Introduction :
Early results of hand and face transplants and other grafts such as those of uterus, penis or abdominal wall (otherwise called vascularized composite allografts, or VCAs) have confirmed the potential to restore appearance, anatomy, function, independence, and social status for individuals suffering from devastating tissue loss and functional or physiologic deficits untreatable by current available options.
Initial reviews are indicating outcomes on par or better than alternative treatments including prosthetics or routine reconstructive techniques. The technical challenges of performing these procedures have received significant scholarly attention but there are overarching bioethical concerns, challenges and controversies that remain open to discussion and debate. Indeed, many barriers to the advancement of VCA practice stemming from negative stakeholder perceptions still exist.
Potential donors, potential recipients and their families, healthcare providers, and health insurance organizations all must accept the value of VCA transplant before it can become the standard of care. That will require more than proving safety and effectiveness. Several facts underpin stakeholder concern, including: hands and faces are the most visible parts of the body and are deeply tied to personal identity; VCA transplants require a lot of money, labor, and time; and hand and face transplants for example, are life-improving, but not life-saving procedures. The procedure costs should become lower as the practice becomes more efficient. Even present price tags might be justified by the benefits to the recipient and to society.
Through a carefully designed Brocher workshop, we propose the first time ever international forum focused on the bioethical dilemmas and challenges in the rapidly evolving field of VCA. The workshop goals encompass topics that will examine bioethical issues that impact public acceptance of VCAs and whether VCA transplant procedures meet standards for safety, efficacy, feasiblity, privacy, confidentiality, fair distribution, informed consent, and follow-up care. The insights from this meeting will help inform the future development of education and policy strategies, as well as the practice itself, to ensure value, accessibility, and acceptance of VCA by potential donors, potential or actual recipients and their families, healthcare providers (VCA surgeons), and health insurance organizations.