Logistics and Strategy of Multiorgan Procurement Involving Total Face Allograft

Abstract

The face is the latest body structure to be added to the field of transplantation and the learning curve is ongoing. In the scenario of multiorgan recovery, the face is a nonvital 'organ' structure compared with other life-saving organs. To date, the face has been the first 'organ' to be procured in a multiorgan procurement. A technique for simultaneous recovery of the whole face, heart, lungs, liver, pancreas and kidneys is described. Thirty professionals participated in the procedure, of whom 13 were surgeons. No tracheotomy was performed. A mask of the donor's face was made from a mold impression. Duration of the procedure from skin incision to the end of surgery was 7.3 h. The face was perfused with Wisconsin solution through a cannula inserted into the aortic arch between the origin of the brachiocephalic arterial trunk and the left subclavian artery. Blood requirements consisted of 4 units of packed red blood cells. After the procedure, the mask was placed on the donor's face. All recovered grafts functioned immediately. In summary, simultaneous multiorgan procurement including the whole face is feasible, effective and saves time without jeopardizing life-saving organs and without the need for tracheotomy.

Successful Recovery and Transplantation of 11 Organs Including Face, Bilateral Upper Extremities, and Thoracic and Abdominal Organs From a Single Deceased Organ Donor

“…Simultaneous VCA and solid organ procurements have been reported before, although not to the extent of our case (3, 4). All those cases include a careful organization and communication with all participating procuring surgeons.…”

Donor Facial Composite Allograft Recovery Operation

“…However, the Paris and Barcelona teams added anthropometrics as a selection criterion for the donors of their full face transplants. 4,34 Differences in the facial allograft recovery protocols of these published cases are summarized in the recent report by Bueno et al on multiorgan recovery, including facial allograft. 34 …”

“…20,25,33,34 These teams selected donors based on ABO compatibility, skin color, and sex. However, the Paris and Barcelona teams added anthropometrics as a selection criterion for the donors of their full face transplants.…”

Novel Donor Transfer Algorithm for Multiorgan and Facial Allograft Procurement

“…In response, FT teams have described their experiences performing simultaneous (1) and asynchronous procurement (2,3). One unanimous conclusion is that the safe procurement of lifesaving organs must be given priority during the donor operation (1)(2)(3). Another consistent viewpoint is that the ideal location for FA procurement is the FT team's home institution (2,3).…”