Bruce Gelb
NYU Langone Transplant Institute, USA
Title: Tackling the challenge of acute rejection prevention in VCA transplantation: A novel approach utilizing T cell and mature B cell depleting induction
Biography
Biography: Bruce Gelb
Abstract
Vascularized composite allotransplantation (VCA) is defined as “the transplant of intactvascularized body parts, such as hands and faces.” The first successful handtransplant was performed in France in 1998, and the field has expanded to include faces, abdominal walls, arms, legs, scalp, and reproductive organs. From a technical standpoint, feasibility has been proven, as is evidenced by graft and patient survival rates comparative to or exceeding that of solid organ transplant. To date, more than 200 of these procedures have been performed world-wide. Each procedure is necessarily unique.As the field makes the transition from purely experimental to becoming a standard of care, there are notable ethical issues specific to VCA: Are the quality of life and psychological benefits sufficient to justify the operative risk and medical risks associated with life-long immunosuppression therapy for a non-life saving procedure? Is the procedure economically justifiable? Can recipient and donor privacy and anonymity be sufficiently protected in a time of extreme human interest and media attention in these procedures? How do we determine who is an appropriate candidate for this procedure? What is the appropriate timing in relation to the original injury? What should the legal and regulatory framework be to determine which procedures are appropriate currently?It is necessary to have consensus in approaching these issues both thoughtfully and realistically if the field of VCA transplantation is to survive and mature over the next 20 years