A Canadian surgeon says face transplants could be performed on children for the first time, but the ethics surrounding the complex procedure are under the microscope. 

Dr. Gregory Borschel, a plastic surgeon at Toronto’s Sick Kids Hospital, says face transplants are now possible for children from “a technical standpoint,” because the surgeries would be very similar to what’s been done in more than two dozen adults around the world.

“Really in our mind, the major differences would be ethical ones,” he told CTV’s Canada AM Thursday.

Because children “can’t really formulate a full opinion when they’re very young,” drastic surgical measures such as face transplants raise many questions about consent and identity issues, Borschel said.

Even bigger questions surround the donation of a deceased child’s face for transplantation.

“For example, one theoretical concern is that perhaps a family may want to have their child live on through a recipient,” Borschel said.

“In the case of a donor family, they may say, ‘Well, if we donate this face, then maybe my child will live on in this other child’s body.’”

Borschel and several of his colleagues raised the delicate issue in the journal Plastic Surgery. They are calling for a policy statement on pediatric face transplants.

Since 2005, about 25 adults around the world have received face transplants. The world’s first partial face transplant was performed in France on a woman who was mauled by a dog.

Borschel told Canada AM that “all the infrastructure” is currently in place at Sick Kids to perform face transplants on children.

“We could start doing this very soon. But I think we need to be very clear that this is an operation that’s really not for everyone.”

He said patients and donor families would be “highly selected” through a rigorous screening process.  The ethics of each case would be carefully considered.

The surgery is also very expensive. Borschel said a face transplant could cost around $250,000.

One U.S. mother who made the difficult decision to donate her 21-year-old son’s face said she was ultimately grateful to see what a difference it made in the life of a disfigured man who had been a recluse for 15 years.

Gwen Aversano, who lives in Maryland, said the recipient of her son Joshua’s face was able to finally move on with his life and go back to school after surgery.

“After meeting him …we could definitely see our son in him,” Aversano told Canada AM.

If the face transplant includes bones as well as soft tissue, the recipient is more likely to resemble the donor, Borschel said.

He said face transplants can dramatically improve the lives of adults and children with debilitating facial injuries and disfigurements.

“The face really is our window to the world,” he said. “It’s our prime means of communication.”