An overview of psychosocial assessment procedures in reconstructive hand transplantation

Kumnig, Martin; Jowsey, Sheila G.; Moreno, E.; Brandacher, Gerald; Azari, Kodi; Rumpold, Gerhard

doi:10.1111/tri.12220

Cited by 35 publications

(45 citation statements)

References 62 publications

(226 reference statements)

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“…This problem has been well documented in the pediatric solid organ transplant literature, especially in adolescents . In the adult VCA literature, non‐compliance with immunosuppression has been demonstrated to be the greatest risk factor for graft loss . In order to mitigate this issue, strong family/parental support and understanding should be essential criteria when screening children for CVA.…”

Section: Discussionmentioning

confidence: 99%

“…[34][35][36] In the adult VCA literature, non-compliance with immunosuppression has been demonstrated to be the greatest risk factor F I G U R E 3 World's first pediatric bilateral hand transplant recipient performing the 9-hole peg test at 31 months post-transplantation for graft loss. [37][38][39] In order to mitigate this issue, strong family/parental support and understanding should be essential criteria when screening children for CVA.…”

Section: Induction Of Tolerance In Transplant Patients Has Potential Tomentioning

confidence: 99%

See 1 more Smart Citation

Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Mendenhall

Sawyer

West

et al. 2019

Pediatric Transplantation

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Listing the world's first pediatric bilateral hand transplant patient for a donor posed many challenges including matching the appropriate donor age, bone size, skin tone, and growth potential in an already limited donor population. This study describes the prevalence and distribution of potential pediatric VCA donors in the United States. We assessed the UNOS database from 2008 to 2015 to identify the prevalence of potential pediatric VCA donors. Standard VCA inclusion and exclusion criteria were applied to the dataset for all pediatric solid organ donors. Frequency analyses were performed of characteristics important for VCA matching. The dataset began with 57 300 brain‐dead donors and after applying the inclusion and exclusion criteria including age <18, decreased to 4663 (8.1%). The number of pediatric potential VCA donors per UNOS region ranged from 11 to 112/year. The majority of pediatric potential VCA donors were blood type O Whites, with the least common profile being blood type AB of “other” ethnicity. The present study confirmed that pediatric VCA donors are rare and may require longer travel times for procurement and listing at multiple centers in order to find a suitable donor. This will be a limiting factor for the expansion of pediatric VCA.

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Section: Discussionmentioning

confidence: 99%

Section: Induction Of Tolerance In Transplant Patients Has Potential Tomentioning

confidence: 99%

Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Mendenhall

Sawyer

West

et al. 2019

Pediatric Transplantation

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show abstract

“…6 Currently, there are no psychosocial instruments designed specifically for use in this unique population. 6,10,11,12,13 In consequence, a variety of PSE protocols are used by individual transplant centers (see Supplementary Appendix). Standardized collection of subjective QoL outcomes data would likely increase confidence in research findings on factors predictive of improved QoL.…”

Section: Data Collection Standardizationmentioning

confidence: 99%

Why Quality-of-Life Data Collection and Use Should Be Standardized When Evaluating Candidates for Hand Transplantation

2019

AMA Journal of Ethics

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This article argues for 3 mutually reinforcing interventions in the field of hand transplantation (HTx): (1) collection of qualitative data about hand transplant recipients' subjective quality of life (QoL) outcomes, (2) multicenter standardization of data collection, and (3) use of data to develop evidence-based, standardized protocols for HTx candidate evaluation and information disclosure. These interventions are needed to improve candidate evaluation and informed consent processes in HTx, wherein the highly personal nature of desired outcomes justifies holding a candidate's consent to a standard approaching authenticity rather than the usual minimal standard of being informed and voluntary.

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“…30 The poor quality of QoL outcomes reporting in the first 2 decades of HTx and VCA experimentation has been remarked on by health care policy and behavioral health researchers and HTx practitioners. 17,19,31 Martin Kumnig and colleagues wrote in a 2014 review paper:…”

Section: Gaps In the Literature On Htx And Vcamentioning

confidence: 99%

“…The majority of articles do not address the psychosocial assessment in any greater than passing detail, so the conclusion that can be made from these highly descriptive, mostly empiric studies in the current literature is limited. 31 According to United Kingdom hand transplant surgeons Simon Kay and Daniel Wilks, "Of the large number of [hand and face] transplants completed now, outcome data of value is to be found in few." 32…”

Section: Gaps In the Literature On Htx And Vcamentioning

confidence: 99%

What's Missing in Our Thinking About Quality of Life in VCA?

Herrington

2019

AMA Journal of Ethics

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Drawing on the principles of respect for autonomy and beneficence, many scholars have argued that despite significant drawbacks of immunosuppression and surgery, vascularized composite allotransplantation (VCA), such as hand and face transplantation, has the potential to enhance the lives of patients who meet appropriate criteria and are well supported. This article provides a brief overview of the literature on VCA with a focus on hand transplantation (HTx) and offers a critique of the lack of empirical data on HTx patients' perspectives. Quality of Life in Hand Transplants Within a few years after the publication of the first journal articles arguing for the ethical and scientific viability of hand transplantation in the modern era of immunosuppression, 1,2,3 hand transplantation (HTx) and other forms of vascularized composite allotransplantation (VCA) had become technically possible, 4,5,6 and they now are viewed as beneficial for properly selected and supported recipients. 7,8,9,10 Because reconstructive transplantation, such as hand and face transplantation, does not afford the lifesaving or life-extending benefits that have so far characterized transplant medicine, the permissibility of VCA resides in the potential of these transplants to enhance recipients' subjective quality of life (QoL) for as long as they have their allograft. Realizing potential gains in QoL is complicated, however, by the burdens of lifelong immunosuppression to prevent graft rejection and loss, which can also potentially limit longevity.

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An overview of psychosocial assessment procedures in reconstructive hand transplantation

Cited by 35 publications

References 62 publications

Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Why Quality-of-Life Data Collection and Use Should Be Standardized When Evaluating Candidates for Hand Transplantation

What's Missing in Our Thinking About Quality of Life in VCA?

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