A Tucson surgeon is part of the national committee that developed standards for a new federal category of organ donation — body structures for hand and face transplants.
The nerves, muscle, bone, and ligaments needed for hand and face transplants fall under a category of organ transplantation called vascular composite allografts (VCA). VCA transplants were added to the definition of transplantable organs covered by federal regulation and legislation on July 3.
Donations will be handled differently than for kidneys, lungs and internal organs, because hands and faces are tied to a person’s identity and donating them is potentially more emotional and sensitive.
Dr. Warren C. Breidenbach III, chief of the division of reconstructive and plastic surgery at the University of Arizona Medical Center, was one of 18 experts from across the country who developed the new policies for VCA donation and transplantation.
Breidenbach performed the world’s first long-term successful hand transplant in 1999 with a team at Louisville Jewish Hospital. The surgery was performed on 24-year-old New Jersey native Michael Scott, who lost his hand in a fireworks accident.
Breidenbach has since performed more hand transplants than any other surgeon in the world, according to his bio.
He was also the first president of the International Hand and Composite Tissue Allotransplantation Society and founding president for the American Society of Reconstructive Transplantation.
Breidenbach came to the UA Medical Center in 2011 as part of an effort by then-surgery chair Dr. Rainer Gruessner to expand and rebuild the surgery department.
He has previously stated his goal at the UA is to establish an Institute for Composite Tissue Allotransplantation and Regenerative Surgery, including hands, face, legs and feet.
Breidenbach has not performed a hand transplant in Tucson and did not respond to requests for an interview from the Star.
The United Network for Organ Sharing (UNOS) is now developing a waiting list for people who need hand and face transplants.
UNOS serves as the Organ Procurement and Transplantation Network by contract with the U.S. Department of Health and Human Services. The network brings together medical professionals, transplant recipients and donor families to develop organ transplantation policy.
The addition of VCA marks the first time in more than a decade that a new category of organ has been added to the list of transplants under federal regulation.
Through January , 28 VCA transplants had been performed at 11 hospitals in the U.S. Those procedures have included transplantation of the face and either single or double hands.
People who are registered organ donors are not automatically VCA donors.
Officials with the Donor Network of Arizona stress that consent for face and limb donation will remain separate from organ and tissue donation.
Checking the box at Arizona’s Motor Vehicle Division or signing up at donatelifeaz.org only authorizes recovery for organs and tissue, network spokeswoman Jacqueline Keidel wrote in the email.
Donors or next of kin must give explicit consent for a hand or face organ donation, and individual states could further refine the consent process.
The new VCA requirements will be in effect for 15 months, allowing the federal Organ Procurement and Transplantation Network during that time to seek public comment regarding potential improvements, including how the consent process should work.
The committee will continue development of other aspects of VCA policy. Priorities include refining allocation policy, data requirements and data collection procedures for VCAs, UNOS officials said.
While face and hand transplantation are the most widely known VCA procedures, other types of VCA transplantation may be developed in the future, UNOS officials said.
“We want to make this treatment more widely available while recognizing the unique medical and ethical issues involved,” Dr. Kenneth Andreoni, president of both UNOS and the Organ Procurement and Transplantation Network, said in news statement.
“These policies establish the framework for further development of this groundbreaking therapy, which returns vital function and identity to people who have suffered a devastating injury or illness.”
Other members of the committee who created the policies include Dr. Sue V. McDiarmid, medical director of the hand transplantation program at UCLA Medical Center, New England Organ Bank president and chief executive officer Richard S. Luskin and Dr. Gerald Brandacher, scientific director of the reconstruction transplantation program at Johns Hopkins University School of Medicine.