117.2: Organ donation organization preparation for facial transplantation: The Transplant Québec experience.

Abstract

Background: Globally, there have been 43 face transplants performed since the first one in France, 2005. The preparation required to proceed towards vascularized composite allotransplant donation is dynamic and complex. Three years of collaborative, multi-disciplinary planning were required prior to the completion of the first facial transplantation in Canada and the Commonwealth. Methods: Transplant Québec worked in a coordinating role with multiple teams and agencies, including the transplant team, Hôpital Maisonneuve-Rosemont (located in Montréal), Health Canada, and the Ministry of Health of Québec. While developing a standard operating procedure (SOP), Transplant Québec looked to other jurisdictions which had already successfully performed this highly sophisticated procedure including the University of Maryland in Baltimore, Maryland, and New York University. Using these existing SOPs as a model, a specific SOP, tools and manuals were created and adapted to educate the Transplant Québec clinical staff regarding donor eligibility evaluation and the, logistics of procurement procedure. Concurrently, the ethics committee of Transplant Québec and the hospital research ethics board reviewed the research protocol, to ensure that the donor families were aware that images from the transplant recipient will presented to the media, and to ensure that no lifesaving organs were put at risk during the procurement. Results: Transplant Québec deployed the SOP for facial donation in February 2018. The protocol was executed by the donor coordinators who displayed interest in the project and who helped outline throughout the 3-year process. In accordance with ethics recommendations and the new SOP, facial transplantation was successfully performed in May 2018 during a 30 hours operation. Thoracic and abdominal organs were also successfully recovered and transplanted from the same donor. Coordinators approached the family in two distinct steps: first general consent was obtained for organ donation from a patient determined brain death, then separate consent was obtained for facial recovery and transplantation. The transplant surgeon was then called to the bedside to perform a bone, tooth and skin tone evaluation. The donor family was given guidance and support regarding media exposure. Conclusions: Successful facial transplantation requires focused and strong collaboration of all shareholders. While the medical, ethical and logistic issues were difficult to overcome, the result for the donor family, the recipient and the interest generated in the donation and transplantation system will generate benefits for years to come.