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

Abstract

On July 3, 2014, the Organ Procurement and Transplantation Network/United Network for Organ Sharing was charged with the oversight of vascularized composite allograft (VCA) procurement and transplantation in the United States. As of December 31, 2017, 61 VCA programs at 27 centers were approved in the United States. Fifty candidates have been added to the waiting list at 15 centers. Twenty-eight VCA transplants have been performed at 14 programs (10 upper limb, 10 uterus, 5 craniofacial, 1 scalp, 1 abdominal wall, and 1 penile). Twenty-two VCAs were procured from 21 deceased donors, resulting in 109 non-VCA organs transplanted (15 hearts, 3 intestine, 40 kidney, 20 livers, 24 lungs, and 7 pancreata). Six uterus transplants were performed from living donors. Fourteen candidates were still waiting at 9 centers on December 31, 2017. Two of the 10 uterus recipients had live births and 3 still had viable grafts. Seventeen of 18 nonuterus recipients had functioning grafts. At present, VCA is an emerging field with a small number of patients transplanted. Data on posttransplant survival and functional outcomes continue to be collected to further the understanding of this complex and evolving field. Further systematic data are important for policy refinement and assurance of patient safety.

Hand transplantation in the United States: A review of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Database

“…Prior to implementation of the mandatory OPTN data collection for upper extremity VCA on July 3, 2014, a total of 10 institutions reported to have performed upper extremity transplantation. After July 3, 2014, there have been 9 programs that have reported to have performed upper extremity transplantation, with 18 programs approved for upper extremity VCA as of 2017 …”

<p>Public attitudes toward vascularized composite allograft donation: a literature review</p>

“…As the field of VCA is elementary, proceeding with VCA in clinical practice and research has several ethical implications. As the regulatory guidance 15,17,44,45 on patient selection, qualifications of the surgical team, management of transplant failure and patient dissatisfaction is mostly derived from solid organ transplant literature; there is an urgent need to focus on factors that are unique to VCA. To elaborate, the patient-provider relationships in VCA are distinct and challenging as surgeons, patient, family and caregivers spend extensive time with each other due to the complexity and long-term risks of the procedure.…”

“…Patients who undergo VCA face the lifelong burden of immunosuppression and its associated side-effects and complications, possible rejection (acute and chronic), psychological adjustment and need for prolonged rehabilitation. 16,17 As such, the costs of VCA-associated interventions can be extensive. The growth of VCA procedures depends on the availability of skilled restorative plastic surgeon and surgical team, institutional support with required tangible and intangible resources and the viewpoints of medical community and general public on the benefit and risks of VCAs.…”

VCA Joins UNOS: A Five-Year Update

“…VCA allografts are now defined as organs and, therefore, VCA falls under the organ transplant legislation. 1 Dr. McDiarmid was the first chair of the OPTN/UNOS VCA Transplantation Committee, and Dr. Cendales is the current chair. According to Dr. McDiarmid, "It took quite a while to get the piece of legislation that defined a VCA as an organ passed."…”