The psychological and psychiatric evaluation of all candidates for face transplantation focuses on the identification of any risk factors that may have a direct impact in the development of postoperative complications or problems with self-adaptation and treatment compliance. Strong medical evidence demonstrates that the adaptation to posttransplant life, treatment adhesion and morbidity are directly related to specific psychosocial factors. In general terms, a detailed psychosocial evaluation of all patients is necessary before they are included in a transplant waiting list. Given the experimental nature of vascularised composite tissue allotransplantation, the psychosocial evaluation is mandatory. This is a formal requirement of the face transplant protocol and ethics committee. A negative psychosocial evaluation contraindicates VCA.

The evaluation and support by psychosocial services may be divided in three different stages:

There are certain disease characteristics that the patient has to face and adapt to. Some patients will present with a disease that may be present from birth or may have appeared during growth; such is the case of benign neoplasms (neurofibromatosis) and vascular malformations. Others may have a traumatic aetiology; hence the patients had to adapt to a sudden change in face appearance and quality of life. Patients included in the latter group present with special needs that differ from patients that had a prolonged period of adaptation to face disfigurement and change of quality of life. The motivation of the patient is crucial for the determination of a good indication for a face transplantation. The overall goal of face VCA is improvement of function and quality of life. Those patients that are well adapted may not benefit much from a face transplantation. Risks and side effects, hospital readmissions and change of life to a chronic condition (regular visit to clinic, biopsies and immunosuppression) are not uncommon, and the patients may not obtain a complete psychosocial improvement. Personal circumstances, social and family support, individual expectations and overall impact of the deformity need to be evaluated and explored to assess the potential benefit of the proposed treatment. The process does not only affect the postoperative adaptation to the new situation. Patients have to undergo a long evaluation process that includes hospital stay, procedures and techniques that may also induce psychological disadaptation, through an impact on their family, social and ethical environment. Psychological support has to be directed also to this initial phase. Some individuals may be well adapted to their situation before the possibility of a new treatment for improvement has arisen. During or following full evaluation, they can show high levels of anxiety and psychosocial problems. Therefore, the support has to be implemented and maintained for all patients, regardless of the final outcome of the candidacy evaluation.

The intervention of psychosocial health professionals, through a multidisciplinary approach within the face transplant team, is directed to: