NYU Langone Transplant Institute, USA
Scientific Tracks Abstracts: Health Care Current Reviews
Vascularized Composite Allotransplantation (VCA) is defined as the transplant of intact vascularized body parts, such as hands and faces. The first successful hand transplant was performed in France in 1998 and the field has expanded to include faces, abdominal walls, arms, legs, scalp and reproductive organs. From a technical standpoint, feasibility has been proven, as is evidenced by graft and patient survival rates comparative to or exceeding that of solid organ transplant. Till date, more than 200 of these procedures have been performed worldwide. Each procedure is necessarily unique. As the field makes the transition from purely experimental to becoming a standard of care, there are notable ethical issues specific to VCA: Are the quality of life and psychological benefits enough to justify the operative risk and medical risks associated with life-long immunosuppression therapy for a non-life saving procedure? Is the procedure economically justifiable? Can recipient and donor privacy and anonymity be sufficiently protected in a time of extreme human interest and media attention in these procedures? How do we determine who is an appropriate candidate for this procedure? What is the appropriate timing in relation to the original injury? What should the legal and regulatory framework be to determine which procedures are appropriate currently? It is necessary to have consensus in approaching these issues both thoughtfully and realistically if the field of VCA transplantation is to survive and mature over the next 20 years.
Bruce Gelb is an Assistant Professor of Surgery at the NYU Langone Transplant Institute. He performs liver, kidney, pancreas and living donor transplant surgery, as well as he is a key member of the face transplant team, leading the development and management of the immunosuppression regimens for the VCA program. He also serves as the Chair of the Quality Improvement Committee of NYU Langone Health. He serves on the United Network for Organ Sharing (UNOS) Ethics Committee. He is concerned with a variety of issues in bioethics, with interest in the ethics of transplantation. He currently serves as the President of the Board of Directors of the Global Bioethics Initiative, an NGO Member of the United Nations Academic Impact with special consultative status with the UN Economic and Social Council.
E-mail: [email protected]