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The status of vascularized composite allograft allocation

The status of vascularized composite allograft allocation

Vascularized composite allografts (VCAs) involve the transplantation of multiple structures that may include skin, bone, muscles, blood vessels, nerves and connective tissue. In July 2014, the Organ Procurement and Transplantation Network (OPTN) assumed the responsibility for developing policy for VCA transplantation.

As of October 29, 20 VCA transplant programs have been approved, 10 candidates were waiting for VCA transplants and 3 VCA transplants had been allocated through the OPTN.

VCA Policy
In June 2014, the OPTN/UNOS Board of Directors unanimously approved the first national policies and standards for transplantation of limbs, faces and other structures collectively known as vascularized composite allografts (VCAs). The requirements will be in effect for 15 months, allowing the transplant network during that time to seek public comment regarding potential improvements.

  • criteria for defining VCAs to be covered in OPTN policy
  • OPTN membership requirements for VCA transplant programs
  • initial policies for VCA allocation
  • guidance for gaining specific consent for donation of VCAs

The board approved a bylaws requirement at the meeting on November 13, 2014, that a VCA program must specify the type of VCAs they will transplant. Additionally, the transplant hospital must specify the reconstructive surgeon, and transplant physician or surgeon responsible for the VCA program. The assurance from the local OPO must specify the type of VCAs they will recover.

Two VCA policy proposals are available for public comment through December 5.

  • Implement OPTN oversight of VCAs
  • VCA data collection and submission requirements

The VCA Transplantation Committee continues to develop other aspects of VCA policy. Priorities include refining allocation policy, data requirements and data collection procedures for VCAs as well as membership requirements.

Instructional materials are available to help transplant professionals at hospitals and OPOs manage patients and donors in this new area.

Access VCA resources, including the following:

  • VCA presentation, developed by UNOS staff, that explains processes to register candidates, enter donor information, run a match and remove candidates
  • Supporting materials – screenshots, worksheets and help documentation
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