The landscape of vascularized composite allograft donation in the United States

Henderson, Macey L.

doi:10.1097/mot.0000000000000703

Cited by 10 publications

(12 citation statements)

References 27 publications

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“…VCA transplantation holds high potential for the recovery of life function and quality for those with catastrophic injury or deformity. [8][9][10][26][27][28][29] This includes thousands of military service members who have suffered traumatic improvised explosive device injuries to the face, neck, limbs, and genitourinary system that, in another era, would have resulted in death for many. 15,30 As a result, the DoD has invested more money and resources in VCA transplantation than any other public or private entity.…”

Section: Discussionmentioning

confidence: 99%

Attitudes Toward Organ, Tissue, and Vascularized Composite Allograft (VCA) Donation and Transplantation: A Survey of United States Military Veterans

et al. 2020

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Original Clinical Science-GeneralBackground. There are 20 million living US armed forces veterans; however, the organ donation attitudes of veterans have not been examined. Methods. Over a 17-month period, a convenience sample of 1517 veterans in New England completed a survey to assess attitudes about organ, tissue, and vascularized composite allograft (VCA) donation. Results. Most veterans (96%) supported the donation of organs and tissue for transplantation, and 59% were registered as an organ and tissue donor. Being younger (adjusted odds ratio [aOR]: 0.96 0.97 0.98 ; P = 0.01), female (aOR: 1.06 1.46 2.03 ; P = 0.02), non-Hispanic white (aOR: 1.30 2.07 3.30 ; P = 0.01), Hispanic (aOR: 1.28 2.43 4.61 ; P = 0.01), and having more trust that the transplant process is fair and equal (aOR: 1.19 1.40 1.65 ; P = 0.01) were predictive of donor registration. Also, most veterans were willing to donate their face (57%), hands/arms (81%), legs (81%), penis (men: 61%), and uterus (women: 76%) at time of death; donation willingness was higher for upper and lower limbs than for face or genitourinary organs (P < 0.001). Those unwilling to donate VCA organs expressed concerns about identity loss, psychological discomfort of self and others, body integrity, funeral presentation, and religious beliefs. Most (54%) felt that VCA donation should require permission of legal next-of-kin at the time of one's death, even if the decedent was a registered donor. Conclusions. There is a high level of support for organ, tissue, and VCA transplantation and donation among veterans, despite limited educational campaigns targeting this population. There is high potential among veterans to further increase donor registry enrollment and raise awareness about VCA benefits for severely injured service members.

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Section: Discussionmentioning

confidence: 99%

Attitudes Toward Organ, Tissue, and Vascularized Composite Allograft (VCA) Donation and Transplantation: A Survey of United States Military Veterans

et al. 2020

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“…However, VCA transplantation is a much more novel surgical procedure that may be met with more hesitation in comparison to SOT due to the personal connotation that body parts like the hands, face, or genitourinary organs may carry. 30,35,36 A survey of public opinion regarding willingness to donate one’s face revealed that the main reasons limiting individuals from donating their face included the fear of family members seeing their donated body parts on another individual, fear of losing their identity, and a discomfort surrounding the procurement process and funeral concerns. 37 Despite these hesitations, Plana et al demonstrated that educational initiatives that discuss the indications of FVCA, the process of matching donors with recipients, and operative complications and outcomes may increase the likelihood of individuals’ willingness to donate their face.…”

Section: Discussionmentioning

confidence: 99%

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

Abousy

Jenny

Xun

et al. 2021

Craniomaxillofacial Trauma & Reconstruction

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Study Design: Survey study. Objective: Facial vascularized composite allotransplantation (FVCA) can cost over 1 million dollars per procedure and is usually not covered by insurance, yet this financial burden and public opinion surrounding this procedure are not well understood. This study is the first to evaluate the layperson’s opinions on the allocation of financial responsibility for FVCA and its inclusion in organ donation registries. Methods: Eight hundred and fifteen laypersons were surveyed through MTurk to assess their agreement with 11 statements about FVCA perceptions, funding, and inclusion on organ donation registries. Responses were analyzed with the Wilcoxon Signed-Rank test, the Kruskal-Wallis test, and the Dunn’s test. Results: The majority of respondents were supportive of FVCA in 10 out of 11 statements ( P < 0.0001). They would be willing to undergo FVCA if they suffered from facial disfigurement; believe FVCA is as important as other organ transplants; believe faces should be included on the organ donation registry; support insurance companies providing coverage for FVCA regardless of trauma etiology; support tax dollars funding the procedure; and believe FVCA improves physical appearance and quality of life. Although respondents generally supported their tax dollars funding the procedure, fewer supported this for self-inflicted trauma ( P > 0.01). Conclusions: This study highlights a disconnect between public preference for insurance coverage of FVCA and current lack of coverage in practice. Respondents’ acceptance of including faces in organ donation registries may help alleviate the issue of locating a donor, and increasing financial coverage may broaden this procedure’s accessibility to a wider range of individuals.

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“…There is limited enthusiasm from hand amputees to receive a VCA, despite the increasing number of VCA centres (9). Despite this, 80.3% of those in a government survey were willing to donate their hands and there is evidence that donation is increasing (10). Any discussion is challenging given the limited clinical data available.…”

Section: Donation Screening Matching and Zonal Allocationmentioning

confidence: 99%

Bionic Prostheses: The Emerging Alternative to Vascularised Composite Allotransplantation of the Limb

Amin

Fildes

2022

Front. Surg.

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Twenty years have surpassed since the first vascularised composite allotransplantation (VCA) of the upper limb. This is an opportunity to reflect on the position of VCA as the gold standard in limb reconstruction. The paucity of recipients, tentative clinical outcomes, and insufficient scientific progress question whether VCA will remain a viable treatment option for the growing numbers of amputees. Bionic technology is advancing at a rapid pace. The prospect of widely available, affordable, safely applied prostheses with long-standing functional benefit is appealing. Progress in the field stems from the contributions made by engineering, electronic, computing and material science research groups. This review will address the ongoing reservations surrounding VCA whilst acknowledging the future impact of bionic technology as a realistic alternative for limb reconstruction.

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The landscape of vascularized composite allograft donation in the United States

Cited by 10 publications

References 27 publications

Attitudes Toward Organ, Tissue, and Vascularized Composite Allograft (VCA) Donation and Transplantation: A Survey of United States Military Veterans

Attitudes Toward Organ, Tissue, and Vascularized Composite Allograft (VCA) Donation and Transplantation: A Survey of United States Military Veterans

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

Bionic Prostheses: The Emerging Alternative to Vascularised Composite Allotransplantation of the Limb

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