The Public Face of Transplantation: The Potential of Education to Expand the Face Donor Pool

Plana, Natalie M.; Kimberly, Laura L.; Parent, Brendan; Khouri, Kimberly S.; Diaz-Siso, J. Rodrigo; Fryml, Elise; Motosko, Catherine C.; Ceradini, Daniel J.; Caplan, Arthur L.; Rodriguez, Eduardo D.

doi:10.1097/prs.0000000000003954

Cited by 35 publications

(36 citation statements)

References 21 publications

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“…An educational video has previously been shown to affect willingness to donate for FT, with an 18% increase among participants in one study. 62 Likewise in this study, participants expressed a significant increase in willingness to donate for CSFT if further research could also demonstrate similar outcomes to SSFT. With significant efforts being made to increase VCA donation and expand the donor pool, this again highlights the importance of public education and awareness, as well as the need to pursue CSFT research endeavors to support further evidence-based discussion.…”

Section: Discussionmentioning

confidence: 51%

“…Participants were more willing to donate and receive a facial allograft for SSFT than CSFT, reflecting the skepticism around CSFT. Despite media coverage, a significant portion of the general population remains unaware of its existence, with persistent misconceptions surrounding FT. 62 – 64 Concerns regarding facial appearance, hormonal effects on the allograft and preservation of one’s masculinity or femininity may contribute to the reluctance towards CSFT, as compared to SSFT. Participants were also asked to rate their satisfaction with the outcomes of SSFT and CSFT and to compare one versus the other.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and Perception of Cross-sex Face Transplantation to Expand the Donor Pool

Sosin

Robinson

Diep

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: A major challenge in face transplantation (FT) is the limited donor allograft pool. This study aimed to investigate the feasibility of cross-sex FT (CSFT) for donor pool expansion by: (1) comparing craniomaxillofacial metrics following CSFT versus same-sex FT (SSFT); and (2) evaluating the public and medical professionals’ perception of CSFT. Methods: Seven cadaveric FTs were performed, resulting in both CSFT and SSFT. Precision of bony and soft tissue inset was evaluated by comparing pre- versus post-operative cephalometric and anthropometric measurements. Fidelity of the FT compared to the virtual plan was assessed by imaging overlay techniques. Surveys were administered to medical professionals, medical students, and general population to evaluate opinions regarding CSFT. Results: Five CSFTs and 2 SSFTs were performed. Comparison of recipients versus post-transplant outcomes showed that only the bigonial and medial intercanthal distances were statistically different between CSFT and SSFT (P = 0.012 and P = 0.010, respectively). Of the 213 survey participants, more were willing to donate for and undergo SSFT, compared with CSFT (donate: 59.6% versus 53.0%, P = 0.001; receive: 79.5% versus 52.3%, P < 0.001). If supported by research, willingness to receive a CSFT significantly increased to 65.6% (P < 0.001). On non-blinded and blinded assessments, 62.9% and 79% of responses rated the CSFT superior or equal to SSFT, respectively. Conclusions: Our study demonstrates similar anthropometric and cephalometric outcomes for CSFT and SSFT. Participants were more reticent to undergo CSFT, with increased willingness if supported by research. CSFT may represent a viable option for expansion of the donor pool in future patients prepared to undergo transplantation.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Feasibility and Perception of Cross-sex Face Transplantation to Expand the Donor Pool

Sosin

Robinson

Diep

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“… 19 Furthermore, authorization for VCA donation is often difficult to navigate with families, although educational intervention has been proved to significantly increase willingness to donate. 20 …”

Section: Pre-transplantation Considerationsmentioning

confidence: 99%

The 2020 Facial Transplantation Update: A 15-Year Compendium

Diep

Berman

Alfonso

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary Over the past 15 years, landmark achievements have established facial transplantation (FT) as a feasible reconstructive option for otherwise irreparable craniofacial defects. However, as the field matures and long-term outcomes begin to emerge, FT teams around the world are now facing new challenges. Data for this review were identified by searches of the PubMed/MEDLINE database from inception through August 2020. All English-language articles pertaining to FT were included. Significant advances in candidate selection, technology, operative technique, posttransplant care, and immunosuppressive management have contributed to the tremendous expansion of the field, culminating in the execution in the past 3 years of 2 facial re-transplantations, and most recently the world’s first successful combined face and double hand transplant in August 2020. Despite these achievements, the allograft donor pool remains limited, with long wait times, requiring surgical experimentation with cross-sex FT. Immunosuppressive management has improved, but significant adverse events continue to be reported. Most recently, the COVID-19 pandemic has placed an unprecedented strain on the healthcare system, with various implications for the practice of reconstructive transplantation. In this article, we provide the most comprehensive and up-to-date FT review, highlighting fundamental lessons learned and recent advancements, while looking toward the challenges ahead. Over the past 15 years, extensive multidisciplinary efforts have been instrumental to the establishment of FT as a feasible reconstructive option. As novel challenges are beginning to emerge, continued collaborative and multispecialty research efforts are needed to further this field.

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“…Since the first successful case in France in 2005, more than 45 cases in 10 countries have been reported worldwide, with 1 successfully executed facial transplantation in Belgium in 2012 11–14. Unlike other organ transplantations, facial allograft donation is explicitly visible and concerns an important identity characteristic, making the donation process different and possibly more difficult and complex 11,15,16…”

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confidence: 99%

Facial Allograft Donation: An Interpretative Phenomenological Analysis of the Experiences of Family Members

Verfaillie

Corte

Parys

et al. 2023

Journal of Craniofacial Surgery

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Facial allograft transplantation can be regarded as a particular and complex type of donation because of its perceptibility and the importance of the face as an identity characteristic. As research on this topic is currently lacking, the objective of this study is to explore the experiences of the family members of the donor in facial allograft donation. In-depth, semi-structured interviews were conducted separately with the donor's family members and analyzed using interpretative phenomenological analysis. Six themes were identified: (1) Contrasting facial donation to that of more commonly donated organs; (2) Consenting to facial donation; (3) Expectations towards the recipient of the facial graft; (4) Expectations and consequences of restoration of the donor's face; (5) Relationship with the medical team during the process; and (6) Media attention. The findings of our study help to better support donor families through the facial donation process and to improve facial transplantation procedures.

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The Public Face of Transplantation: The Potential of Education to Expand the Face Donor Pool

Abstract: Educational interventions hold much promise for increasing the general public's awareness of facial transplantation and willingness to participate in donation of facial allografts.

Cited by 35 publications

References 21 publications

Feasibility and Perception of Cross-sex Face Transplantation to Expand the Donor Pool

Feasibility and Perception of Cross-sex Face Transplantation to Expand the Donor Pool

The 2020 Facial Transplantation Update: A 15-Year Compendium

Facial Allograft Donation: An Interpretative Phenomenological Analysis of the Experiences of Family Members

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