A Multisystemic Approach to Psychosocial Evaluations of Vascularized Composite Allotransplantation Candidates

Abstract

This report seeks to shed light on multisystem domains of interest in vascularized composite allotransplantation (VCA) to improve patients’ psychosocial assessment and candidacy, to decrease environmental barriers to transplant success, and to add to the discussion concerning bioethical dilemmas associated to VCA. Psychosocial assessment tools cover availability, accessibility, and common sense of the treatment at microsystem and individual levels. However, macro-, exo-, and mesosystem risk factors remain unevaluated. Readers are invited to expand and complement the factors described in the review. Psychosocial assessment of individual and microsystem domains in VCA is not enough for patients in developing countries where higher contextual barriers to treatment adherence are expected. To expand contextual domains of interest, Bronfenbrenner’s social-ecological theory and Ungar’s multisystemic social-ecological theory of resilience are taken into consideration.