Ethical lapses associated with the first facial transplant included breaches of confidentiality, bending of research rules, and film deals. However, discussions of the risk-benefit ratio for face transplantation are often deficient in that they ignore the needs, experience, and decision-making capability of potential recipients.

Face transplantation is a landmark in reconstructive surgery involving vascularised composite allotransplantation. A recent issue of FT for patients who are blind has arisen. Some bioethicists recommend not excluding a patient who is blind, as this may amount to discrimination. From an ethical standpoint, FT for those with blindness is appropriate in selected candidates. This article seeks to add to the clinical evidence supporting FT for those with blindness by detailing a complementary psychosocial perspective. Currently, there is little relevant (...) research about the subjectivity of the blind. This is critical since the arguments against FT for the blind refer to their inability to see their face and to view the reaction of others to their disfigured faces. We begin with a brief look at examples of FT involving blindness and associated arguments. The next part is a multidisciplinary investigation of the experiences of the blind. These are gleaned from a close reading of the literature and drawing inferences, as direct studies are rare. The discussion analyses identity themes of the blind in relation to their faces: as they experience it; the face they wish to show to the world; and how others perceive and react to their face in a saturated environment of imagery and visual communication. Disability and the blind person’s experience of faces are well-founded considerations for medical practitioners and ethics boards in the process of FT decision-making. (shrink)

The face is the first thing that others notice and remember about a person. This is true for the severely facially burned patient, with disfigurement, impaired self-esteem and body image. They and others suffer from chronic devastating facial sequelae resulting from tumors, burns, or congenital malformations and trauma, e.g. ballistic injury to the face. Face transplantation is considered a way to restore eating, swallowing, and speech, and to reestablish esthetics.Alongside these vital bodily functions, the face plays (...) a remarkable role in a person’s identity. Societies place a high value on the face and this gives... (shrink)

A face transplant is as challenging a surgical procedure as any patient can undergo. In this introduction I present the medical aspects of this surgery, the profound ethical issues it raises, and optimal interventions that clinicians can pursue to help these patients and their loved ones. I then discuss how to help other kinds of patients and loved ones who confront similar stresses. I end by presenting a goal that author Sharrona Pearl puts forth after she studied many (...) class='Hi'>face transplant patients. The efforts she urges should maximize our capacity to see face transplant patients—and anyone—as they are, as opposed to how they look. (shrink)

Animal blood -- Fabricating noses -- The face transplant -- The Manson effect -- Robles' disease -- Chagas' error.

Should face transplants be undertaken? This article examines the ethical problems involved from the perspective of the recipient, looking particularly at the question of identity, the donor and the donor’s family, and the disfigured community and society more generally. Concern is expressed that full face transplants are going ahead.

Should face transplants be undertaken? This article examines the ethical problems involved from the perspective of the recipient, looking particularly at the question of identity, the donor and the donor’s family, and the disfigured community and society more generally. Concern is expressed that full face transplants are going ahead.

When the world's first face transplant was performed in France in 2005, the complex medical procedure and accompanying worldwide media attention sparked many ethical issues, including how the media covered the story. This study uses framing theory to examine what happens when media ethics intersect with bioethics by analyzing French, American, and British media coverage on the transplant and its aftermath. This study looks at how this story was framed and which bioethical issues were focused upon. The media ethical (...) implications of these findings are then discussed. By doing so, this article attempts to contribute to the debate on how complex medical stories with bioethical components can be reported in an ethical manner. (shrink)

ABSTRACT An American surgical team has announced its intention to perform the first human facial transplantation. The team has, however, invited further analysis of the ethical issues before it proceeds and in this paper we take up that challenge in seeking to frame the debate with a particular focus on the recipients of the transplant. We address seven related areas of concern and identify numerous questions that require answers or, perhaps, better answers. We start by examining the nature of the (...) procedure and its intended benefits, why the procedure is being developed, and whether or not this should be viewed as experimental. Having concluded that this is experimental in nature, we then consider the broad question, who is the patient? Here we perceive difficulties in terms of the autonomy of the recipient, the unpredictable effects of receiving the transplant, and the role and influence of society. We conclude by asking whether the question should be ‘whether or not?’ rather than ‘when?’, particularly while the risks of losing face appear to far outweigh the likelihood of gaining face. (shrink)

Fecal microbiota transplantation is reportedly the most effective therapy for relapsing Clostridium Difficile infection and a potential therapeutic option for many diseases. It also poses important ethical concerns. This study is an attempt to assess clinicians’ perception and attitudes towards ethical and social challenges raised by fecal microbiota transplantation. A questionnaire was developed which consisted of 20 items: four items covered general aspects, nine were about ethical aspects such as informed consent and privacy issues, four concerned social and regulatory issues, (...) and three were about an FMT bank. This was distributed to participants at the Second China gastroenterology and FMT conference in May 2015. Basic descriptive statistical analyses and simple comparative statistical tests were performed. Nearly three quarters of the 100 respondents were gastro-enterologist physicians. 89% of all respondents believed FMT is a promising treatment modality for some diseases and 88% of whom chose clinical efficacy as the primary reason for recommending FMT. High expectation from patients and pressure on clinicians was reported as the most frequent reasons for not recommending FMT. The clinicians who had less familiarity with FMT reported significantly more worry related to the dignity and psychological impact of FMT compared to those who have high familiarity with FMT.More than half of the respondents were concerned about the commercialization of FMT, although almost one in five respondents did not see this as a problem. We found most respondents have positive attitudes towards FMT but low awareness of published evidence. Informed consent for vulnerable patients, privacy and protection of donors were perceived as the most challenging ethical aspects of FMT. This study identified areas of limited knowledge and ways of addressing ethical issues and indicates the need to devise the education and training for clinicians on FMT. (shrink)

An analysis of the identity issues involved in facial allograft transplantation is provided in this paper. The identity issues involved in organ transplantation in general, under both theoretical accounts of personal identity and subjective accounts provided by organ recipients, are examined. It is argued that the identity issues involved in facial allograft transplantation are similar to those involved in organ transplantation in general, but much stronger because the face is so closely linked with personal identity. Recipients of facial allograft (...) transplantation have the potential to feel that their identity is a mix between their own and the donor’s, and the donor’s family is potentially likely to feel that their loved one ‘‘lives on’’. It is also argued that facial allograft transplantation allows the recipients to regain an identity, because they can now be seen in the social world. Moreover, they may regain expressivity, allowing for them to be seen even more by others, and to regain an identity to an even greater extent. Informing both recipients and donors about the role that identity plays in facial allograft transplantation could enhance the consent process for facial allograft transplantation and donation. (shrink)

In this paper, changes in identity and selfhood experienced through organ transplantation are analyzed from a phenomenological point of view. The chief examples are heart and face transplants. Similarities and differences between the examples are fleshed out by way of identifying three layers of selfhood in which the procedures have effects: embodied selfhood, self-reflection, and social-narrative identity. Organ transplantation is tied to processes of alienation in the three layers of selfhood, first and foremost a bodily alienation experienced through (...) illness or injury and in going through and recovering from the operation. However, in cases in which the organ in question is taken to harbor the identity of another person, because of its symbolic qualities (the heart) or its expressive qualities (the face), the alienation process may also involve the otherness of another person making itself, at least imaginatively, known. (shrink)

The ethical discussion of facial allograft transplantation for severe facial deformity, popularly known as facial transplantation, has been one sided and sensationalistic. It is based on film and fiction rather than science and clinical experience. Based on our experience in developing the first IRB approved protocol for FAT, we critically discuss the problems with this discussion, which overlooks the plight of individuals with severe facial deformities. We discuss why FAT for facial deformity is ethically and surgically justified despite its negative (...) portrayal in the media. (shrink)

Two competing intuitions have dominated the debate over facial tissue transplantation. On one side are those who argue that relieving the suffering of those with severe facial disfigurement justifies the medical risks and possible loss of life associated with this experimental procedure. On the other are those who say that there is little evidence to show that such transplants would have longterm psychological benefits that couldn’t be achieved by other means and that without clear benefits, the risk is simply (...) too great. Ethicists on both sides have called for more analysis of the link between the face and personal identity in order to get a better grasp on potential gains and losses. This paper responds to that call by looking at contemporary philosophical analyses of the relation between organ transplants and personal identity and between the human face, human dignity, and human vulnerability. It is argued that the face matters not because it is the unique marker of our identity, but because of its role in the intersubjective constitution of moral identity and human dignity. (shrink)

Face transplants have been performed, in a small number, since 2005. Popular concern over the morality of the face transplant has tended to focus on the role that one’s face plays in one’s sense of self or one’s personal identity. In order to address this concern, the current paper will explore the significance of face transplants in the light of a theory of the self that draws on symbolic interactionism, narrative theory, and accounts of (...) embodiment. The paper will respond to certain presuppositions concerning personal identity made by Huxtable and Woodley. A theory of the self will be articulated that draws on the work of Merleau-Ponty and G. H. Mead, in order to place embodiment and social interaction centrally to an understanding of self-identity. This will allow an account of the nature of the suffering that a face transplant seeks to remedy, and its worth as an operation, and crucially the impact that it may have on the sense of personal identity of the recipient of the transplant. The conclusion will review the treatment in the context of the prejudices that members of contemporary societies may hold against those with disfigurements. (shrink)

Face transplantation—or, more properly, facial allograft transplantation —generates much public interest and academic debate. In this paper, we suggest that it is up to opponents of FAT to make the case for its impermissibility. We allow that there is a number of apparently strong arguments that might be deployed against FAT. However, all but one of these turn out not to be compelling after examination. The remaining argument is not so easily dismissed—but its central point is fairly workaday and (...) certainly does not tell us anything about FAT in particular. Therefore, qua argument about facial transplant surgery, it fails to hit its target. Overall, we conclude that a compelling case against FAT remains to be made. (shrink)

A dissociated area of medical research warrants bioethical consideration: a proposed transplantation of a donor’s entire body, except head, to a patient with a fatal degenerative disease. The seeming improbability of such an operation can only underscore the need for thorough bioethical assessment: Not assessing a case of such potential ethical import, by showing neglect instead of facing the issue, can only compound the ethical predicament, perhaps eroding public trust in ethical medicine. This article discusses the historical background of full-body (...) transplantation, documents the seriousness of its current pursuit, and builds an argument for why prima facie this type of transplant is bioethically distinct. Certainly, this examination can only be preliminary, indicating what should be a wide and vigorous discussion among practitioners and ethicists. It concludes with practical suggestions for how the medical and bioethics community may proceed with ethical assessment. (shrink)

Uterus transplantation (UTx) research has been introduced in several countries, with trials in Sweden and the United States producing successful outcomes. The growing interest in developing UTx trials in other countries, such as Spain, the Netherlands, Japan, and Australia, raises important questions regarding the ethics of surgical innovation research in the field of UTx. This paper examines the current state of UTx in the context of the surgical innovation paradigm and IDEAL framework and discusses the ethical challenges faced by those (...) considering the introduction of new trials. We argue that UTx remains an experimental procedure at a relatively early stage of the IDEAL framework, especially in the context of de novo trials, where protocols are likely to deviate from those used previously and where researchers are likely to have limited experience of UTx. We conclude that countries considering the introduction of UTx trials should build on the strengths of the reported outcomes to consolidate the evidence base and shed light on the uncertainties of the procedure. Authorities responsible for the ethical governance of UTx trials are advised to draw on the ethical framework used in the oversight of surgical innovation. (shrink)

In May 2023, the world’s first whole-eye and partial-face transplant was performed, representing the first known whole-eye transplant in history and the “only successful combined transplant case of...

Uterus transplantation is an emerging technology adding to the arsenal of treatments for infertility; specifically the only available treatment for uterine factor infertility. Ethical investigations concerning risks to uteri donors and transplant recipients have been discussed in the literature. However, missing from the discourse is the potential of uterus transplantation in other groups of genetically XY women who experience uterine factor infertility. There have been philosophical inquiries concerning uterus transplantation in genetically XY women, which includes transgender women and women with (...) complete androgen insufficiency syndrome. We discuss the potential medical steps necessary and associated risks for uterus transplantation in genetically XY women. Presently, the medical technology does not exist to make uterus transplantation a safe and effective option for genetically XY women, however this group should not be summarily excluded from participation in trials. Laboratory research is needed to better understand and reduce medical risk and widen the field to all women who face uterine factor infertility. (shrink)

This book supports the emerging field of vascularized composite allotransplantation for face and upper-limb transplants by providing a revised, ethically appropriate consent model which takes into account what is actually required of facial and upper extremity transplant recipients. In place of consent as permission-giving, waiver, or autonomous authorization, this book imagines consent as an ongoing mutual commitment, i.e. as covenant consent. The covenant consent model highlights the need for a durable personal relationship between the patient/subject and the care (...) provider/researcher. Such a relationship is crucial given the recovery period of 5 years or more for VCA recipients. The case for covenant consent is made by first examining the field of vascularized composite allotransplantation, the history and present understandings of consent in health care, and the history and use of the covenant concept from its origins through its applications to health care ethics today. This book explains how standard approaches to consent are inadequate in light of the particular features of facial and upper limb transplantation. In contrast, use of the covenant concept creates a consent model that is more appropriate ethically for these very complex surgeries and long-term recoveries. (shrink)

Human uterus transplantation is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such (...) as face and limb grafts, and shares some of the ethical concerns raised by these non-life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx. (shrink)

Transplantation is a field of perpetual innovation. In the last 15 years, novel surgical interventions include uterine, tracheal, hand, face, and penile allotransplantation, as well as cardiac xeno...

Interventional research on deceased organ donors and donor organs prior to transplant holds the promise of reducing the number of patients who die waiting for an organ by expanding the pool of transplantable organs and improving transplant outcomes. However, one of the key challenges researchers face is an assumption that someone who receives an organ that was part of an interventional research protocol is always a human subject of that same study. The consequences of this assumption include the need (...) for oversight by an institutional review board and for research-level informed consent from transplant recipients, all within the complex practical realities of the organ donation and transplantation process in the United States. The current national focus on this issue provides an opportunity to think critically about the policy goals of the human subjects regulations and their application to the nascent field of deceased organ donor intervention research. We propose that for donor research where the transplant recipient does not fall under the definition of human subject, the clinical consent model—rather than the consent model used for human research subjects—best facilitates the policy objectives of balancing clinical innovation, transparency, and protection of patients in an ethically responsible and legally compliant manner. (shrink)

The animalist view of personal identity, according to which we human persons are identical to animals, is arguably the simplest view of the relationship between human persons and animals. But animalism faces a serious challenge from the possibility of brain transplants. This chapter develops, on behalf of animalism, a new way of modeling such cases. The model is developed by analogy with situations of environmentally determined reference shift familiar from the literature on externalism in the philosophy of mind and (...) language. The resulting externalist animalist model is put to work in describing a range of variant cases and in accounting for certain anti-animalist intuitions. In the final section some wider consequences are elucidated, concerning the extrinsic nature of thought, and the coherence, within a broadly materialist framework, of disembodied consciousness. (shrink)

Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical (...) requirements usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase. (shrink)

Wiggins and his colleagues (2004) are to be commended for their willingness to raise the question of the ethics of undertaking the world's first face transplant prior to initiating the experiment....

Definition of the problem: Even after the new German legislation about organ donors and transplantation (“information solution”), the question of criteria for distributing the organs is still not solved. The various alternatives to solve this problem face different social acceptance and economic efficiency.Arguments: Medical criteria (e.g. HLA compatibility) and non-medical criteria (e.g. willingness to pay of the patients) are valued on the basis of generally accepted objectives (e.g. equal access to health services or low costs). As an innovative form (...) of organ distribution systems the club solution is introduced. It allows the donor to realise preferences regarding use of the organs.Conclusion: Scoring systems may help to increase the transparency of organ allocation. From an economic point of view medical criteria have to be weighted more than non-medical criteria. (shrink)

The face embodies for the individual the sense of identity, that is to say, precisely the place where someone recognizes himself and where others recognize him. From the outset the face is meaning, translating in a living and enigmatic form the absoluteness yet minuteness of individual difference. Any alteration to the face puts at stake the sense of identity. Disfigurement destroys the sense of identity of an individual who can no longer recognize himself or be recognized by (...) others. Disfigurement places a mask on the face. The goal of a facial transplant consists of restoring an individual’s place in the world and reviving his taste for life, returning to him his ‘human shape’. Facial transplants raise essential anthropological questions such as ‘Who am I?’ and ‘To whom belongs this face that henceforth is mine?’. (shrink)

In recent years much research has been undertaken regarding the feasibility of the human uterine transplant as a treatment for absolute uterine factor infertility. Should it reach clinical application this procedure would allow such individuals what is often a much-desired opportunity to become not only social mothers, or genetic and social mothers but mothers in a social, genetic and gestational sense. Like many experimental transplantation procedures such as face, hand, corneal and larynx transplants, UTx as a therapeutic option (...) falls firmly into the camp of the quality of life transplant, undertaken with the aim, not to save a life, but to enrich one. However, unlike most of these novel procedures – where one would be unlikely to find a willing living donor or an ethics committee that would sanction such a donation – the organs to be transplanted in UTx are potentially available from both living and deceased donors. In this article, in the light of the recent nine-case research trial in Sweden which used uteri obtained from living donors, and the assertions on the part of a number of other research teams currently preparing trials that they will only be using deceased donors, I explore the question of whether, in the case of UTx, there exist compelling moral reasons to prefer the use of deceased donors despite the benefits that may be associated with the use of organs obtained from the living. (shrink)

An analysis of the identity issues involved in facial allograft transplantation is provided in this paper. The identity issues involved in organ transplantation in general, under both theoretical accounts of personal identity and subjective accounts provided by organ recipients, are examined. It is argued that the identity issues involved in facial allograft transplantation are similar to those involved in organ transplantation in general, but much stronger because the face is so closely linked with personal identity. Recipients of facial allograft (...) transplantation have the potential to feel that their identity is a mix between their own and the donor’s, and the donor’s family is potentially likely to feel that their loved one “lives on”. It is also argued that facial allograft transplantation allows the recipients to regain an identity, because they can now be seen in the social world. Moreover, they may regain expressivity, allowing for them to be seen even more by others, and to regain an identity to an even greater extent. Informing both recipients and donors about the role that identity plays in facial allograft transplantation could enhance the consent process for facial allograft transplantation and donation. (shrink)

Many people in desperate need of an organ will die on waiting lists for transplantation or face increased morbidity because of their wait. This circumstance is particularly troubling since many viable organs for transplantation go unused when individuals fail to participate in their local organ donation system. In this paper, I consider whether participating in organ transplantation should be considered a form of a rescue of others from the great harms caused by a shortage in transplantable organs. Specifically, I (...) consider whether cadaver organ transplantation is a case of an easy rescue. If so, participation in cadaver organ transplantation will be a duty rather than a supererogatory act.1 This question is important in illuminating individual duties to participate in organ transplantation. Moreover, as I will argue, it has repercussions for community-wide policies for enrolling individuals in transplantation schemes. -/- In the first section of this paper, I tie cadaver organ transplantation to the duty to rescue others from great harm when it is easy to do so. Given the number of persons who will die or be greatly harmed without transplanted organs, the transfer of organs upon death is seemingly similar to other, classical cases of easy rescue. In the second section, I consider objections to this proposal on the ground that cadaver organ transplantation is structurally dissimilar to classical rescue cases, especially given uncertainty over when and to whom organs will be transplanted, if they are transplanted at all. In the third section, I consider the objection that cadaver organ transplantation is a demanding, rather than easy, rescue. While I grant that cadaver organ transplantation will be demanding for some persons, I argue that there remain many cases where it will be an easy rescue. In the final section, I consider the policy implications of my argument. In particular, I argue that understanding cadaver organ transplantation as a duty should shift the debate over opt-out, opt-in, and mandatory choice procedures for participating in organ transplantation upon death. While different systems will be appropriate for different communities, understanding transplantation as a duty in some cases helps to justify an opt-out system. (shrink)

This research examines the implementation and judicial response to Uzbekistan's new domestic violence laws enacted in 2023. Through an exploration of the semiotics of these laws, we uncover the nuanced portrayal of victim as "wife" instead of "human," reflecting a societal prioritization of family dynamics over individual rights. Through this analytical lens, we examine how domestic violence laws, as legal transplants, are interpreted by the judicial system. We highlight their translation into people’s behavior, judicial traditions, and the struggling with (...) socio-cultural norms. The findings from both quantitative and qualitative research contribute to understanding effectiveness and improving practices to achieve justice for victims. We investigated how new domestic violence laws are applied in the judicial system and the challenges victims face in seeking justice. The research highlights the necessity and effectiveness of laws while revealing socio-cultural resistance within the judicial system, such as holding victims accountable in domestic violence cases. The judicial response to domestic violence cases often favors restorative justice mechanisms, emphasizing reconciliation and lenient penalties. Notably, 61% of criminal cases conclude with reconciliation. Despite the impossibility of reconciliation in administrative cases, courts resort to the concept of "insignificance" of the violation, terminating cases on this basis in 28% of instances. However, the absence of reconciliation significantly diminishes the effectiveness of laws, depriving victims of restitution and the ability to influence the perpetrator's behavior. In the era of restorative justice application, rising questions emerge regarding its effectiveness, particularly due to socio-cultural pressure on victims and their unequal negotiation opportunities. (shrink)

Background Several ethical issues are associated with providing living organ transplantation services, and there is limited information on these issues faced by the teams providing service to refugees or asylum seekers. Aim To determine the challenges healthcare professionals face in organ transplant centers providing services to Syrians under temporary protection status and discern whether these difficulties align with ethical issues in living organ transplantation. Research design This study employed a qualitative design and conducted individual semi-structured, in-depth interviews with 18 (...) transplant team members in Istanbul between September and November 2022. Data analysis was based on Braun and Clarke’s thematic analysis. Participants and research context The participants comprised 18 healthcare professionals, including 6 physicians and 12 nurses working in organ transplant teams in Istanbul. Ethical considerations The University’s Ethics Committee provided approval. Participants were informed regarding confidentiality and signed an informed consent form. Results Three themes emerged from the data on ethical issues faced by organ transplantation services to Syrians: (a) beneficence or double equipoise, (b) autonomy, and (c) justice. Transplant teams experience problems related to preserving double equipoise in the provision of living donor organ transplantation because of language barriers, poor socioeconomic conditions, and cultural factors, which increases transplant teams’ individual and indirect social burden. Although problems arise from the language barrier when obtaining informed consent in the autonomy theme, institutional and national policies in preventing donor abuse have a comforting effect. Health workers had the least problems with the justice theme, wherein national health policies are determined. Conclusion Fewer issues related to autonomy and justice were reported in providing organ transplantation services to Syrians, with the most intense reported issues being maintaining double equipoise. The results revealed the need to develop institutional, national, and international policies with individual solutions to prevent difficulties healthcare professionals face in this process. (shrink)

It is now eighteen years on since the Human Tissue Act 1961, but this legislation is still unchanged in England, Scotland and Wales. Ian Kennedy, in this paper, lays before us the law as it is, the problems of its interpretation and his opinion of what government should be doing to help clarify the situation and remove some of the problems which exist daily for the doctors who face the dilemma of seeking consent for transplants at the moment (...) of extreme grief for the surviving spouses or relatives of the patient who has been in his care only moments before. Ian Kennedy suggests that by doing nothing the Department of Health and the government are being both callous and less than honest. (shrink)

While extensive scholarship has been dedicated to the emotional experiences of transplant patients, little is known about the emotional experiences of transplant co‐ordinators. Semi‐structured face‐to‐face interviews conducted with ten transplant co‐ordinators who have worked for more than 20 years in this job. The transplant co‐ordinators spoke of negative feelings and moral distress with regard to futile care of deceased donor family members as well as of living donors. Transplant co‐ordinators experience intense negative feelings, emotional pain, and moral distress (...) on a daily basis. Transplant co‐ordinators play a pivotal role in the process of obtaining consent for live or dead donation of organ; however, their well‐being and job satisfaction are impaired by contradictions between their moral values and the tasks they are instructed to perform. The study exposes the silent emotional suffering of transplant co‐ordinators; main findings show that the transplant co‐ordinators are torn between contradictory expectations and a gap between values and praxis. It is recommended to offer them training and support for the sake of their retention. (shrink)