Overview

When someone experiences the loss of a limb or severe facial disfigurement, one of their options may be vascularized composite allotransplantation (VCA), which transfers a graft containing multiple tissues transferred as a functional unit. Using VCA to restore the functionality and aesthetics of a lost upper limb or disfigured face is a profound and life-altering gift; however, the process and the decision to accept (or donate) a VCA graft is complex and deeply emotional. In addition to psychosocial considerations, a VCA recipient must commit to undergoing years of rigorous rehabilitation, have a robust support system in place, and accept and understand the risks of being on immunosuppressive drugs for the rest of their life. Despite VCA advances over the last 25 years, challenges remain, and the small number of recipients of face or hand transplants makes it difficult to generalize outcomes. To address these challenges, the Department of Defense Reconstructive Transplant Research Program tasked a committee of the National Academies with developing principles and a framework for the standardization, assessment, and validation of protocols and standard operating procedures for face and hand transplantation. The resulting report offers guidance for the newly established Clinical Organization Network for Standardization of Reconstructive Transplantation (CONSORT), but it also includes specific recommendations to enable the larger VCA community to mature, advance, and thrive into the future. Table of Contents Front Matter Summary PART I: Background on VCA 1 Introduction and Study Context 2 VCA Background Information and Context 3 Overarching Considerations Influencing Face and Hand Transplantation PART II: The Transplant Experience 4 The Transplant Experience: The Preoperative Stage 5 The Transplant Experience: Surgical Procedures and Care Management 6 The Transplant Experience: Outcomes PART III: The Future of Face and Hand Transplantation 7 Framework for the Future and Designing a Productive and Sustainable Clinical Network 8 Data Management and Registry Development 9 Overarching Conclusions and Recommendations Appendix A: Biographical Sketches of Committee Members and Staff Appendix B: Open Session Agendas Appendix C: Timeline of Previous Face and Hand Transplantations Appendix D: Relevant National Academies Studies and Historical and Ongoing VCA Work

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