More than 1,600 service members from the conflicts in Afghanistan, Iraq and Syria have experienced devastating battle injuries—the loss of a face, for instance, or limbs, hands or feet—according to a 2015 report from the Congressional Research Service. While some veterans are treated through a combination of prosthetics and physical therapy, a new form of transplantation could help provide a new face or hands for those who experience particularly catastrophic blast injuries.
Known as vascularized composite allografts (VCAs), these larger sections of biological material are made up of multiple interconnected tissues and present a promising, relatively new form of transplantation after injury. Unlike a single organ (such as a kidney) or a tissue (like a piece of bone), VCAs involve very complex systems of muscle, bone, skin, nerves, blood vessels and connective tissues and include body parts such as the face, forearms, hands, legs, feet, and even uterus and penis.
Not only is VCA transplantation more difficult from a surgical perspective, but it also involves a bigger ask of families of deceased patients who could donate. In addition to asking a grieving family to donate something more known and familiar, such as a liver, the staff of organ procurement organizations must now discuss a larger and more visible organ.
“When the first U.S. face transplant occurred in 2005, even the professionals at the local organ procurement organization were unsure what it was and how a family would respond to the request for a donor patient’s face,” said Dr. Laura A. Siminoff, dean of the College of Public Health and Laura H. Carnell Professor of Public Health. “It’s still an open question as to how we should really raise this with a grieving family.”
Requests for VCA donation may call for new approaches when communicating with the donor’s family, she said. Those conversations are the subject of a new study by Dr. Siminoff and Dr. Heather Gardiner, director of community-engaged research and practice and associate professor in the Department of Social and Behavioral Sciences. Funded by a $1.5 million, three-year grant from the U.S. Department of Defense, Dr. Siminoff and Dr. Gardiner will develop a training program targeting organ procurement staff and the conversations that take place in the solicitation of VCAs.
In the first year, the research team will use focus groups with members of the general public to understand perceptions surrounding VCA donation and the factors that would motivate individuals to donate. The team will also interview organ procurement staff about attitudes and knowledge regarding VCA donation, challenges faced in asking for donations, and thoughts about how to improve VCA requests. The findings will be incorporated into an evidence-based, online training program to educate procurement staff about VCA and communication techniques proven to increase the likelihood of donation. The program, Communicating Effectively about VCA Donation, will be adapted from a training program Dr. Siminoff and Dr. Gardiner previously developed to help procurement staff more effectively ask for solid organ tissue and organ donations.