Patient preferences of patient selection criteria for upper extremity vascularized composite allotransplantation: A qualitative study

Karen B Vanterpool; Jessica Gacki-Smith; Max C Downey; Michelle Nordstrom; Michelle Luken; Tiffany Riggleman; Shannon Fichter; Withney Altema; Sally E Jensen; Gregory A Dumanian; Carisa M Cooney; Macey L Levan; Scott Tintle; Gerald Brandacher; Elisa J Gordon

doi:10.1177/20503121231181236

Patient preferences of patient selection criteria for upper extremity vascularized composite allotransplantation: A qualitative study

SAGE Open Med. 2023 Jun 15:11:20503121231181236. doi: 10.1177/20503121231181236. eCollection 2023.

Authors

Karen B Vanterpool¹, Jessica Gacki-Smith², Max C Downey¹, Michelle Nordstrom³, Michelle Luken^{3

4}, Tiffany Riggleman³, Shannon Fichter^{3

4}, Withney Altema^{3

4}, Sally E Jensen⁵, Gregory A Dumanian⁵, Carisa M Cooney⁶, Macey L Levan¹, Scott Tintle³, Gerald Brandacher⁶, Elisa J Gordon⁷

Affiliations

¹ Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.
² Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³ Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁴ The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, MD, USA.
⁵ Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁶ Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Department of Surgery and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA.

Abstract

Background: Upper extremity vascularized composite allotransplantation is a life-enhancing reconstructive treatment option that aims to improve recipients' quality of life and maximize function. This study assessed upper extremity vascularized composite allotransplantation patient selection criteria perceptions among individuals with upper extremity limb loss. The perceptions of individuals with upper extremity limb loss on patient selection criteria may enable vascularized composite allotransplantation centers to improve criteria to avoid mismatched expectations about the posttransplant vascularized composite allotransplantation experience and outcomes. Realistic patient expectations may increase patient adherence, improve outcomes, and reduce vascularized composite allotransplantation graft loss.

Methods: We conducted in-depth interviews with civilian and military service members with upper extremity limb loss and upper extremity vascularized composite allotransplantation candidates, participants, and recipients from three US institutions. Interviews assessed perceptions of patient selection criteria for suitability as a candidate for upper extremity vascularized composite allotransplantation. Thematic analysis was used to analyze qualitative data.

Results: A total of 50 individuals participated (66% participation rate). Most participants were male (78%), White (72%), with a unilateral limb loss (84%), and a mean age of 45 years. Six themes emerged regarding upper extremity vascularized composite allotransplantation patient selection criteria, including support for candidates who: (1) are of younger age, (2) are in good physical health, (3) have mental stability, (4) are willing to "put in the work," (5) have specific amputation characteristics, and (6) have sufficient social support. Patients had preferences about selecting candidates with unilateral versus bilateral limb loss.

Conclusions: Our findings suggest that numerous factors, including medical, social, and psychological characteristics, inform patients' perceptions of patient selection criteria for upper extremity vascularized composite allotransplantation. Patient perceptions of patient selection criteria should inform the development of validated screening measures that optimize patient outcomes.

Keywords: Hand transplantation; amputation; candidate evaluation; eligibility criteria; ethics; interviews; limb loss; patient expectations; perceptions; rehabilitation.