HAND AND UPPER EXTREMITY DONATION A GUIDE TO CLINICAL AND FAMILY SUPPORT FOR ORGAN PROCUREMENT ORGANIZATIONS
Abraham, James Alexander
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Abstract Loosing a limb due to extensive trauma, severe burns, or from infection, can be devastating and mentally taxing on an individual. With the advent of Vascularized Composite Allotransplantation (VCA), individuals with amputated extremities have a new option: they can receive a donor hand or arm, in a procedure that is similar to the more traditional solid organ donation and transplantation. Organ Procurement Organizations (OPOs) play a pivotal role in organ procurement: they are responsible for donor registration, and coordination of the donation process. Staff at OPOs need to have appropriate resources and educational material to guide their practices, however there is limited literature, lack of visuals, and no guidebooks or choreography on the recovery process of VCAs. The Living Legacy Foundation (LLF) is developing a guidebook to provide OPOs with the necessary training and education for their organization. Five key steps in upper extremity VCA were selected for illustrations for the LLF guidebook:(i) tourniquet application, (ii) vessel dissection, (iii) possible levels of transection, (iv) perfusion process, and (v) prosthetic fitting. Quick reference guides showing the 3 pathways of VCA recovery were developed to help non-VCA teams with choreography in the operating room. Pen and ink was used for the illustrations for simplified schematic lines. An aerial view with icons was used for the VCA pathways for quick readability. Limited color was utilized on all images to draw emphasis and importance to specific elements. There was a focus group held at the LLF where eight staff members filled out evaluation sheets for preliminary images and quantitative and qualitative data was collected. Feedback was also collected from Dr. Brandacher and transplant surgeons. All recommendations were considered and revisions were made for all images. Upon completion, the guidebook containing created visuals and text written by the LLF, will be distributed to their employees. If successful amongst the LLF employees, the guidebook will be presented to regional OPOs, professional societies and eventually to UNOS/OPTN for consideration as a nation-wide resource for all OPOs and VCA centers.