Advancing Face and Hand Transplantation: Principles and Framework for Developing Standardized Protocols
2025

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When someone experiences the loss of a limb or severe facial disfigurement, one of their options may be vascularized composite allotransplantation (VCA), which transfers a graft containing multiple tissues transferred as a functional unit. Using VCA to restore the functionality and aesthetics of a lost upper limb or disfigured face is a profound and life-altering gift; however, the process and the decision to accept (or donate) a VCA graft is complex and deeply emotional. In addition to psychosocial considerations, a VCA recipient must commit to undergoing years of rigorous rehabilitation, have a robust support system in place, and accept and understand the risks of being on immunosuppressive drugs for the rest of their life. Despite VCA advances over the last 25 years, challenges remain, and the small number of recipients of face or hand transplants makes it difficult to generalize outcomes.

To address these challenges, the Department of Defense Reconstructive Transplant Research Program tasked a committee of the National Academies with developing principles and a framework for the standardization, assessment, and validation of protocols and standard operating procedures for face and hand transplantation. The resulting report offers guidance for the newly established Clinical Organization Network for Standardization of Reconstructive Transplantation (CONSORT), but it also includes specific recommendations to enable the larger VCA community to mature, advance, and thrive into the future.

Additional materials

One Pager for Patients and Caregivers
Action Guide for CONSORT and RTRP

Publication information

388 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-73108-9
ISBN Ebook: 0-309-73109-7
DOI: https://doi.org/10.17226/28580

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2025. Advancing Face and Hand Transplantation: Principles and Framework for Developing Standardized Protocols. Washington, DC: The National Academies Press.

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Front Matter i-xxvi
Summary 1-20
PART I: Background on VCA 21-22
1 Introduction and Study Context 23-48
2 VCA Background Information and Context 49-84
3 Overarching Considerations Influencing Face and Hand Transplantation 85-114
PART II: The Transplant Experience 115-116
4 The Transplant Experience: The Preoperative Stage 117-156
5 The Transplant Experience: Surgical Procedures and Care Management 157-206
6 The Transplant Experience: Outcomes 207-244
PART III: The Future of Face and Hand Transplantation 245-246
7 Framework for the Future and Designing a Productive and Sustainable Clinical Network 247-282
8 Data Management and Registry Development 283-300
9 Overarching Conclusions and Recommendations 301-310
Appendix A: Biographical Sketches of Committee Members and Staff 311-320
Appendix B: Open Session Agendas 321-328
Appendix C: Timeline of Previous Face and Hand Transplantations 329-354
Appendix D: Relevant National Academies Studies and Historical and Ongoing VCA Work 355-362

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Advancing Face and Hand Transplantation: Principles and Framework for Developing Standardized Protocols (2025)

Chapter: PART I: Background on VCA

PART I

Background on VCA