Vascularized Composite Tissue Allografts (VCA): the Policy Side

McDiarmid, Sue V.; Levin, L. Scott; Luskin, Richard S.

doi:10.1007/s40472-016-0094-9

Cited by 16 publications

(13 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One report indicated a lack of uniformity in how OPOs handle family approaches for allograft donation. 13 Our own national study of DPs employed by 39 OPOs confirmed wide variability in allograft request frequency and practices. 1 Over 70% of the sample reported no experience discussing VCA and allograft donation or limited experience 1 and nearly one-fifth reported feeling completely unprepared to discuss allograft donation with families.…”

Section: Introductionmentioning

confidence: 59%

“…The general public's limited awareness and understanding of VCA, coupled with DPs' infrequent discussion of the topic or allograft donation present unique, but modifiable, challenges to securing family authorization. 10,13 To address these challenges, we adapted an evidencebased and empirically proven training for DPs, Communicating Effectively about Donation (CEaD), for allograft donation discussions. [14][15][16][17][18] The training program was modified for discussions of hand and face donation by integrating formative research about the public's most common VCA-related concerns and questions, 19 as well as DPs' experiences with allograft discussions.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2022

View full text Add to dashboard Cite

Introduction Vascularized composite allotransplantation (VCA) donation relies on obtaining surrogate authorization. Yet, many donor professionals have limited experience discussing composite allograft donation. Using virtual and interactive elements, the eLearning program, Communicating Effectively about Donation for Vascularized Composite Allotransplantation (CEaD-VCA), was developed to enhance the quality of donor professionals’ communication approach. Research Questions We tested the effectiveness of the eLearning program in improving donor professionals’ knowledge, preparedness, and confidence leading discussions with families. Design Donor professionals who primarily obtain family authorization for solid organ and tissue donation were recruited from 2 regional Organ Procurement Organizations. The training was evaluated using a nonrandomized pre-post design. Participants completed an online survey with items assessing their knowledge, preparedness, and confidence for donation discussions. Pre- and post-training responses were compared using paired sample t-tests. Results The sample included 42 donor professionals. The majority (71.4%) had at least 3 years of work experience, and over half (52.4%) had no experience discussing VCA donation with families. Post-training, significant increases in mean knowledge scores (6.4 pre to 7.0 post, P < 0.01) and mean self-reported preparation (6.6 pre to 7.9 post, P < 0.0001) were observed. There were significant increases in mean confidence scores for discussing face (6.2 pre to 7.9 post, P < 0.0001) and hand (6.2 pre to 8.0 post, P < 0.0001) transplants. Conclusion The CEaD-VCA program was effective in increasing donor professionals’ knowledge, preparation, and confidence when discussing donation, and holds potential for improving donor professional communication during donation discussions.

show abstract

Section: Introductionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

View full text Add to dashboard Cite

show abstract

“…In 2008, the United States Department of Health and Human Services asked for oversight of VCA transplant, beginning with a definition and inclusion as an organ in the Final Rule 3 . In 2014, VCA was defined in the Final Rule, which established ongoing Organ Procurement and Transplantation Network (OPTN) oversight and gave access to solid‐organ procurement and transplant guidelines 4,5 . The definition of VCA transplant is the transplant of any body part which meets all of the following criteria: 6 ‐Is vascularized and requires blood flow by surgical connection of blood vessels to function after transplant ‐Contains multiple tissue types ‐Recovered from a human donor as an anatomic/structural unit ‐Surgically implanted in a human recipient as an anatomic/structural unit ‐Minimally manipulated (ie, processing that does not alter the original relevant characteristics of the organ relating to its utility for reconstruction, repair, or replacement) ‐For homologous use (the replacement or supplementation of a recipient’s organ with an organ that performs the same basic functions in the recipient as in the donor) ‐Not combined with another article such as a device ‐Susceptible to ischemia and, therefore, stored only temporarily and without cryopreservation ‐Susceptible to allograft rejection …”

Section: Introductionmentioning

confidence: 99%

OPTN/SRTR 2020 Annual Data Report: VCA

Hernández

Miller

Oleck

et al. 2022

American Journal of Transplantation

View full text Add to dashboard Cite

The first vascularized composite allograft (VCA) transplant in the United States was performed in 1998 in a 40‐year‐old man who received a laryn‐geal transplant after experiencing severe trauma to the throat 20 years before. The following VCA was a hand transplant in 1999 in a 37‐year‐old man who lost his left hand 13 years before. Since then, the field of VCA transplantation has made significant strides. On July 3, 2014, the Or gan Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) oversight of VCA procurement and transplant in the United States went into effect. In the last decade, the number of candidates listed for and transplanted with VCA has increased. While patient demographic data, whether listed candidates or patients undergoing VCA transplant, is limited by sample size, the trend is a predominance toward a young/middle‐aged, White population. Overall outcomes data have been promising, with the vast majority of VCA transplants resulting in functioning grafts.

show abstract

“…The Committee, which included transplantation and reconstructive physicians and surgeons, an ethicist, a hand recipient, and representatives from OPOs and transplant centers, recommended new policies, drawing on the more than 60 years of collective knowledge of solid organ transplantation. After approval by the OPTN Board of Directors, these policies were implemented and included modifications to definitions within the OPTN policy and bylaw structure in addition to new parameters for VCA allocation, membership requirements for VCA transplant programs, donor authorization requirements distinct from other solid organ donation, data collection and submission requirements, and guidance documents for the donation and authorization process …”

Section: Introductionmentioning

confidence: 99%

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

Cherikh¹,

Cendales

Wholley³

et al. 2019

American Journal of Transplantation

View full text Add to dashboard Cite

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.

show abstract

Vascularized Composite Tissue Allografts (VCA): the Policy Side

Cited by 16 publications

References 7 publications

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

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

OPTN/SRTR 2020 Annual Data Report: VCA

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

Contact Info

Product

Resources

About