Vascularized composite allotransplantation: emerging psychosocial issues in hand, face, and uterine transplant

Abstract

Purpose of reviewCurrently, several research approaches warrant further attention, given the influence of psychosocial and bioethical issues on the success of upper extremity (UETx), face (FTx), and uterine transplantation (UTx). This review will highlight recent results of psychosocial and bioethical research in the field of vascularized composite allotransplantation (VCA), discuss most recent findings, provide information to guide future research approaches, and address the importance of a multicenter research approach to develop international standards. Recent findingsPreviously published reports have tried to identify psychosocial factors that are essential to predict psychosocial outcomes and guide posttransplant treatment after VCA procedures. These issues in VCA are receiving more attention but we are still at the beginning of a systematic investigation of these domains. This review article summarizes the emerging psychosocial issues in UeTx, FTx, and UTx by including recent literature and current clinical practice. SummaryEven though different VCA procedures address different domains leading to specific psychosocial issues, common aspects impacting all forms of VCA would benefit of further coordination. These domains include clinical resources, public attitude and perception, bioethical considerations, adherence and rehabilitation, motives for VCA, information needs and multidisciplinary communication, body image, domains of quality of life, coping strategies, and follow-up care.

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.…”

“…Lack of insurance coverage and disparity in evaluation criteria for VCA may lead to access inequity [9 && ]. Thus far, for uterus transplant, 89.2% of recipients were white, 5.4% Asian, and 2.8% Black, possibly highlighting the beginnings of racial and ethnic disparities [33]. On the other hand, outside of the United Kingdom (UK), VCA is performed through clinical trials in Europe, but it may be covered by insurance, with patients in the UK, France, and Spain absolved of any financial responsibility [8,32,33].…”

“…Thus far, for uterus transplant, 89.2% of recipients were white, 5.4% Asian, and 2.8% Black, possibly highlighting the beginnings of racial and ethnic disparities [33]. On the other hand, outside of the United Kingdom (UK), VCA is performed through clinical trials in Europe, but it may be covered by insurance, with patients in the UK, France, and Spain absolved of any financial responsibility [8,32,33]. Standardization of indications and metrics of success is reasonably requested to justify payment coverage, but difficult in a heterogeneous field like VCA [9 && ].…”

“…In addition to these objective results, improved subjective assessment with PROs will be needed. The US Department of Defense (DoD) recognized the lack of standardization in obtaining PROs and issued a call for proposals in 2022 [33]. Currently, as with solid organ transplantation, screening for depression and anxiety is routine.…”

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

“…The Chauvet Workgroup holds great value and potential because of its core principle of collaborative international research and clinical approach to the psychosocial evaluation in VCA. The Chauvet Workgroup has been endorsed by both the International Society for VAC (ISVCA) and American Society for Reconstructive Transplantation (ASRT) with regular presentations at their meetings to summarize activities of the biennial workshops (Jowsey-Gregoire et al, 2016 ; Kumnig and Järvholm, 2022 ).…”