Face and Hand Transplants: Eight Things to Know

VCA stands for Vascularized Composite Allograft organs, which are made up of multiple types of tissue including skin, bone, nerves, and blood vessels. Examples of VCA organ transplants include face, hands and abdominal wall. As of January 2018, less than 200 VCA organ transplants have been performed around the world.
The VCA transplants that you probably hear about most often are hand, arm, and face transplants. But they can also include the larynx, genitalia, the abdominal wall, and other body parts.

VCA transplants can restore abilities and independence in ways that artificial limbs cannot. These transplants can completely transform lives.

Hand, arm, and double hand transplants are very complicated. Bones have to be fixed onto the arm; arteries, and veins must be reattached; and tendons and nerves need to be repaired. The medical and surgical team can include dozens of professionals and the surgery can take up to 16 hours to perform.

Full face and partial face transplants also require teams of doctors and many hours to perform — how long depends on the recipient’s injury or illness. For example, if the mouth and jaw need to be replaced, then teeth, bone, tongue, chin, and skin also might need to be transplanted, increasing the complexity of the process.

The answer is yes and no. Yes, skin characteristics such as moles, freckles, and scars will be visible on the recipient. However, since the recipient’s underlying bone structure may be different from the donor’s, any resemblance will likely be minimal.

Criteria for matching donors and recipients in a traditional transplant also apply for VCA, such as compatible blood and tissue types. VCA also requires matching other features such as skin color and tone and body size — and gender.

Yes, there is a risk of rejection, just as any organ transplant. Patients could be on anti-rejection medication for the rest of their lives. Rehabilitation with physical therapy and occupational therapy (and speech therapy for face transplant patients) can be a full-time job for years. And, there can be various other complications, such as infections, bleeding, and scars, anytime a person undergoes a surgical procedure.

When you sign up as an organ, eye, and tissue donor, you’re not automatically authorizing a VCA donation. VCA donations are handled individually after your death and your family makes that decision. It is important to share your wishes to become a VCA donor with your family.

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