":"J Craniofac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2153","DOI":"10.1016\/S0140-6736(13)62632-X","article-title":"Facial transplantation: the first 9 years","volume":"384","author":"Khalifian","year":"2014","journal-title":"Lancet"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1097\/TP.0000000000003513","article-title":"Long-term outcomes after facial allotransplantation: systematic review of the literature","volume":"105","author":"Tchiloemba","year":"2021","journal-title":"Transplantation"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1097\/SAP.0000000000004487","article-title":"Psychological outcomes of facial transplantation: a systematic review of depression and mental health\u2013related quality of life","volume":"10","author":"Blankenstein","year":"2025","journal-title":"Ann Plast Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.ajt.2024.10.007","article-title":"Ten-year follow-up after face transplantation\u2014a single-center retrospective cohort study","volume":"25","author":"Huelsboemer","year":"2025","journal-title":"Am J Transplant"},{"key":"B15","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1038\/nm0516-448","article-title":"Saving face: the search for alternatives to life-long immunosuppression for face transplants","volume":"22","author":"Keener","year":"2016","journal-title":"Nat Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1022e","DOI":"10.1097\/PRS.0000000000007932","article-title":"Facial transplantation: principles and evolving concepts","volume":"147","author":"Kantar","year":"2021","journal-title":"Plast Reconstr Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1097\/PRS.0000000000002387","article-title":"Ethical issues in pediatric face transplantation: should we perform face transplantation in children?","volume":"138","author":"Marchac","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"B18","author":"Laspro","year":""},{"key":"B19","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1177\/2374373517730556","article-title":"A lifesaving view of vascularized composite allotransplantation","volume":"5","author":"Bramstedt","year":"2018","journal-title":"J Patient Exp"},{"key":"B20","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1111\/ajt.12956","article-title":"Functional outcomes of face transplantation","volume":"15","author":"Fischer","year":"2015","journal-title":"Am J Transplant"},{"key":"B21","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1037\/0003-066X.55.5.469","article-title":"Emerging adulthood: a theory of development from the late teens through the twenties","volume":"55","author":"Arnett","year":"2000","journal-title":"Am Psychol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/jomf.12612","article-title":"The demography of families: a review of patterns and change","volume":"82","author":"Smock","year":"2020","journal-title":"J Marriage Fam"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1007\/s13524-020-00910-7","article-title":"Marriage and union formation in the United States: recent trends across racial groups and economic backgrounds","volume":"57","author":"Bloome","year":"2020","journal-title":"Demography"},{"key":"B24","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.maturitas.2019.08.002","article-title":"Associations of parental ages at childbirth with healthy aging among women","volume":"129","author":"Shadyab","year":"2019","journal-title":"Maturitas"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1037\/dev0001969","article-title":"Within-person imbalance of reward sensitivity and executive functioning across adolescent development: a longitudinal examination of the dual systems model from childhood to adulthood","volume":"61","author":"Lozano Wun","year":"2025","journal-title":"Dev Psychol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.dcn.2015.12.010","article-title":"The dual systems model: review, reappraisal, and reaffirmation","volume":"17","author":"Shulman","year":"2016","journal-title":"Dev Cogn Neurosci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1093\/cercor\/bhy330","article-title":"Waves of maturation and senescence in micro-structural MRI markers of human cortical myelination over the lifespan","volume":"29","author":"Grydeland","year":"2019","journal-title":"Cerebral cortex"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1097\/TP.0b013e31823411d7","article-title":"Association between age and graft failure rates in young kidney transplant recipients","volume":"92","author":"Foster","year":"2011","journal-title":"Transplantation"},{"key":"B29","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1038\/s41386-021-01137-9","article-title":"Development of prefrontal cortex","volume":"47","author":"Kolk","year":"2022","journal-title":"Neuropsychopharmacology"},{"key":"B30","doi-asserted-by":"publisher","first-page":"768","DOI":"10.3389\/fpsyg.2018.00768","article-title":"The influence of different kinds of incentives on decision-making and cognitive control in adolescent development: a review of behavioral and neuroscientific studies","volume":"9","author":"Kray","year":"2018","journal-title":"Front Psychol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1056\/NEJMra2014530","article-title":"Long-term survival after kidney transplantation","volume":"385","author":"Hariharan","year":"2021","journal-title":"N Engl J Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1196\/annals.1440.010","article-title":"The adolescent brain","volume":"1124","author":"Casey","year":"2008","journal-title":"Ann N Y Acad Sci"},{"key":"B33","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/MPG.0000000000003560","article-title":"Health care transition for adolescents and young adults with pediatric-onset liver disease and transplantation","volume":"76","author":"Vittorio","year":"2023","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e13110","DOI":"10.1111\/petr.13110","article-title":"Psychosocial functioning in pediatric heart transplant recipients and their families","volume":"22","author":"Cousino","year":"2018","journal-title":"Pediatr Transplant"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1097\/PRS.0000000000009634","article-title":"Early cleft lip repair: demonstrating efficacy in the first 100 patients","volume":"150","author":"Wlodarczyk","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"2779","DOI":"10.1007\/s00381-023-06113-w","article-title":"Technical evolution of pediatric neurosurgery: craniosynostosis from 1972 to 2023 and beyond","volume":"39","author":"Di Rocco","year":"2023","journal-title":"Childs Nerv Syst"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e2020015511","DOI":"10.1542\/peds.2020-015511","article-title":"Identifying the misshapen head: craniosynostosis and related disorders","volume":"146","author":"Dias","year":"2020","journal-title":"Pediatrics"},{"key":"B38","doi-asserted-by":"publisher","first-page":"151101","DOI":"10.1016\/j.sempedsurg.2021.151101","article-title":"The ethics of informed consent and shared decision-making in pediatric surgery","volume":"30","author":"Loeff","year":"2021","journal-title":"Semin Pediatr Surg"},{"key":"B39","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.jviscsurg.2019.04.014","article-title":"From informed consent to shared decision-making in surgery","volume":"156","author":"Slim","year":"2019","journal-title":"J Visc Surg"},{"key":"B40","doi-asserted-by":"publisher","first-page":"100626","DOI":"10.1016\/j.dcn.2019.100626","article-title":"Neurodevelopmental correlates of the emerging adult self","volume":"36","author":"Davey","year":"2019","journal-title":"Dev Cogn Neurosci"},{"key":"B41","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1111\/jcpp.13776","article-title":"Research review: the neuroscience of emerging adulthood\u2014reward, ambiguity, and social support as building blocks of mental health","volume":"64","author":"Silvers","year":"2023","journal-title":"J Child Psychol Psychiatry"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1016\/S0140-6736(20)32438-7","article-title":"First human facial retransplantation: 30-month follow-up","volume":"396","author":"Lantieri","year":"2020","journal-title":"Lancet"},{"key":"B43","doi-asserted-by":"publisher","first-page":"3472","DOI":"10.1111\/ajt.16696","article-title":"Full facial retransplantation in a female patient\u2014technical, immunologic, and clinical considerations","volume":"21","author":"Kauke","year":"2021","journal-title":"Am J Transplant"},{"key":"B44","doi-asserted-by":"publisher","first-page":"e159","DOI":"10.1093\/cid\/ciz1113","article-title":"Burden and timeline of infectious diseases in the first year after solid organ transplantation in the Swiss transplant cohort study","volume":"71","author":"Van Delden","year":"2020","journal-title":"Clin Infect Dis"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e1302","DOI":"10.1093\/cid\/ciaa1189","article-title":"Immunosuppressive agents and infectious risk in transplantation: managing the \u201cnet state of immunosuppression\u201d","volume":"73","author":"Roberts","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B46","doi-asserted-by":"publisher","first-page":"10301","DOI":"10.3390\/ijms241210301","article-title":"Current status regarding immunosuppressive treatment in patients after renal transplantation","volume":"24","author":"Szumilas","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B47","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1097\/01.prs.0000270316.33293.ec","article-title":"Risk assessment of immunosuppressive therapy in facial transplantation","volume":"120","author":"Vasilic","year":"2007","journal-title":"Plast Reconstr Surg"},{"key":"B48","doi-asserted-by":"publisher","first-page":"85","DOI":"10.3390\/livers2020006","article-title":"A comprehensive review on the risk of metabolic syndrome and cardiovascular disease after liver transplantation","volume":"2","author":"Chauhan","year":"2022","journal-title":"Livers"},{"key":"B49","doi-asserted-by":"publisher","first-page":"R1","DOI":"10.1093\/ejendo\/lvaf182","article-title":"Endocrine effects of long-term calcineurin inhibitor use in solid organ transplant recipients","volume":"193","author":"Diker Cohen","year":"2025","journal-title":"Eur J Endocrinol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1097\/LVT.0000000000000341","article-title":"Management of long-term complications from immunosuppression","volume":"30","author":"Russo","year":"2024","journal-title":"Liver Transpl"},{"key":"B51","doi-asserted-by":"publisher","first-page":"arztebl.m2026.0019","DOI":"10.3238\/arztebl.m2026.0019","article-title":"Diabetes Mellitus and osteoporosis after organ transplantation: frequency, clinical features, and treatment","author":"Sarabhai","year":"2026","journal-title":"Dtsch Arztebl Int"},{"key":"B52","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1016\/S1470-2045(24)00189-X","article-title":"Cancer risk in people living with HIV and solid organ transplant recipients: a systematic review and meta-analysis","volume":"25","author":"Jin","year":"2024","journal-title":"Lancet Oncol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/S2215-0366(14)00080-7","article-title":"The new life stage of emerging adulthood at ages 18\u201329 years: implications for mental health","volume":"1","author":"Arnett","year":"2014","journal-title":"Lancet Psychiatry"},{"key":"B54","doi-asserted-by":"publisher","first-page":"91","DOI":"10.5500\/wjt.v6.i1.91","article-title":"Key psychosocial challenges in vascularized composite allotransplantation","volume":"6","author":"Kumnig","year":"2016","journal-title":"World J Transplant"},{"key":"B55","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1006\/drev.2000.0514","article-title":"Determinants and mechanisms in ego identity development: a review and synthesis","volume":"21","author":"Bosma","year":"2001","journal-title":"Dev Rev"},{"key":"B56","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1177\/0743558408322146","article-title":"Employment, sense of coherence, and identity formation: contextual and psychological processes on the pathway to sense of adulthood","volume":"23","author":"Luyckx","year":"2008","journal-title":"J Adolesc Res"},{"key":"B57","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1177\/2167696813479781","article-title":"Identity in emerging adulthood:reviewing the field and looking forward","volume":"1","author":"Schwartz","year":"2013","journal-title":"Emerg Adulthood"},{"key":"B58","doi-asserted-by":"publisher","first-page":"e2027491","DOI":"10.1001\/jamanetworkopen.2020.27491","article-title":"Association of social support during adolescence with depression, anxiety, and suicidal ideation in young adults","volume":"3","author":"Scardera","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"B59","doi-asserted-by":"publisher","first-page":"6","DOI":"10.3238\/arztebl.m2026.0019","article-title":"Identity development, personality, and well-being in adolescence and emerging adulthood: theory, research, and recent advances","author":"Schwartz","year":"2012","journal-title":"Handbook of Psychology, Second Edition"},{"key":"B60","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1097\/SLA.0b013e3181e3ec61","article-title":"Enhancement of surgical informed consent by addition of repeat back: a multicenter, randomized controlled clinical trial","volume":"252","author":"Fink","year":"2010","journal-title":"Ann Surg"},{"key":"B61","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/j.1399-0012.2011.01536.x","article-title":"Kidney transplant candidates' Understanding of increased risk donor kidneys: a qualitative study","volume":"26","author":"Gordon","year":"2012","journal-title":"Clin Transplant"},{"key":"B62","doi-asserted-by":"publisher","first-page":"1092725","DOI":"10.3389\/fpsyg.2023.1092725","article-title":"Psychosocial predictors in upper-extremity vascularized composite allotransplantation: a qualitative study of multidimensional experiences including patients, healthcare professionals, and close relatives","volume":"14","author":"Hummel","year":"2023","journal-title":"Front Psychol"},{"key":"B63","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1097\/TP.0000000000001013","article-title":"The chauvet 2014 meeting report: psychiatric and psychosocial evaluation and outcomes of upper extremity grafted patients","volume":"100","author":"Jowsey-Gregoire","year":"2016","journal-title":"Transplantation"},{"key":"B64","doi-asserted-by":"publisher","first-page":"e13353","DOI":"10.1111\/ctr.13353","article-title":"Report from the American society of transplantation psychosocial community of practice adherence task force: real-world options for promoting adherence in adult recipients","volume":"32","author":"Myaskovsky","year":"2018","journal-title":"Clin Transplant"}],"container-title":["Frontiers in Transplantation"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1880820\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:34:06Z","timestamp":1783575246000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1880820\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":64,"alternative-id":["10.3389\/frtra.2026.1880820"],"URL":"https:\/\/doi.org\/10.3389\/frtra.2026.1880820","relation":{},"ISSN":["2813-2440"],"issn-type":[{"value":"2813-2440","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"article-number":"1880820"}}