Prevalence and Distribution of Potential Vascularized Composite Allotransplant Donors, Implications for Optimizing the Donor-recipient Match

Abstract

Background:Vascularized composite allotransplantation (VCA) is an emerging and growing field. Little is known about the prevalence and distribution of the adult potential donor population in the United States now that it falls under the oversight of the United Network for Organ Sharing (UNOS).Methods:We assessed the UNOS database from 2008 to 2015 to estimate the prevalence and distribution of adult potential vascularized composite allograft donors. Donor inclusion and exclusion criteria were developed in a way to minimize risk to recipients and were applied to the dataset. Donors were categorized by factors that influence vascularized composite allograft matching including ABO blood type, cytomegalovirus status, and ethnicity (correlate for skin color) and sorted by UNOS region.Results:Just under half of all brain dead donors met the inclusion/exclusion criteria. Blood type O, cytomegalovirus+, White donors represented the most frequent donor profile while blood type AB, cytomegalovirus-, Asian donors were the least common. UNOS region 3 had the most and region 1 had the least potential VCA donors per year. Nearly all potential VCA donors were solid organ donors with the liver being the most commonly donated solid organ in this population.Conclusions:A large portion of the solid organ donor pool would qualify as adult vascularized composite allograft donors in the current UNOS system. These data will assist transplant teams in determining the prevalence and distribution of vascularized composite allograft donors for their individual patients awaiting composite allografts based on relevant matching characteristics in addition to standard transplant criteria.

Validating a Novel Device to Improve Skin Color Matching for Face Transplants

“…This seems to be a more objective method than what has been previously described in the literature, where ethnicity has been used as a correlate for skin color. 3 The major limitation in studying VCA is its relatively small sample size. This makes studying the impact of a mismatch and the potential to avoid it a difficult task, due to the lack of procedures performed and of available donors.…”

Pre-transplant management and sensitisation in vascularised composite allotransplantation: A systematic review

“…Approximately 40% of all donors after brainstem death (DBD) currently meet the united Network for Organ Sharing criteria for eligible VCA donation. 40 Estimates from the USA alone indicate that 185,000 individuals undergo extremity amputation each year, of which approximately 100,000 are due to vascular disease and 83,000 are due to traumatic injury. 41 A further 3 million craniofacial injuries present to emergency departments annually, of which 15,000 are catastrophic disfiguring injuries.…”

Should a Caregiver's QoL Be Considered in Decisions About Whether a Patient Has an Experimental Double-Hand Transplant?

“…Related to the lack of preparedness, the couple's expectations of financial security from medical celebrity after hand transplantation were unfounded. Additionally, the caregiver would seldom accompany her partner to consults, but, when present, the caregiver perseverated on the inability to find a donor-a not uncommon happening 31 -and often became argumentative. Differences between the nonprofessional caregiver and the treatment teams impeded the development of trusting relationships, which led to our institution's declining this patient's candidacy for transplant.…”