Developing a Communication Approach to Discuss VCA Donation with Families Who Have Authorized Organ Donation
Abstract
Making vascularized composite allotransplantation (VCA) a medical reality for the thousands of American Service men and women who experience limb loss or severe disfigurement as a result of their Service will require the option of vascularized composite allograft donation be presented as a routine part of requests for solid organ donation. Given its novelty, however, there is limited awareness of the need for or benefits of vascularized composite allograft donation among Organ Procurement Organization (OPO) request staff or the families they approach about donating the solid organs and tissues of deceased donor-eligible patients. Further, securing family authorization to organ, tissue, or vascularized composite allograft donation requires a unique skill set and use of evidence-based communication techniques. The Communicating Effectively about Donation (CEaD) training program was developed from a large body of research demonstrating the effectiveness of communication tactics to increase the likelihood of family authorization, including discussion of specific donation-related topics, correction of myths or misinformation about donation, and use of discrete relational and persuasive communication strategies. The overarching goal of the proposed research is to increase the number of vascularized composite allografts (faces and limbs) available for transplantation by optimizing authorization for vascularized composite allograft donation among families of deceased organ donors. To accomplish this objective, we propose to: (1) understand reservations about discussing vascularized composite allograft donation among OPO request staff and barriers to authorization of vascularized composite allograft donation by families of deceased organ donors; (2) adapt the existing CEaD training for the vascularized composite allograft donation context; and (3) beta-test the CEaD-VCA training program. The proposed research addresses “Psychosocial considerations and challenges associated with VCA: factors influencing donor registration and authorization,” a priority area of the Department of Defense Fiscal Year 2017 Reconstructive Transplant Investigator-Initiated Research Award. The ongoing conflicts in Iraq, Afghanistan, and other locales leave thousands of Service men and women with devastating bodily injuries annually. From 2003 to 2011, over 7,000 American Soldiers suffered traumatic injury to the head and neck. Of those sustaining injuries to the upper or lower extremities, 28.7% experienced injury to the wrist, hand, and finger, and 30% experienced injury to the face. Civilians also sustain catastrophic bodily injuries. Of the 861,888 injuries reported in 2015, 532,001 (61.7%) were classed as serious to unsurvivable, with 18% occurring to the head, 16.2% to an upper extremity, and 2.7% to a lower extremity. Advances in reconstructive surgery and other medical/surgical care have increased rates of survival from such injuries, but often leave the injured with severe disfigurement, functional limitations, and reduced quality of life. For patients whom currently available reconstructive procedures or prosthetics have not helped, VCA offers a promising alternative. As with all transplants, the primary risk of VCA is rejection of the graft or transplanted organ/tissue. Researchers are actively working to improve the immunosuppression therapies needed to reduce this risk. Research teams are also seeking to improve the pre- and post-operative care of VCA patients. To date, over 100 VCAs have been performed worldwide, most with very positive results, including increased function, mobility, and use of the affected body part and improved quality of life for recipients. In the United States, the use of VCA has been on the rise. In 2014, only four VCAs were performed in the United States; this increased fourfold by 2016, with 16 VCAs performed to repair severe injuries of the head and neck, upper limbs, penis, and uterus. The singl
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810680
Entities
People
- Laura Siminoff
Organizations
- Temple University
- United States Army