The University of Washington Medical Center is seeking approval to perform face transplants, hand transplants and other major surgeries. This would create the second such center on the West Coast.
Face transplants, hand transplants and even abdominal-wall transplants may soon be performed at the University of Washington Medical Center, where officials have applied to join an elite group of U.S. hospitals designated to perform the life-changing surgeries.
Dr. Peter Neligan, director of the Center for Reconstructive Surgery at UWMC, confirmed that officials have requested approval to conduct the complicated procedures from the United Network for Organ Sharing, or UNOS, the private, nonprofit federal contractor that oversees organ transplants in the U.S.
“I think it’s very exciting,” said Neligan, 62, who is leading the effort. “Some of these patients are completely reclusive; they don’t go out in public; they basically have no life.”
If the UW’s application is approved, the first transplants could take place within a year, he added. It would establish the second such center on the West Coast and extend the capabilities of the medical center’s already-expansive organ-transplant program.
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The UW would join 19 other centers nationwide authorized to perform what are known as vascularized composite allograft (VCA) transplants. It’s a newly defined category of organ transplant that includes body parts composed of several kinds of tissue, with working blood supplies, which can be donated as a single unit from one person to another.
Such transplants are rare, experts say. Since 1999, U.S. centers have performed eight face transplants, eight double-arm or hand transplants, 15 single-arm or hand transplants and one multiple VCA transplant that included a face and double upper limbs.
Still, the transplants are becoming common enough that they’re no longer regarded as research procedures. Instead, they are now state-of-the art treatments for people ravaged by disease, accident or disaster, Neligan said.
“We’re seeing some patients who stretch our abilities to reconstruct and those are the patients who would be candidates for transplant,” he said. “For face transplants, we’re looking for people with significant disfigurement and functional loss.”
Burn patients, victims of gunshot wounds and soldiers who’ve suffered multi-limb amputations during battle could be among candidates for the new procedures.
VCA transplants require extended surgeries involving well-coordinated teams of surgeons and support staff. In the case of a face transplant, the process can involve a graft that includes the nose, the soft tissues of the mid-face, including blood vessels, muscles and nerves. It also includes a portion of the facial skeleton. Surgeons connect the blood vessels from the donor to the recipient before connecting nerves and other tissue.
The Seattle VCA program would focus on face transplants — the most high-profile type of VCA procedure — but also on upper limb transplants and abdominal wall transplants, Neligan said.
Abdominal wall transplants are often performed in conjunction with intestinal transplants in people with intestinal failure caused by conditions such as short bowel syndrome, Crohn’s disease or other conditions.
Other organs that qualify as VCA transplants include the uterus and the larynx. Lower-limb transplants haven’t been performed yet in the U.S., but they’re on the horizon, experts said.
The UWMC application, which capped three years of discussions, seeks to build on the center’s existing transplant programs, which include heart, liver, kidney, pancreas, lung and multi-organ procedures, Neligan said.
Planning has been conducted in conjunction with LifeCenter Northwest, the regional organ-procurement organization, or OPO, which serves 7.7 million people throughout Alaska, Montana, North Idaho and Washington.
Kevin O’Connor, president and chief executive of LifeCenter Northwest, came to the agency from the New England Organ Bank, which has been a leader in developing practice and protocol for VCA transplants.
A UNOS spokeswoman declined to comment on UWMC’s status, but she said applications are typically approved within two weeks after required materials are submitted. O’Connor said he expected approval to be granted.
At first, the program would draw from donors within a two-hour drive of Seattle, O’Connor said. From the time the organs are harvested, there’s a window of just four to six hours in which they need to be transplanted into the recipient.
The existing staff, equipment and training already exist at UW to perform the transplants. Neligan, for instance, is an acknowledged expert in reconstructive microsurgery. Similarly, the staff at LifeCenter Northwest is already trained in counseling families about the delicate and emotional process of donating a loved one’s organs.
Still, a VCA donation is very different from a standard organ donation. There’s a separate consent process, which means people who’ve designated themselves as donors on driver’s licenses won’t automatically be placed in the pool for face or hand donations.
LifeCenter Northwest staff is being trained now about the best way to request VCA donations and about the consent process. One consideration is that donor families and recipients could inadvertently meet.
“There’s a psychological aspect to it as well,” O’Connor said. “When you meet the person who received the heart from your son three years ago, you don’t see the heart. When you meet the person who received part of the face of your loved one, you see that face.”
Finding candidates for VCA transplants will be no problem, Neligan said. But doctors have no one in mind just yet.
“We haven’t gotten that far,” he said. “We want to avoid the floodgate issue. There certainly will be a few. I’m sure there are patients out there.”
The decision to accept a VCA transplant is momentous. Patients are required to take immune-system suppressing drugs for the rest of their lives to prevent rejection of the transplants, which can have side effects and leave them vulnerable to infections and other hazards.
But for those who carefully weigh the risks and benefits, the results can be life changing, said Neligan, adding that the UWMC team is eager to begin.
“If we get approval, we’ll start looking right away,” he said.