Algorithm for total face and multiorgan procurement from a brain-dead donor

P. S. Brazio, R. N. Barth, B. Bojovic, Amir Dorafshar, J. P. Garcia, E. N. Brown, S. T. Bartlett, E. D. Rodriguez

Research output: Contribution to journalArticle

Abstract

Procurement of a facial vascularized composite allograft (VCA) should allow concurrent procurement of all solid organs and ensure their integrity. Because full facial procurement is time-intensive, "simultaneous-start" procurement could entail VCA ischemia over 12 h. We procured a total face osteomyocutaneous VCA from a brain-dead donor. Bedside tracheostomy and facial mask impression were performed preoperative day 1. Solid organ recovery included heart, lungs, liver, kidneys, and pancreas. Facial dissection time was 12 h over 15 h to diminish ischemia while awaiting recipient preparation. Solid organ recovery began at 13.5 h, during midfacial osteotomies, and concluded immediately after facial explantation. Facial thoracic and abdominal teams worked concurrently. Estimated blood loss was 1300 mL, requiring five units of pRBC and two units FFP. Urine output, MAP, pH and PaO2 remained normal. All organs had good postoperative function. We propose an algorithm that allows "face first, concurrent completion" recovery of a complex facial VCA by planning multiple pathways to expedient recovery of vital organs in the event of clinical instability. Beginning the recipient operation earlier may reduce waiting time due to extensive recipient scarring causing difficult dissection. The authors detail a full-face and thoracoabdominal organ procurement and present an algorithm for "face first, concurrent completion" that ensures the integrity of all organs by coordinating multiple surgical teams based on continual reassessment of donor status.

Original languageEnglish (US)
Pages (from-to)2743-2749
Number of pages7
JournalAmerican Journal of Transplantation
Volume13
Issue number10
DOIs
StatePublished - Oct 2013
Externally publishedYes

Fingerprint

Composite Tissue Allografts
Brain Death
Dissection
Ischemia
Tissue and Organ Procurement
Tracheostomy
Masks
Osteotomy
Cicatrix
Pancreas
Thorax
Urine
Kidney
Lung
Liver

Keywords

  • Composite tissue transplantation
  • face transplantation
  • multiorgan donor
  • organ and tissue procurement
  • organ protection and preservation
  • organ sharing

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Brazio, P. S., Barth, R. N., Bojovic, B., Dorafshar, A., Garcia, J. P., Brown, E. N., ... Rodriguez, E. D. (2013). Algorithm for total face and multiorgan procurement from a brain-dead donor. American Journal of Transplantation, 13(10), 2743-2749. https://doi.org/10.1111/ajt.12382

Algorithm for total face and multiorgan procurement from a brain-dead donor. / Brazio, P. S.; Barth, R. N.; Bojovic, B.; Dorafshar, Amir; Garcia, J. P.; Brown, E. N.; Bartlett, S. T.; Rodriguez, E. D.

In: American Journal of Transplantation, Vol. 13, No. 10, 10.2013, p. 2743-2749.

Research output: Contribution to journalArticle

Brazio, PS, Barth, RN, Bojovic, B, Dorafshar, A, Garcia, JP, Brown, EN, Bartlett, ST & Rodriguez, ED 2013, 'Algorithm for total face and multiorgan procurement from a brain-dead donor', American Journal of Transplantation, vol. 13, no. 10, pp. 2743-2749. https://doi.org/10.1111/ajt.12382
Brazio PS, Barth RN, Bojovic B, Dorafshar A, Garcia JP, Brown EN et al. Algorithm for total face and multiorgan procurement from a brain-dead donor. American Journal of Transplantation. 2013 Oct;13(10):2743-2749. https://doi.org/10.1111/ajt.12382
Brazio, P. S. ; Barth, R. N. ; Bojovic, B. ; Dorafshar, Amir ; Garcia, J. P. ; Brown, E. N. ; Bartlett, S. T. ; Rodriguez, E. D. / Algorithm for total face and multiorgan procurement from a brain-dead donor. In: American Journal of Transplantation. 2013 ; Vol. 13, No. 10. pp. 2743-2749.
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