Early in 2016 Toronto’s University Health Network announced a #Canadian first: the completion of a successful #hand transplant. For Trillium Gift of Life Network (TGLN), the organization responsible for directing and overseeing transplantation in Ontario, this achievement marks the start of a new era in #transplant in Canada.
Vascular Composite Allotransplantation (or VCA), is the umbrella term used to describe the transplant of multiple tissues such as nerves, bone and skin, as a functional unit. TGLN has been planning for Ontario’s first VCA for some time, beginning with the creation of the VCA working group in 2013. This group, which included bioethicists, transplant surgeons, plastic surgeons, hand/upper limb surgeons and immunology specialists, along with other administrative and medical leadership, developed policies and procedures to guide and advise on the delivery of upper limb transplantation.
TGLN has a mandate to ensure equitable access to quality care throughout the patient continuum, from referral to post transplant care. In order to be consistent with TGLN policies for solid organ transplants, the VCA working group created donor exclusion criteria, patient referral and listing criteria, and an allocation algorithm, all designed to support fair and equitable transplant related practices.
Once Health Canada designated TGLN the source establishment in Ontario for VCA upper limb/hand, clinical process instructions and a detailed list of surgical requirements were developed, along with a new donor consent form. TGLN established a provincial waitlist for VCA to support potential patients, once identified, and Organ and Tissue Donation Coordinators (OTDCs) were provided with education and screening procedures to help them determine the potential for VCA donation.
Educational material was also prepared for the eventual donor family, keeping in mind that there was an increased potential for media attention.
“We always knew that for this family, no matter the circumstance, this wasn’t going to be about being the first. This was going to be about supporting donation and fulfilling the wishes of their loved one, says Ronnie Gavsie, TGLN President and CEO. “What we want is to ensure that when donation is a possibility, every family is offered the information and the opportunity to leave a legacy and save lives. We hope that this particular family finds some comfort in the gift given not only to this recipient, but to all those who will benefit in the future.”
For those present during the actual recovery process, respect and admiration for the donor was paramount. The team knew history was being made. As a member of the clinical team reflected, “It was a profound experience for each of us. During the customary moment of silence for the donor, I found myself thinking: what an amazing way to honour the donor and the gift of life.”
A TGLN organ and tissue donation coordinator worked closely with the donor family to support them through the donation process and share information, such as the option of prosthesis for the donated limb. The Trillium Gift of Life Network Act guarantees the confidentiality of the process, so the family was also assured that their privacy would be respected. Matching was done by TGLN’s Provincial Resources Centre (PRC) and was based on blood type, age, gender, size, skin tone and tissue matching.
Hand transplantation has the potential to significantly increase a patient’s quality of life. The recipient of an upper limb transplant can look forward to a return to normalcy, to function, to independence. This type of allograft provides results not possible to achieve through an artificial limb or prosthetic device.
According to Julie Trpkovski, Vice President of Transplant for TGLN, “Trillium Gift of Life Network has a responsibility to offer the best quality of care possible for all segments of the population. The organization is proud to have brought the skills, equipment, resources and team of experts together so that Ontario can now offer hand transplantation to its residents.”
“Trillium Gift of Life Network really directed this process, right from the initial planning stages,” says Dr. McCabe, director of the Toronto Western Hospital’s hand and upper extremity transplant program. “Their leadership has allowed for the creation of a safe, effective hand transplant program in Ontario, with all of the dimensions of quality one has come to expect from their oversight of the organ and tissue donation and transplantation system. I feel fortunate to be a hand surgeon at this time and this place with these confluence of events.”