A Single Center's Experience with Donation of Facial Allografts for Transplantation

Face transplantation offers superior functional and aesthetic outcomes when compared with conventional reconstruction. Optimizing criteria to match donors and recipients will improve outcomes. However, there is limited available literature regarding donor procurement and matching. The Brigham and Women's Hospital describes its experience with facial allograft donation for 7 face transplants performed between 2009 and 2014. Important considerations include donors' type of death, allograft ischemia time, demographics, immunologic compatibility, serology, and donor facial restoration. Brain-dead, heart-beating donors were preferred because their hemodynamic stability facilitated procurement logistics. The maximum allograft ischemia time allowed by our team was 4 hours. Donor and recipient should be matched in appearance by having the same gender, similar age, and comparable skin tone/texture. Immunologic compatibility requires ABO compatibility, suitable HLA typing, and negative crossmatch. Donor serology for infectious diseases, especially cytomegalovirus (CMV) and Epstein-Barr virus (EBV), is important because of implications of post-transplant immunosuppression. High-risk CMV and EBV matches (donor-positive/recipient-negative) should be avoided when possible. Facial restoration with a prosthetic mask was performed to preserve the donor's dignity. Although every face transplant recipient has unique needs, we hope this report will help identify important donor characteristics that can be incorporated in a national donor registry.