2549: Results of a survey of organ procurement organizations to identify barriers to VCA authorization and recovery in the US

Cherikh, Wida S.; Harper, Ann; Luskin, Richard S.; Wholley, Christopher; McDiarmid, Sue V.

doi:10.1080/23723505.2016.1232979

Cited by 3 publications

(4 citation statements)

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“…A published work by Aycart et al concluded that with careful planning, and coordination, the procurement of facial VCA and simultaneous upper extremities is safe and does not appear to interfere with the procurement and outcomes of lifesaving, solid organ transplants . The Committee conducted a survey to examine barriers to VCA authorization and recovery across OPOs . Briefly, the result showed that 54% of 44 OPOs that responded indicated no interest in establishing a written protocol for VCA authorization and recovery due to lack of approved local programs as a barrier for establishing a written protocol, whereas 46% indicated no barriers.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the survey also underscore the need for educational efforts among OPOs, especially in OPOs with no active VCA transplant center, in order to optimize VCA recovery from deceased donors and increase the numbers of VCA transplants. Additionally, a survey on public attitude towards VCA donation and transplantation has been reported . The survey showed that 67% of responders would donate hands/forearms and legs; however, many who opposed VCA donation reported concerns regarding apprehension related to psychological discomfort, mutilation, identity loss, and the reaction of others to seeing familiar body parts on a stranger .…”

Section: Discussionmentioning

confidence: 99%

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Vascularized composite allotransplantation in the United States: A descriptive analysis of the Organ Procurement and Transplantation Network Data

Cherikh¹,

Cendales

Wholley³

et al. 2019

American Journal of Transplantation

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On July 3, 2014, the Organ Procurement and Transplantation Network/United Network for Organ Sharing was charged with the oversight of vascularized composite allograft (VCA) procurement and transplantation in the United States. As of December 31, 2017, 61 VCA programs at 27 centers were approved in the United States. Fifty candidates have been added to the waiting list at 15 centers. Twenty-eight VCA transplants have been performed at 14 programs (10 upper limb, 10 uterus, 5 craniofacial, 1 scalp, 1 abdominal wall, and 1 penile). Twenty-two VCAs were procured from 21 deceased donors, resulting in 109 non-VCA organs transplanted (15 hearts, 3 intestine, 40 kidney, 20 livers, 24 lungs, and 7 pancreata). Six uterus transplants were performed from living donors. Fourteen candidates were still waiting at 9 centers on December 31, 2017. Two of the 10 uterus recipients had live births and 3 still had viable grafts. Seventeen of 18 nonuterus recipients had functioning grafts. At present, VCA is an emerging field with a small number of patients transplanted. Data on posttransplant survival and functional outcomes continue to be collected to further the understanding of this complex and evolving field. Further systematic data are important for policy refinement and assurance of patient safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vascularized composite allotransplantation in the United States: A descriptive analysis of the Organ Procurement and Transplantation Network Data

Cherikh¹,

Cendales

Wholley³

et al. 2019

American Journal of Transplantation

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“…In 2016, the OPTN VCA Committee coordinated a survey of US OPOs to better understand barriers and opportunities for deceased donor VCA. Cherikh et al [32] demonstrated that OPOs see several barriers to VCA recovery, including distance to the nearest VCA program, concern over additional operating room time at donor hospital, potential for interference with life-saving organ recovery, concern over donor family resistance, and variability in organ acquisition fees passed on to VCA transplant programs. The barriers described above likely contribute to delays in OPOs developing and optimizing VCA recovery procedures and protocols, which contributes to missed potential VCA donors, and has been the subject of new OPTN guidance.…”

Section: Expanding Vascularized Composite Tissue Allograft Donation I...mentioning

confidence: 99%

The landscape of vascularized composite allograft donation in the United States

Henderson

2019

Current Opinion in Organ Transplantation

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Purpose of reviewVascularized composite allograft (VCA) donation and transplantation has now demonstrated feasibility and impact to the lives of patients suffering from devastating and traumatic injury. This review summarizes the current landscape of VCA donation in the United States. Recent findingsVCA donations are nonlife-saving allografts, for nonlife-saving transplants -and therefore, conservative donor selection focused on the optimization of donors for the lowest risk to transplant recipients is paramount. VCA donors in the United States are a demographically and clinically diverse group that largely reflects the characteristics of the VCA candidates waiting for transplants. Public opinion about VCA donation is generally supportive, but has lower support for VCA transplants than for solid organ transplants.

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“…The VCA community has been sensitive to this question and its implications for—among other things—operating room procedures and the process of donor consent, so as to not interfere with protocols in place for solid organ transplants 4 . In 2016, the OPTN VCA Committee surveyed organ procurement organizations (OPOs) in the United States to identify the barriers to VCA recovery, noting that (a) a perception that additionally seeking VCA authorization from a donor family could inadvertently discourage SOT authorization , and (b) a perception that additional time in the operating room attributed to VCA recovery could have adverse effects on the success of SOT recovery were among the reasons how VCA could potentially interfere with the utilization of solid organs 5 …”

Section: Introductionmentioning

confidence: 99%

Maximizing donors’ gifts: A comparison of actual and expected solid organ yield among VCA donors

Vece¹,

Robinson²,

Rosendale³

et al. 2021

American Journal of Transplantation

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Vascularized Composite Allograft (VCA) transplantation provides life‐changing transplants, but VCA adds complexity to the donation process and timing, possibly impeding solid organ donation. Expanding upon descriptive analyses, this study examines risk‐adjusted predictions versus the observed number of organs donated by VCA donors. Our cohort included VCA donors in the United States during January 1, 2008–December 31, 2017 (n = 51), using OPTN Deceased Donor Registration Form data and the Scientific Registry of Transplant Recipients (SRTR) donor yield models to calculate observed‐to‐expected (O:E) yield ratios. Almost all VCA donors’ livers (48/51; 94.1%) and kidneys (92/102; 90.2%) were transplanted, with fewer hearts (28/51; 54.9%), lungs (46/102; 45.1%), pancreata (15/51; 29.4%), and intestines (3/51; 5.9%) transplanted. O:E ratios for overall organ yield were slightly greater than expected for VCA donors (1.10; 95% CI: 1.02–1.17). Liver (1.17: 1.08–1.27) and lung yields (1.38: 1.07–1.68) were both greater than expected, while kidney, heart, and pancreas yields were similar to expected. Across VCA types, bilateral upper limb and abdominal wall donors had better‐than‐expected yields while uterus, face, and unilateral upper limb donors all had similar‐to‐expected yields. Solid organ yield among VCA donors was as good or better than predicted, suggesting that VCA donation does not compromise recovery and transplantation of lifesaving organs.

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2549: Results of a survey of organ procurement organizations to identify barriers to VCA authorization and recovery in the US

Cited by 3 publications

References 0 publications

Vascularized composite allotransplantation in the United States: A descriptive analysis of the Organ Procurement and Transplantation Network Data

Vascularized composite allotransplantation in the United States: A descriptive analysis of the Organ Procurement and Transplantation Network Data

The landscape of vascularized composite allograft donation in the United States

Maximizing donors’ gifts: A comparison of actual and expected solid organ yield among VCA donors

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