But Barker may have opened a can of worms with statements that the technique might be appropriate for burn victims. Many burn victims have their entire faces destroyed. Skin grafts save their lives. But even multiple operations leave them with such a distorted appearance that many patients feel unable to leave home.
"There are burn patients that have lost all the skin on their faces," Papel says. "But at this point, they are probably better off with skin grafts."
Pearlman agrees that face transplants should be reserved only for people with fatal conditions.
"The first candidate should be one of those patients with no other alternatives," he says. "Especially those with cranial facial cancer or severe craniofacial deformity where there is no other surgical procedure that could cure them."
Pearlman says that he and others in the American Academy of Facial, Plastic, and Reconstructive Surgery are developing guidelines for experimental face transplants.
For the time being, the only guidelines are those of the Royal College of Surgeons.
"Until there is further research and the prospect of better control of these complications, it would be unwise to proceed with human facial transplantation," they state. "This conclusion is not adverse to facial transplantation. Indeed, it acknowledges the need to recognize it as a possible future treatment. It simply means that the work should take a much more incremental approach than some of the current hype surrounding it has suggested."