Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 24, 2016; 6(1): 91-102
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.91
Key psychosocial challenges in vascularized composite allotransplantation
Martin Kumnig, Sheila G Jowsey-Gregoire
Martin Kumnig, Department of Medical Psychology, Center for Advanced Psychology in Plastic and Transplant Surgery, Innsbruck Medical University, 6020 Innsbruck, Austria
Sheila G Jowsey-Gregoire, Department of Psychiatry and Psychology, Mayo Graduate School of Medicine, Mayo Clinic Rochester, Rochester, MN 55905, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Supported by The Tirol Kliniken, Innsbruck, Austria.
Conflict-of-interest statement: No potential conflicts of interest to disclose as described by World Journal of Transplantation. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Martin Kumnig, PhD, MSc, Professor of Clinical Psychology, Department of Medical Psychology, Center for Advanced Psychology in Plastic and Transplant Surgery, Innsbruck Medical University, Schöpfstraße 23a, 6020 Innsbruck, Austria.
Telephone: +43-512-50427709 Fax: +43-512-585418
Received: July 27, 2015
Peer-review started: August 4, 2015
First decision: October 13, 2015
Revised: December 16, 2015
Accepted: January 8, 2016
Article in press: January 11, 2016
Published online: March 24, 2016

Psychosocial factors are important elements in the assessment and follow-up care for vascularized composite allotransplantation (VCA) and require multidisciplinary evaluation protocols. This review will highlight differences between VCA with solid organ transplantation (SOT), provide information on the psychosocial selection of VCA candidates, ethical issues, psychological outcomes, and on the need for multicenter research. VCA is primarily a life-enhancing procedure to improve recipients’ quality of life and psychological well-being and it represents a potential option to provide reproduction in case of penile or uterine transplantation. The risk benefit ratio is distinctly different than SOT with candidates desiring life enhancing outcomes including improved body image, return to occupations, restored touch, and for uterine transplant, pregnancy. The Chauvet Workgroup has been convened with membership from a number of transplant centers to address these issues and to call for multicenter research. A multicenter research network would share similar evaluation approaches so that meaningful research on psychosocial variables could inform the transplant community and patients about factors that increase risk of non-adherence and other adverse psychosocial and medical outcomes.

Keywords: Vascularized composite allotransplantation, Psychological evaluation, Motivation, Psychosocial outcomes, Quality of life

Core tip: A psychosocial evaluation for vascularized composite allotransplantation (VCA) is unique and should be informed by many characteristics that are described in this review article including the importance of multidisciplinary care and the need for careful selection of candidates for VCA. Important areas to consider in the evaluation include: History of ability to comply with medical care, body image, adaptation to previous trauma and preparedness for transplantation, reasonable expectations, and presence of adaptive coping skills of the candidate. Multicenter research will support better understanding of psychosocial variables that predict outcome. Optimally, developing a common evaluation strategy to enhance comparison of candidates with good outcomes to those with less optimal outcomes will help in future selection of candidates.