VCA Deceased Donors in the United States

Abstract

Background. Vascularized composite allograft (VCA) transplants include diverse organ types and are made possible primarily by deceased donors. Methods. We used Organ Procurement and Transplantation Network data to characterize VCA deceased donors (n = 66 of 70) in the United States from 1998 to 2017 and compare their characteristics with those of kidney donors in 2017. Results. Through December 31, 2017, 20 transplant programs performed 72 deceased-donor VCA transplants, with organs donated by 70 donors, including 30 upper limb (17 unilateral and 13 bilateral) and 11 face donors. Other donors donated both upper limbs and face (n = 2), uterus (n = 4), abdominal wall (n = 19), larynx (n = 2), penis (n = 1), and scalp (n = 1). About a third of VCA donors were female, and the majority (86.4%) were white. Almost half (45.5%) were between the ages 18 and 34 years. Smaller proportions were younger than 18 years (19.7%), 35 to 44 years (15.2%), 45 to 54 years (13.6%), and older than 55 years (6.1%). Median body mass index for all VCA donors was 24.9 and varied widely, especially for upper limb and face donors. There was considerable variation in Kidney Donor Profile Index among VCA donors (median, 27.5; interquartile range, 11–59). Donor causes of death included head trauma (39.4%), cerebrovascular/stroke (25.8%), and anoxia (31.8%). VCA donors also donated solid organs that were transplanted, including 87.1% of kidneys, 93.9% of livers, 40.2% of lungs, and 56.1% of hearts. Conclusions. donors are a demographically and clinically diverse group. Understanding this diversity and future trends in VCA donor characteristics is critical in supporting this life-changing field of transplantation.

Vascularized composite allotransplantation in the United States: A retrospective analysis of the Organ Procurement and Transplantation Network data after 5 years of the Final Rule

“…The present analysis of VCAs reported after the OPTN Final Rule adds to an expanding body literature that seeks to characterize the clinical indications and outcomes of VCA. 20,21 In our study, the most well-reported variables in the analysis dataset are binary values for medications prescribed. Other well-reported variables include perioperative metrics (antibiotics, anticoagulation, ischemia times).…”

“…Unlike SOT, where improvements in serum creatinine or MELD score can be imputed as clinical improvement, the VCA field relies upon assessment of clinical function. The present analysis of VCAs reported after the OPTN Final Rule adds to an expanding body literature that seeks to characterize the clinical indications and outcomes of VCA 20,21 . In our study, the most well‐reported variables in the analysis dataset are binary values for medications prescribed.…”

Policies and Price Tags: The Public’s Perception of Face Transplantation and Its Funding

“…Post-hoc analysis revealed a significant difference in opinions in the improvement of appearance (item 2) and importance of FVCA compared to SOT (item 8) based on respondent age (P < 0.05 for both). Older respondents (55-64) found FVCA to improve patient appearance more than younger respondents (25)(26)(27)(28)(29)(30)(31)(32)(33)(34). However, older respondents (45-74) were less likely than younger to think FVCA was as important as other organ transplants.…”

Evaluation of an eLearning System to Train Health Professionals to Communicate about Vascularized Composite Allotransplantation with Donor Families

“…Vascularized composite allotransplantation (VCA) refers to the transplantation of anatomical units with multiple types of tissue, such as the face and hands. 1 Considered life-changing 2 by trauma patients for whom traditional reconstructive procedures have not been optimally successful, VCA transplants are novel. Approximately 200 to 300 VCAs have taken place around the world, 3 with 113 having been performed in the United States to date.…”