OPTN Vascularized Composite Allograft (VCA) Waiting List: Current Status and Trends in the United States

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% male, 79.6% white, and 70.4% aged 18-44 - 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 US, 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. Corresponding Author: Jennifer L. Wainright, 700 N 4th Street, Richmond, VA 23219. jennifer.wainright@unos.org Authorship: Participated in research design: Jennifer Wainright, Christopher Wholley, Wida Cherikh, David Klassen Participated in writing of paper: Jennifer Wainright, Christopher Wholley, Wida Cherikh, Jennifer Musick, David Klassen Participated in performance of the research: Jennifer Wainright Participated in data analysis: Jennifer Wainright Disclosure: The authors declare no conflicts of interest. Funding: 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). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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