Living Donation of Vascularized Composite Allografts

Living donation has become a medically and ethically accepted practice in solid organ transplantation. Published proceedings from the international kidney transplant community and from the Ethics Committee of The Transplantation Society (TTS) articulated the general principles as well as specific recommendations for living donation, which remain the backbone of the Centers for Medicare and Medicaid Services (CMS) and Organ Procurement and Transplantation Network (OPTN) requirements and policies. Meanwhile, there have been major advancements in another revolutionary field of transplant medicine: vascularized composite allotransplantation, or VCA. Recent interventions have demonstrated potential for superior functional and aesthetic outcomes in a single operation when compared to stage conventional reconstructions. In view of these successes, the indications of VCA are expected to broaden to include less extensive types of transplants, which would introduce the possibility of utilizing living VCA donors. Here we discuss the feasibility and ethics associated with living donation of vascularized composite allotransplantions. We explore the current guidelines and policies set by the OPTN regarding living organ donation. In addition, we provide several clinical scenarios in which living donation of VCA could be used to augment the reconstructive ladder currently used by reconstructive surgeons to guide their reconstructive strategies. Financial Disclosure statement: The authors have no financial interest to declare in relation to the content of this article. Drs. Pomahac and Bueno receive partial salary support from a research contract with the U.S. Department of Defense (no. W911QY-09-C-0216) Corresponding Author: Bohdan Pomahac, MD, Associate Professor of Surgery, Harvard Medical School, Director of Plastic Surgery Transplantation and Burn Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, Tel: 617-732-7796 / Fax: 617-732-6387; Email: bpomahac@partners.org ©2018American Society of Plastic Surgeons

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