The psychological results of the procedure were unclear as well. While concerns were raised about whether recipients of a face transplant and their social circle would have difficulty adjusting, studies had found that disruptions had been minimal. But no transplant had ever been performed where the entire body of an individual is unfamiliar at the conclusion of the procedure, and one of the few documents discussing the ethics in the biomedical literature, a letter to the editor of a journal published in 2015, foresaw a high risk of insanity as a result of the procedure.