Outcomes of Multi-Organ Donation Recipients Following Prioritized Facial Vascular Composite Allograft Procurement

Background: Facial transplantation offers transformative solutions for patients with severe facial disfigurements. Minimizing ischemia time is critical for preserving tissue viability, and prioritizing facial allograft recovery during multi-organ procurement aims to optimize outcomes. This study evaluates whether prioritizing face allograft procurement affects the outcomes of non-vascularized composite allotransplantation (non-VCA) organ transplants. Methods: This retrospective study analyzed four VCA donor recoveries and face transplants at our center. Perioperative data, including operation times, blood pressure, oxygenation, urine output, and blood product administration, were recorded. Donor data were verified using the United Network for Organ Sharing database, institutional records, and data from LiveOnNY and Gift of Life Organ Procurement Organizations to assess recipient and graft survival. Results: Twenty-one allografts (VCAs and organs) were transplanted into 16 patients. One-year patient survival was 92% (11/12) among non-VCA recipients. One patient died during surgery, and two patients died more than three years post-transplant from unrelated causes. Three non-VCA graft failures occurred within the first year, resulting in an 87% graft survival rate. The median ischemia time for face transplants was 3 hours and 18 minutes. Preoperative planning, including cadaveric rehearsals, computerized surgical plans, and 3D-printed cutting guides, contributed to stable perioperative parameters and reduced blood loss. Conclusion: This study suggests that prioritizing facial allograft procurement is feasible and does not appear to compromise non-VCA organ transplant outcomes. Further multicenter studies are needed to validate these findings and further refine protocols.