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Rodrigue JR, Shenkel J, Boger M, Pomahac B, Fleishman A. Video Messaging to Increase Vascularized Composite Allograft Donation Willingness in United States Military Veterans. Transplant Direct 2022; 8:e1355. [PMID: 36204186 PMCID: PMC9531254 DOI: 10.1097/txd.0000000000001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022] Open
Abstract
Expansion of vascularized composite allograft (VCA) transplantation depends on the public's willingness to donate VCA organs, including face, extremities, and genitourinary organs. This study evaluated the effectiveness of video messaging on VCA donation willingness in US military veterans, a key stakeholder in VCA transplantation. Methods Participants (n = 556) were randomized to 1 of 3 VCA video messaging interventions (informational, testimonial, or blended), a general (non-VCA) organ donation video message, or a control (nondonation) video message. Questionnaires were completed at pre- and postintervention and at 3-wk follow-up. Results Veterans exposed to any VCA video messaging were more likely to express VCA donation willingness (69%, n = 203/296) than those exposed to general donation messaging (53%, n = 47 of 89; P = 0.006) or No Donation Messaging (37%, n = 36 of 97; P < 0.001). A significantly higher proportion of participants who received Blended VCA Messaging were willing to be VCA donors, compared with the Informational VCA Messaging group (79% versus 61%, P = 0.006). Each VCA messaging video resulted in a significant pre- to postintervention increase in the proportion of participants willing to donate their own face, hands, and legs (P < 0.03). Conclusions Brief educational videos focused on VCA transplantation can have a demonstrable and verifiable impact on rates of VCA donation willingness in veterans.
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Affiliation(s)
- James R. Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Jessica Shenkel
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Bohdan Pomahac
- Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
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2
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Wang YC, Lee SS, Ramachandran S, Lin YN, Chen RF, Lin SD, Lai CS, Kuo YR. Attitudes toward face transplantation in Asia: A survey of Taiwanese population. Microsurgery 2021; 41:599-602. [PMID: 34019315 DOI: 10.1002/micr.30755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Yu-Chi Wang
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Su-Shin Lee
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Savitha Ramachandran
- Department of Plastic and Reconstructive Surgery, KK Women's and Children's Hospital, Singapore.,Academic Clinical Program for Musculoskeletal Sciences, Duke-NUS Graduate Medical School, Singapore.,Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Singapore
| | - Yun-Nan Lin
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Rong-Fu Chen
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Sin-Daw Lin
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Sheng Lai
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yur-Ren Kuo
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Academic Clinical Program for Musculoskeletal Sciences, Duke-NUS Graduate Medical School, Singapore.,Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Singapore.,Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Ward S, Boger M, Fleishman A, Shenkel J, Calvo A, Pomahac B, Zwolak R, Krishnan N, Rodrigue JR. Attitudes Toward Organ, Tissue, and Vascularized Composite Allograft (VCA) Donation and Transplantation: A Survey of United States Military Veterans. Transplantation 2021; 105:1116-1124. [PMID: 32639399 DOI: 10.1097/tp.0000000000003376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are 20 million living US armed forces veterans; however, the organ donation attitudes of veterans have not been examined. METHODS Over a 17-month period, a convenience sample of 1517 veterans in New England completed a survey to assess attitudes about organ, tissue, and vascularized composite allograft (VCA) donation. RESULTS Most veterans (96%) supported the donation of organs and tissue for transplantation, and 59% were registered as an organ and tissue donor. Being younger (adjusted odds ratio [aOR]: 0.960.970.98; P = 0.01), female (aOR: 1.061.462.03; P = 0.02), non-Hispanic white (aOR: 1.302.073.30; P = 0.01), Hispanic (aOR: 1.282.434.61; P = 0.01), and having more trust that the transplant process is fair and equal (aOR: 1.191.401.65; P = 0.01) were predictive of donor registration. Also, most veterans were willing to donate their face (57%), hands/arms (81%), legs (81%), penis (men: 61%), and uterus (women: 76%) at time of death; donation willingness was higher for upper and lower limbs than for face or genitourinary organs (P < 0.001). Those unwilling to donate VCA organs expressed concerns about identity loss, psychological discomfort of self and others, body integrity, funeral presentation, and religious beliefs. Most (54%) felt that VCA donation should require permission of legal next-of-kin at the time of one's death, even if the decedent was a registered donor. CONCLUSIONS There is a high level of support for organ, tissue, and VCA transplantation and donation among veterans, despite limited educational campaigns targeting this population. There is high potential among veterans to further increase donor registry enrollment and raise awareness about VCA benefits for severely injured service members.
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Affiliation(s)
- Stephanie Ward
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jessica Shenkel
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Amanda Calvo
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Bohdan Pomahac
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Robert Zwolak
- Department of Surgery, Veterans Affairs Medical Center, Manchester, NH
- Department of Surgery, Veterans Affairs Medical Center, White River Junction, VT
| | - Namrata Krishnan
- Department of Medicine, Veterans Affairs Medical Center, West Haven, CT
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - James R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
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Martindale AM, Fisher P. Disrupted faces, disrupted identities? Embodiment, life stories and acquired facial 'disfigurement'. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1503-1519. [PMID: 31241188 DOI: 10.1111/1467-9566.12973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Questions about the relationship between faces, 'disfigurement' and identity intensified following the first facial transplant (2005). Over a decade later, empirical research exploring the influence of acquired facial 'disfigurement' on embodied identity disruption and re-formation remains limited. A common strand of thinking assumes identities are contained within faces. Commentators have suggested that identities can be diminished through 'disfigurement' and restored or replaced through reconstruction or transplantation. The authors question this claim and provide a conceptually informed, empirical alternative drawing on the results of a phenomenologically located, narrative study exploring identity shift in British adults following acquired 'disfigurement'. Findings suggest that faces are important to humans and that identities can be disrupted in the aftermath of facial 'disfigurement'. Though, the relationship is not simple and cannot be predicted by the degree of corporeal change. Disrupted, liminal and contradictory strands of identity emerged; pre-existing identities were strengthened, new ones emerged, and other non-related experiences were also influential. Nuanced relationality was at the heart of participant sense-making. Consequently, the authors reject the idea that identities are contained within faces and call for the development of a wider social and relational facial phenomenology to more comprehensively explore this fascinating, multifaceted relationship.
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Affiliation(s)
- Anne-Marie Martindale
- Centre for Primary Care and Health Services Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Pamela Fisher
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
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The Ethics of Facial Allotransplantation: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2425. [PMID: 31772878 PMCID: PMC6846319 DOI: 10.1097/gox.0000000000002425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text. Currently, there are more than 40 cases of facial allotransplantation performed by 13 different groups in 10 countries. Although it has become a potential option to reconstruct and restore the function and appearance of severely facially disfigured individuals, the ethical concerns of facial allotransplantation remain unsolved. We conducted a systematic review to better understand the ethical concerns on facial allotransplantation and the changing trends of the ethical debate over time.
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Rodrigue JR, Tomich D, Fleishman A, Glazier AK. Vascularized Composite Allograft Donation and Transplantation: A Survey of Public Attitudes in the United States. Am J Transplant 2017; 17:2687-2695. [PMID: 28390109 DOI: 10.1111/ajt.14302] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 01/25/2023]
Abstract
Vascularized composite allograft (VCA) transplantation has emerged as a groundbreaking surgical intervention to return identity and function following traumatic injury, congenital deformity, or disfigurement. While public attitudes toward traditional organ/tissue donation are favorable, little is known about attitudes toward VCA donation and transplantation. A survey was conducted of 1485 U.S. residents in August 2016 to assess VCA donation attitudes. Participants also completed the Revised Health Care System Distrust Scale. Most respondents were willing to donate hands/forearms (67.4%) and legs (66.8%), and almost half (48.0%) were willing to donate the face. Three-quarters (74.4%) of women were willing to donate the uterus; 54.4% of men were willing to donate the penis. VCA donation willingness was more likely among whites and Hispanics (p < 0.001), registered organ/tissue donors (p < 0.001), and those with less health care system distrust (p < 0.001) and media exposure to VCA transplantation (p = 0.003). Many who opposed VCA donation expressed concerns about psychological discomfort, mutilation, identity loss, and the reaction of others to seeing familiar body parts on a stranger. Attitudes toward VCA donation are favorable overall, despite limited exposure to VCA messaging and confusion about how VCA donation occurs. These findings may help guide the development and implementation of VCA public education campaigns.
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Affiliation(s)
- J R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Departments of Surgery and Psychiatry, Harvard Medical School, Boston, MA
| | - D Tomich
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - A Fleishman
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
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Public's Knowledge and Attitudes Toward Vascularized Composite Allotransplantation and Donation. Aesthetic Plast Surg 2016; 40:301-8. [PMID: 26893283 DOI: 10.1007/s00266-016-0623-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/01/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this survey was to assess the public's knowledge and attitudes toward vascularized composite allotransplantation and donation. METHODS Members of the public (n = 5942) were surveyed using a questionnaire that examined their knowledge and attitudes concerning solid organs (kidney, heart, liver, lung, and pancreas) and vascularized composite tissue (hand/upper extremity, lower extremity, abdominal wall, and face) transplantations and donations. RESULTS Respondents demonstrated greater (all P < 0.05) knowledge and willingness to donate and/or receive solid organs than vascularized composite tissues. Educational level, accurate knowledge, willingness to donate, and willingness to receive were significant (all P < 0.05) determinants of acceptance to donate and/or receive hand/upper extremity, lower extremity, face, and/or abdominal wall. CONCLUSION The public presented less knowledge and willingness to donate and/or receive hand/upper extremity, lower extremity, abdominal wall, and face. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Sarwer DB, Ritter S, Reiser K, Spitzer JC, Baumann BM, Patel SN, Mazzarelli AJ, Levin LS, Doll S, Caplan AL. Attitudes Toward Vascularized Composite Allotransplantation of the Hands and Face in an Urban Population. ACTA ACUST UNITED AC 2014. [DOI: 10.4161/23723505.2014.975021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Experiences of Healthcare Team Members Involved in Facial Transplant Surgery and Patient Care. Nurs Res 2013; 62:372-82. [DOI: 10.1097/01.nnr.0000434616.93493.e2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND The goal of facial transplantation is to transform severely deformed features in a single, complex operation. Although nearly 20 have been completed since 2005, there is limited information about the subsequent psychosocial status of recipients. OBJECTIVE The purpose of this study is to describe such changes as captured on a variety of psychosocial measures 3 and 6 months after full facial transplantation among 3 adults who all completed a comprehensive psychiatric assessment before the procedure. RESULTS We hypothesized and found that participants experienced significant improvement on quality of life measures of physical and mental health based on the MOS-SF -12. While the recipients experienced a decline in their physical quality of life in the 3 months immediately after surgery, they had improvement by 6 months (p = 0.02). Overall mental health showed steady improvement from the time before surgery to 6 months later (p = 0.04). These changes, however, were not reflected in another popular measure of quality of life, the EQ-5D. There were no changes in participants ' self-esteem or dyadic function over the same period of time. CONCLUSION As facial transplantation evolves from being a novel surgical procedure to an increasingly common clinical practice, future efforts to delineate the psychosocial changes experienced by recipients might include mixed methods analyses, with both qualitative and quantitative data, as well as collaborative assessment protocols shared among facial transplantation programs.
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Affiliation(s)
- Grace Chang
- Harvard Medical School, Boston, MA 02115, USA.
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