Ethical challenges in vascularized composite allotransplantation of the lower extremity:lessons learned from hand transplantation and implications for the future  

作　　者：Amy L.Xu Casey Jo Humbyrd 

机构地区：[1]Department of Orthopaedic Surgery,Johns Hopkins Hospital,Baltimore,MD 21287,USA [2]Department of Orthopaedic Surgery,Hospital of the University of Pennsylvania,Philadelphia,PA 19106,USA

出　　处：《Plastic and Aesthetic Research》2022年第1期196-212,共17页整形与美容研究（英文版）

摘　　要：Vascularized composite allotransplantation(VCA)is a novel surgical practice that involves the transplantation of multiple tissue types as a functional unit without the primary purpose of extending life.While VCA of the upper extremity is becoming increasingly accepted and performed,VCA of the lower extremity remains largely unexplored despite its acknowledged potential value.There are inherent ethical concerns surrounding VCA that are dominated by a conflict between the principles of beneficence and maleficence.The primary question is whether the quality-of-life benefits to the patient outweigh the risks associated with long-term immunosuppression for a non-lifesaving procedure.In addition,the ethical conversation involves concerns regarding informed consent,donor autonomy,patient privacy and public disclosure,patient selection,and unique considerations in the pediatric patient.Lower extremity VCA has additional ethical issues compared to upper extremity VCA,as current lower limb prostheses provide excellent,near baseline function that upper limb constructs have not yet been able to achieve.In this review,we discuss the ethical challenges of lower extremity VCA using available evidence for the upper extremity.We also compare ethical considerations of VCA of the extremity with other surgical alternatives to limb loss-namely,limb salvage and replantation-and address how the conversation may be altered with further advancements in immunosuppression and prosthetic technology.

关 键 词：Vascularized composite allotransplantation(VCA) lower extremity ETHICS limb salvage REPLANTATION 

分 类 号：G63[文化科学—教育学]