Donating one’s face after euthanasia: when death on demand turns the body into a resource
In autumn 2025, the Vall d'Hebron Hospital in Barcelona performed a face transplant on a patient suffering from a bacterial infection. In twenty years, around fifty transplants of this type have been performed worldwide (including six in Spain). In this case, the face transplant was performed using a donor who had undergone euthanasia. This world first raises questions about the porosity between the decision to die and the medical usefulness of the body after death. Since the protocol authorising organ donation after euthanasia came into force in 2022, 226 people have donated their organs in this context in Spain. Although tissue donations are not specifically covered by this protocol, which is reserved for vital organs, the donor was also able to benefit from donating her organs.
Fascial tissue donation: a technical feat not without risks
The operation to restore the function and sensitivity of the transplanted face remains highly complex. Facial tissue donors are also rare. The operation in question was performed under controlled asystole (controlled cardiac arrest, corresponding to the ‘Maastricht III’ donor category) and required the intervention of around 100 professionals from various medical disciplines (plastic surgery, immunology, psychiatry, etc.).
Although the operation appears to have been successful for the time being and has enabled the patient to regain a certain quality of life, face transplants remain rare. In addition to the technical aspects, face transplants also have a significant psychological impact on the recipient, who must learn to live with another person's face. A 2024 study analysed the difficulties associated with this type of procedure. Among other challenges, it highlights the need for lifelong immunosuppression and the risk of chronic rejection.
From an ethical standpoint, questions also arise regarding the specific context of tissue donation after euthanasia.
Tissue/organ donation and euthanasia: not such distinct procedures
In Spain, according to the specific national protocol for organ donation after euthanasia (ODE), the doctor may inform the patient of the possibility of donating their organs after euthanasia. Although a strict separation between the team performing the euthanasia and the team performing the transplant is required, in practice there is some overlap. From a medical point of view, programmed death increases the chances of a successful transplant. In this case, the anticipation of death gave doctors the opportunity to use 3D modelling tools to define, prior to euthanasia, the best options for reconstructing bone structures in order to optimise the success of the transplant.
This medical benefit should not obscure the very real threat to the patient's freedom of consent in the specific context of donation after euthanasia. On the one hand, the mere mention of the possibility of donating organs or tissues may reinforce some patients' decision to die on demand. On the other hand, these individuals may also no longer feel free to ultimately refuse euthanasia once the procedures to prepare for the transplant have begun.
For further information: EIB Dossier: Organ donation & euthanasia: ethically compatible?
Source: El Pais, 02/02/2026
