Agich and Siemionov are to be congratulated for their attempt to refocus the debate on facial transplantation on those with most to gain: individuals with severe facial disfigurement.¹ They make a good case for the surgical benefits offered by what they term facial allograft transplantation (FAT). Moreover, they fare better than other teams in recognising that candidates for FAT might also have much to lose. The team in Louisville (which has dominated many discussions) had little to say on this issue, writing only rather benignly of the possible “loss of transplanted tissue”.² In contrast, Agich and Siemionov squarely confront this risk and offer the most complete account to date of how the risk will be minimised and rejection dealt with. This is an important development, which can only enhance the discussions that, contrary to what these authors imply, must indeed continue.

According to Agich and Siemionov, their paper also provides a counterbalance to the numerous more sceptical views being expressed in bioethical and media circles—views which are said to rely more on fiction than fact. In response, we wish to argue that, as persuasive as some of their arguments undoubtedly are, the authors will not succeed in stalling this debate for there remain numerous issues that require further attention. We start with a central component of the authors’ argument, their appeal to “clinical need”, and suggest that this is not straightforwardly identifiable. No more straightforward is their suggestion that metaphors and lessons from the creative world have no place in this (or any bioethical?) debate. This seems particularly unlikely when we consider that FAT will not offer the “ideal” solution; perhaps, then, wholesale facial transplantation is or will become the ideal and a film like Face/Off can offer some insights. Finally, we query the role and influence of …