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 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 Siminoff and 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, Siminoff and Gardiner will develop a training program targeting organ procurement staff and the conversations that take place in the solicitation of VCAs.
“Twenty-first century weaponry has outpaced our ability to heal the wounds that these weapons cause,” said Gardiner. “Military personnel come back from deployment with injuries that require large transplants that can restore functionality and help people more easily integrate into civilian life.”
Siminoff and Gardiner have an extensive history of organ donation research. Their previous studies have examined differences in organ donation attitudes and rates across the country; the factors that go into the decision to donate—or to refuse to donate; how to adequately explain the security risks of the data derived from tissue samples; and attitudes toward donation across different racial and ethnic groups. But this is their first study exploring VCA donation, which has only been federally regulated since 2014.
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 Siminoff and Gardiner previously developed to help procurement staff more effectively ask for solid organ tissue and organ donations.
There are a multitude of reasons that families or decision-makers might be hesitant to agree to a VCA donation, says Gardiner. Donation of facial tissue, for example, removes the possibility of a viewing or an open-casket funeral. Since VCA increases the chance of seeing a recognizable part of a loved one after they are deceased, some families may be concerned about ever meeting the recipient of the donation, even casually running into them in the supermarket or at the mall. Members of some cultures or religions may also hold beliefs that forbid dismemberment after death, making any type of organ, tissue or VCA donation culturally unacceptable.
However, Siminoff and Gardiner believe that once decision-makers are made aware of the benefits of VCA transplants—reducing pain, increasing mobility and function, and improving quality of life—they may be more inclined to donate.
It’s something the team has witnessed in solid organ and tissue donation, as well: Often, families report that knowledge that the donation saved or vastly improved the life of another person in need helps in grieving the loss of a beloved family member.