Vascularized Composite Allograft Donation and Transplantation: A Survey of Public Attitudes in the United States

Abstract

Vascularized composite allograft (VCA) transplantation has emerged as a groundbreaking surgical intervention to return identity and function following traumatic injury, congenital deformity, or disfigurement. While public attitudes toward traditional organ/tissue donation are favorable, little is known about attitudes toward VCA donation and transplantation. A survey was conducted of 1485 U.S. residents in August 2016 to assess VCA donation attitudes. Participants also completed the Revised Health Care System Distrust Scale. Most respondents were willing to donate hands/forearms (67.4%) and legs (66.8%), and almost half (48.0%) were willing to donate the face. Three-quarters (74.4%) of women were willing to donate the uterus; 54.4% of men were willing to donate the penis. VCA donation willingness was more likely among whites and Hispanics (p < 0.001), registered organ/tissue donors (p < 0.001), and those with less health care system distrust (p < 0.001) and media exposure to VCA transplantation (p = 0.003). Many who opposed VCA donation expressed concerns about psychological discomfort, mutilation, identity loss, and the reaction of others to seeing familiar body parts on a stranger. Attitudes toward VCA donation are favorable overall, despite limited exposure to VCA messaging and confusion about how VCA donation occurs. These findings may help guide the development and implementation of VCA public education campaigns.

Uterus Transplantation with Live Donors: Screening Candidates in One French Center

“…Re-use of the uterus of recipients after closure hysterectomy could be attractive but is at greater risk of rejection [31]. Altruistic donation is cultural and more developed in the US, where a survey about public attitude toward vascularized composite allograft donation showed that 70% of women were willing to donate their uterus [32]. However, we received two potential altruistic donors in our trial.…”

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

“…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 . In addition, potential donors may decline donation of lifesaving organs if a nonpreferred VCA type is requested (eg, some may consider donation of a face but not a genitourinary organ) …”

Penile transplantation: the US experience and institutional program set-up

“…Penile transplant, while in its infancy, promises improved overall surgical outcomes with regard to cosmesis and function, as well as limiting the need for repeat highly complex surgical re-interventions. Educating the public and overcoming bias against donation of GU tissue for vascularized composite allograft transplantation will be a major hurdle to the success of this treatment modality ( 31 , 32 ). At the Johns Hopkins Medical Institutions, there is an ongoing effort to identify ideal candidates to participate in the GU vascularized composite allotransplantation protocol.…”