A person who suffered a major limb loss in their life may never be able to feel comfortable in public or be completely self sufficient with a prosthetic; however, through reconstructive transplantation the person can regain movement in his or her new, transplanted limb. Reconstructive transplantation, the transfer of tissues between a donor and a recipient, can restore enough function in the transplanted limb so that the patient can provide for themselves and return to work. The majority of patients say that their quality of life is improved after this procedure. Some people contest, nevertheless, that reconstructive transplantation is not ethical because of the risks from lifelong drug therapy required after the procedure. But, when the outcome and effects of the procedure are examined all together, reconstructive transplantation is an ethical procedure because the benefits of self sufficiency, normalcy, and movement outweigh the drawbacks of lifelong therapy for people who suffered a great loss from their amputation.

Reconstructive transplantation, also called vascularized composite allotransplantation (VCA), involves the transplantation of multiple tissues like skin, nerves, muscles, blood vessels, and bone (Foroohar et. al 405). Reconstructive transplantation can rebuild a person’s face, hand, arm, or knee and restore motion to that body part. The procedure is in its experimental stages and few procedures have been conducted. The technical aspect of the procedure is very similar to reconstructive surgery, and most of the surgical technique is exactly the same. A unilateral hand transplant usually requires two teams of doctors while a bilateral hand transplantation usually requires four teams of doctors - one or two to prepare the procured graft and one or two to prepare the patient (Hartzell et al. 524). The operating time may be very lengthy. A hand transplant procedure may last anywhere from eight to ten hours. A face transplant may last from eight to thirty-six hours. A patient’s quality of life is improved through this procedure and it provides an alternative for people who are not comfortable with prosthetics (Gorantla). This type of transplantation has the potential to help many severely injured people.

VCAs have the amazing ability to restore patients’ physical movement in a limb or face that they had gone without for years. Through intensive physical therapy which may last a couple years, more muscle motion can be regained. Sensitivity to the surroundings can also be obtained. It is possible for the patient to feel the difference between smooth and rough surfaces as well as hot and cold objects (Ninkovic et al. 459). In the world experience, about 90% of patients receive tactile sensitivity (the ability to feel physical contact from the environment) and about 84% of patients develop discriminative sensation (the ability to feel touch, pressure, flutter, or vibration). The procedure is able to make a patient look more normal in public. Some patients who underwent face transplants used to wear masks when they went out in public because their face was so disfigured. However after the transplant, their physical appearance was significantly altered to look more normal and they no longer felt like it was necessary to wear the mask. Reconstructive transplantation provides numerous physical benefits for the patients and increases their quality of life.

In addition to the physical benefits of this procedure, there are also immense social benefits for the patients. So far, many patients have been chosen because they feel uncomfortable in public with their injury. But as mentioned before, a result of the transplant is that many of the patients feel normal in public because their original appearance is somewhat restored. They now find it easier to socialize with other humans. Other than returning to society, patients also become more self sufficient as a result of this procedure. Originally hand transplant patients use prostheses which can be unpredictable, unwieldy, and rely on battery power. A hand transplant is more reliable and allows patients to perform tasks that are needed to live independently. Patients can open/close doors, drive, make meals, cut food, clothe themselves, and return to work again at desk jobs or as laborers (Gorantla). Patients feel normal and more comfortable to interact in society as a result of this procedure.

Among the many benefits of vascularized composite allotransplantation, there are also some drawbacks to the procedure. For example, the screening process is extensive and many people who apply for this procedure do not meet the criteria for a potential patient, like having support from family or friends or having no infectious diseases. The person has to undergo physical and psychological evaluation from multiple specialists (Shores 540). After the procedure, the patient will have to follow a strict immunosuppression routine for the rest of their lives to prevent rejection of the graft. Rejection can manifest itself as a rash and may cause the graft to be amputated if the rejection is not treated by the immunosuppressants. Immunosuppression has some adverse effects though which include making the person vulnerable to infections and even cancer. There are people who question whether this non-lifesaving procedure is ethical because of the negative effects of drug therapy (Ravindra and Ildstad 473). Is the benefit of this procedure worth the risk? This is a hard question to answer; however in most cases this procedure gives a patient a new beginning to participate in life, which is spectacular. Another difficulty is that this procedure is very expensive: the cost, which is around $523,400, is comparable to a liver transplant. Currently, the government does not recognize vascularized composite allotransplantation and insurance companies cannot cover much of the cost (Gorantla). Most of the costs are covered by hospitals through research grants. This procedure still has certain challenges, some of which could be solved with more support from the government or insurance companies.

Vascularized composite allotransplantations are a relatively new field in medicine today. In comparison to other types of transplantation, few VCAs have been conducted worldwide. Also, there have not been many hospitals which have performed a VCA. In the United States, there have been only seven centers which has completed a hand transplantation. However, the success rate for VCAs is pretty high. No grafts have had to be amputated if the patient followed their immunosuppression therapy. The current goal for doctors regarding VCAs is to determine ways to decrease the number of immunosuppressant drugs the patient has to take. This would help solve the ethical issues of the procedure because the patient will be less vulnerable to other sicknesses caused by the immunosuppressants (Gorantla et al. 512). A standard procurement procedure of the graft from donor families has yet to be established. For example, sometimes a hand is harvested before the solid organs or sometimes it is harvested after. Different orders of procurement requires communication before the procedure to adjust logistics. There are certain requirements for the procurement of tissue for VCAs that have to be met that are not required for the more common solid organ transplants (kidney, liver, heart, etc… transplants). One example is that the OPO (Organ Procurement Agency) must ask the families of declared organ donors specifically for the donation of a hand, arm, or face because “even if the potential donor volunteered to be an organ donor at the time of acquiring a driver license, it is likely that hand/face donation was not a consideration at the time of decision” (Ravindra and Gorantla 536). Despite procurement difficulties, the results of reconstructive transplantation have been successful and encouraging in most cases; 75% of patients say their quality of life has improved as a result of the procedure (Ninkovic et al. 460). The results of reconstructive transplantation have been promising and with further advances in the field, this procedure can be expanded upon.

Vascularized composite allotransplantation is an innovative field of medicine that has great potential to help many amputees, such as bomb victims, throughout the world. A person can regain movement in their transplanted graft as well as become more comfortable in society. The majority of transplants have been successful and improved the quality of life of the patients significantly. This new field has demonstrated that it is a viable option for treatment of severely injured people. Great improvements in the fields of microsurgery, transplant immunology, and psychiatry have contributed to this procedure’s growth. These developments have increased the number of effective and lasting transplants. Through further improvements in surgical techniques, the psychosocial aspect of transplantation, and immunomodulation strategies, VCAs may be advanced even more (Foroohar et al. 408). In its entirety, vascularized allotransplantation provides benefits like the ability to move, become self sufficient, and feel normal, which outweigh the drawbacks of the procedure.

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