Editorial: Psychosocial and bioethical challenges and developments for the future of vascularized composite allotransplantations

Incorporating Trauma-informed Approaches to Care in Vascularized Composite Allotransplantation

“… 22 This research also has the potential to further identify supportive measures and interventions necessary to improve surgical outcomes and extend surgical eligibility beyond current candidates. 10 The current absence of data is not evidence in and of itself, particularly as the sequelae of trauma can extend far beyond the causative episode.…”

“…9 Many VCA candidates and recipients have endured physical and psychological trauma resulting in the need for VCA, and recognition of the impact of traumatic experiences on short-and long-term outcomes of surgery can help to ensure optimal postsurgical recovery. 10 This is especially the case given that immunosuppressive nonadherence can lead to allotransplant tissue necrosis and graft loss. 11 In other subspecialties of plastic surgery and general surgery, a trauma-informed care (TIC) approach has led to improvements in patient support and surgical outcomes.…”

What is needed to ensure long-term sustainability for the field of vascularized composite allotransplantation?

“…Video messaging to spread awareness of VCA, especially when blended with patient testimonials significantly improved donation willingness [41]. A publicly available website, Within Reach, was developed to provide patients, families, and healthcare providers with patient-centered information on upper extremity VCA [33,[42][43][44]. Such information is critical for informed consent both for the recipient and for potential donors.…”

“…Ethical themes include nonmaleficence, including risks of immunosuppression and clinical imperfections; beneficence, restoring form and function and reintegrating into occupational and social spheres; and justice, involving burden to donors, appropriate and equitable patient selection, and personal and systemic costs [46]. These pillars of medical ethics continue to be debated, but open, honest discussion on a multidisciplinary platform engaging clinical, patient, and research perspectives would help gain public trust [42].…”