Vascularized Composite Allotransplantation

Abstract

In order to discuss the ethics of vascularized composite allotransplan-tation (VCA), it is necessary to have a firm grasp of this rapidly developing field, including its history, its present state and its anticipated future directions. The story of the development of VCA began in the imaginations of ancient peoples, but required important medical and surgical advances for the practice to become a reality. A survey of the history of VCA will emphasize the role of advances in surgical techniques, including anastomosis of blood vessels and nerves and the emergence of microsurgery. It will also review the emergence of a better understanding of immunology and the development of effective means of immunosup-pression. A brief survey of the beginnings of solid organ transplantation and limb replantation will be offered, as they together formed the technical foundation for the first attempts at VCA. The current state of VCA, with a special focus on facial and upper extremity transplantation, will be explored, as will be issues of practical and ethical concern.