In what could mark a turning point for reconstructive surgery in India, the All India Institute of Medical Sciences, New Delhi (AIIMS) has initiated structured preparations to introduce a face transplant programme — one of the most complex procedures in modern medicine and one that remains rare even globally.
The development follows a five-day cadaveric workshop and academic training programme conducted from February 11 to 15 at the institute’s Burns and Plastic Surgery Block. The training is part of an effort to build surgical, immunological and psychological preparedness before undertaking such procedures in clinical settings.
Face transplantation, a form of vascularised composite allotransplantation, involves transplanting skin, muscle, nerves, blood vessels and sometimes bone from a deceased donor to a recipient with severe facial disfigurement. Unlike routine reconstructive surgeries, it requires lifelong immunosuppression, intensive monitoring and multidisciplinary coordination.
Addressing a critical gap
India sees a significant number of patients with disfiguring facial injuries caused by acid attacks, gunshot wounds, burns and road accidents. Many undergo multiple reconstructive surgeries with limited functional and aesthetic recovery.
Dr Maneesh Singhal, Head of the Department of Plastic, Reconstructive and Burns Surgery at AIIMS, said that several patients continue to struggle despite undergoing “10 to 12 surgeries” over the years.
“Identifying the right candidate and counselling is critical. Unmotivated or psychologically unstable patients, and those with active infections or cancers, are not suitable candidates,” he said, underlining the stringent selection process required for such transplants.
Doctors at AIIMS described the initiative as an attempt to provide a definitive option for a small but severely affected patient group that currently has limited avenues for meaningful rehabilitation.
International expertise, local capacity
To support the training effort, AIIMS invited Dr Indranil Sinha, Associate Chief of Plastic Surgery at Brigham and Women’s Hospital and faculty at Harvard Medical School. Dr Sinha, who has experience in composite tissue allotransplantation, conducted hands-on cadaveric dissections and academic sessions.
He noted that the surgical skill base and infrastructure at AIIMS are comparable to international centres and expressed willingness to support the programme’s evolution.
The workshop involved specialists from ENT, Maxillofacial Surgery, Nephrology, Immunology, Pathology, Psychiatry, Critical Care, Anatomy and the Organ Retrieval Banking Organisation (ORBO), reflecting the multidisciplinary structure required for such a programme.
Immunosuppression and long-term risks
Unlike conventional cosmetic or reconstructive procedures, face transplantation is not a one-time intervention. It entails lifelong immunosuppressive therapy to prevent graft rejection — a process that carries risks of infection, organ toxicity and malignancy.
Dr Dipankar Bhowmick, Head of the Department of Nephrology at AIIMS, highlighted that immunosuppression protocols and monitoring infrastructure are already well established at the institute due to its experience with solid organ transplants.
“Immunosuppression plays a critical role, and the required facilities are in place,” he said.
However, experts acknowledge that long-term follow-up, patient compliance and infection control remain among the biggest challenges in vascularised composite transplants.
Psychological and ethical preparedness
Psychiatric evaluation is another key component. Dr Preethy K from the Department of Psychiatry emphasised that rehabilitation and counselling must run parallel to surgical planning.
Face transplant recipients often undergo profound psychological adjustment, given the visible and identity-linked nature of the graft. AIIMS officials said the institute already runs structured transplant-related psychiatric programmes, which would form part of the preparedness framework.
Globally, fewer than 50 face transplants have been reported since the first partial transplant in France in 2005. The procedure remains limited to a handful of specialised centres due to its ethical complexity, donor matching challenges and high resource requirements.
If implemented, AIIMS could become one of the first public-sector institutions in India to institutionalise such a programme, potentially reducing the need for Indian patients to seek experimental or costly treatment abroad.
For now, doctors emphasise that the workshop represents a preparatory step rather than the immediate start of clinical transplants. Structured training, protocol development and ethical clearances will precede any patient selection.
Still, the move signals a shift in ambition for advanced reconstructive surgery in India — from repeated staged corrections toward the possibility of single-stage transformative intervention for the most severe cases.
