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OPTN Vascularized Composite Allograft Waiting List

Current Status and Trends in the United States

Wainright, Jennifer L., PhD1; Wholley, Christopher L., MSA2; Cherikh, Wida S., PhD1; Musick, Jennifer M., BA3; Klassen, David K., MD4

doi: 10.1097/TP.0000000000002232
Original Clinical Science—General

Background Vascularized composite allograft (VCA) transplantation is a developing area in the field of transplantation.

Methods This study used Organ Procurement and Transplantation Network (OPTN) VCA waiting list and transplant data from July 3, 2014 through February 28, 2018, to characterize the OPTN VCA waiting list in terms of composition, removal patterns, waiting time, resulting transplants, and trends over time.

Results Between implementation of the OPTN VCA waiting list on July 3, 2014 and February 28, 2018, 54 candidates—53.7% were male, 79.6% were white, and 70.4% aged 18 to 44 years—were added to the OPTN VCA waiting list. Of these, 22 received deceased donor VCA transplants (6 bilateral upper limb, 4 unilateral upper limb, 5 craniofacial, 1 scalp, 1 abdominal wall, 1 penile, and 4 uterine), and 6 received living donor uterine transplants. Registrations increased in 2016 after uterine and penile transplants were introduced in the United States, resulting in a large shift in the composition of the VCA waiting list. Waiting times for VCA candidates vary greatly, with some VCA candidates receiving deceased donor transplants quickly and others waiting more than 3 years before transplantation.

Conclusions The field of VCA transplantation and the composition of the OPTN VCA waiting list are evolving rapidly. Additional research is needed to understand these changes and investigate whether differences in need or differences in access have resulted in the variation seen on the VCA waiting list.

This study examines temporal changes on the waiting list and types of vascularized composite allograft transplant using data from the Organ Procurement and Transplantation Network highlighting rapid developments and opening opportunities for further investigation.

1 Research Department, United Network for Organ Sharing, Richmond, VA.

2 Policy Department, United Network for Organ Sharing, Richmond, VA.

3 UNOS Organ Center, United Network for Organ Sharing, Richmond, VA.

4 Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, VA.

Received 17 November 2017. Revision received 1 March 2018.

Accepted 20 March 2018.

This work was conducted under the auspices of the United Network for Organ Sharing (UNOS), contractor for OPTN, under Contract 234-2005-370011C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation).

The authors declare no conflicts of interest.

The data reported here have been supplied by the United Network for Organ Sharing (UNOS) as the contractor for the Organ Procurement and Transplantation Network (OPTN). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government.

J.W., C.W., W.C., D.K. participated in research design. J.W., C.W., W.C., J.M., D.K. participated in writing of article. J.W. participated in the performance of the research. J.W. participated in data analysis.

Correspondence: Jennifer L. Wainright, PhD, 700 N 4th St, Richmond, VA 23219. (

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