Conhecimento e opinião da população sobre o transplante e a doação dos tecidos da face / Knowledge and opinion of the population about the transplant and donation of facial tissues

O transplante de face é um procedimento cirúrgico no qual as estruturas da face de uma pessoa são transplantadas para outra. É uma cirurgia ousada do ponto de vista médico, moral e psicológico, pois, proporciona enorme benefício em termos de melhora da função estética e integração social. Avaliar o conhecimento e a opinião da população sobre o transplante e a doação dos tecidos da face. No período de agosto de 2011 a outubro de 2012 foi aplicado um questionário a 430 pessoas, escolhidas aleatoriamente, na faixa etária acima de vinte e um anos de idade, numa sistemática de coleta seguida em todas as regiões (norte, sul, centro, leste e oeste) da cidade de Botucatu, interior do Estado de São Paulo. O estudo das respostas dos participantes nas diferentes questões objetivas apresentadas foi realizado estabelecendo-se a distribuição frequencial dos dados apresentada por meio de tabelas ou gráficos e analisadas pelo teste do Qui quadrado ( א) para uma amostra. A análise das respostas obtidas foram discutidas ao nível de 5% de significância e consideradas significativas quando o valor de p foi < 0,05, mostrando que a distribuição não é uniforme, mas uma distribuição uniforme das classes. Nas questões dissertativas a análise foi realizada a partir da leitura das mesmas, com elaboração de um resumo das respostas e análise preferencial por região. Dos participantes, 65,8% não possuem conhecimento a respeito da doação dos tecidos da face; 90,1% têm conhecimento que o transplante de face está indicado nos casos de deformidades faciais; 51,7% doariam a face; 67,7% não saberiam como seus familiares reagiriam frente a sua manifestação em vida de doar os tecidos da face; 84% não sabem as implicações sobre as cerimônias fúnebres. Dos participantes, 359 aceitariam conviver com outra face caso fosse necessário e 375 apoiariam se algum familiar manifestasse vontade em ser um doador...

The face transplantation is a surgical procedure in which facial structures are transplanted from one person to another. It’s a complex procedure on a medical point of view, moral and psychological, therefore provides many benefits in terms of improving aesthetic function and social integration. To evaluate the knowledge and opinion of the population about the donation and transplantation of facial tissues. From August 2011 to October 2012 a questionnaire was administered to 430 people, randomly selected, with twenty-one years of age or older, systematically collected in all regions (north, south, center , east and west) of the city of Botucatu, state of São Paulo. The study of the objective responses of all participants in the different issues was accomplished by establishing a frequential distribution data presented using tables and graphs and analyzed by chi square (à) for a sample. The analysis of the responses were discussed at the 5% level of significance and considered significant when the p value was <0.05, showing that the distribution is not uniform, but uniformly distributed of the classes. The answers to the descriptive questions were analyzed by reading them and preparation of a summary with analysis by region. Of the participants, 65.8% did not have any knowledge about facial tissue donation, 90.1% knows that face transplantation is indicated in cases of facial deformities, 51.7% are able to donate tissues of the face, 67.7% are not aware how their families would react against its manifestation in life to give tissues of the face, 84% have no knowledge about the implications on the funeral ceremonies. Of all participants, 359 would accept to live with other face if necessary and 375 would support any family members in being a donor...

Perception of transplant coordinator regarding relatives' attitude toward tissue donation request.

INTRODUCTION: Family denials for tissue donation are higher than denials obtained after organ donation. OBJECTIVES: To find out families' perception toward tissue request as well as its relation with the degree of acceptance or denial. MATERIALS AND METHODS: Following the request for tissue donation (corneas or different tissues), a five closed-question survey was designed and immediately answered by the Transplant Coordinator. The main aim was to find out whether the request determined surprise, disapproval, understanding, knowledge, and immediacy in the decision-making process, as well as its relation with the decision to donate. RESULTS: Of 1751 surveys, 991 were answered and collected from 2009 to 2011, which represents a 56% from the total. Data collected relate to families 510 who donated and 481 who did not (P = NS). The fact of requesting corneas only or different tissues did not influence the answers. Surprise and disapproval variables significantly predicted refusal to donation (P = .000). CONCLUSIONS: Regardless the request type (corneas or multitissue) variables influencing the decision making when approaching families are expression of surprise and disapproval. Neither understanding the application nor existence of a prior approach to donation has any influence whatsoever in the decision-making process.

Impact of the educational resource one life many gifts on attitudes of secondary school students towards organ and tissue donation and transplantation.

BACKGROUND: Increased awareness of organ donation/transplantation has been found to have a positive influence on organ donation rates. One Life … Many Gifts is a curriculum resource in Ontario, Canada, to educate and raise awareness for senior secondary school students about the importance of organ and tissue donation and transplantation. Teachers administered pre- and post- attitudinal surveys to senior secondary school students to evaluate changes in their attitudes toward organ and tissue donation and transplantation. In this study, the effect of the One Life … Many Gifts educational intervention on changing the attitudes and awareness of organ donation and transplantation of senior secondary students was assessed. METHODS: Mann-Whitney U tests were used to compare the pre- and post-surveys as a whole and then again for the data from individual schools. Kruskal-Wallis H-tests were used to compare data between schools. RESULTS: A total of 1832 pre- and 1440 post-educational surveys returned to Trillium Gift of Life Network were assessed in the 2008-2009 academic year. Overall, comparison of all pre- and post-educational program survey data showed significant improvement in the students' attitudes toward organs and tissue donation and transplantation (P = .00625). CONCLUSION: The One Life … Many Gifts program made an impact on changing the attitudes toward and awareness of organ donation among high school students in Ontario. Evaluation of its impact on donor registration and organ donation among the students and their parents is complex and remains to be seen.

Transplantation of a latissimus dorsi flap between identical twins.

We present a case of composite tissue transplantation of a latissimus dorsi flap between monozygotic twins. The recipient twin, a 19 year old male, suffered from a complex spinal kyphoscoliosis for which he had undergone multiple previous operations over many years. Soft tissue breakdown on his back causing metalwork exposure had necessitated the removal of his most recent spinal rod. This in turn led to rapid severe deterioration of his spinal deformity and consequent critical impairment of lung function. Robust soft tissue cover was required urgently in order to allow the insertion of a new spinal rod. His previous surgeries and body habitus precluded an adequate autologous reconstruction. Instead, reconstruction using composite tissue transplantation from his identical twin brother was successfully undertaken. We discuss the ethical, psychological and surgical issues involved in this case.

Composite tissue allotransplantation: a proposed classification system based on relative complexity.

Numerous achievements have been made encompassing a wide array of composite tissue allograft (CTA) subtypes. We sought to develop a simple, reproducible CTA classification system for the purpose of comparing clinical investigation. Each CTA subtype differs in relative complexity and can therefore be theoretically classified based on its unique combination of multiple factors. Eight complexity factors (CFs) are hypothesized: anatomic detail, psychological obstacles, rejection risk, required rehabilitation, relative antigenicity, functionality/cosmesis, skin ratio, and salvageability. A distribution of total complexity scores, ranging from 8 to 24, is classified into 3 ordered categories representing varying degrees of complexity. In conclusion, we have created a new classification system so that ongoing research and future data may be compared in a type-specific fashion.

Ethical considerations in face transplantation.

Human face transplantation is now a clinical reality. The surgical techniques necessary to perform these procedures have been used routinely in reconstructive microsurgery for many years. From an immunological standpoint since face and hand contain mostly the same tissues it is reasonable to assume that the same immunosuppressive regimen found to be effective in human hand transplants should also work in face transplantation. It is the ethical issues associated with the risks and benefits of performing facial transplantation that have posed the greatest challenges leading up to performing this new procedure. In this editorial, we will review some of the main events that have led to the recently performed human face transplants, specifically focusing on the key ethical issues at the center of this debate. We will discuss how the research and clinical experience in human hand transplantation laid the foundation for performing face transplantation and describe the research and the ethical guidelines upon which a team at the University of Louisville based their position "to move ahead" in spite of much criticism. Finally we will outline some of the key arguments against face transplantation, and conclude with a discussion on what comes next now that the first human face transplants have been performed.

Face transplantation: a review of the technical, immunological, psychological and clinical issues with recommendations for good practice.

Three years ago, the Working Party on Facial Transplantation concluded that until there was more information available about risks any potential patient would be exposed to, it would be unwise to proceed with transplantation of the human face. Over the last three years, there has been a deepening understanding of the potential psychological problems of facial transplantation as well as a very considerable debate on the ethical aspects of the procedure. Further data on experimental work in animal models of facial transplantation as well as medium-term follow-up data from 24 hand and forearm transplants in 18 patients has now become available. Furthermore, a partial facial transplantation has been performed in France and a second one in China. In this second edition of the report, the technical, immunological, psychological, and ethical issues are discussed again in the light of this developing knowledge. In particular, there has been a major expansion of the sections on the psychological and societal issues, as well as the ethical and legal problems of facial transplantation. The working party still has considerable reservations about facial transplantation. Although it accepts that on balance the risks cannot be precisely quantified, they remain substantial. Therefore, if patients are allowed to make an informed choice to proceed, they must be very carefully selected and protected in the process, along with the families of both the donors and the recipients. To achieve this, the working party insists that 15 minimum requirements, described at the end of this report, must be fulfilled before it would be appropriate for a research ethics committee/institutional review board to approve of a proposal to undertake facial transplantation.

Organ transplantation, organ donation and mental retardation.

We reviewed the literature on accessibility and outcomes of organ transplantation in individuals with mental retardation (MR) and on the prevalence of organ donation in this population. Six centers have published outcome data on renal transplantation in 34 individuals with MR. The one- and three-yr patient survival rates were 100% and 90%, respectively. The studies reported good compliance with post-transplant medications due to consistent support from family members or caregivers. The outcome studies for liver and heart transplantation among these individuals are limited. The literature on organ donation in individuals with MR is mostly concerned with legal issues. The courts generally permit organ donations when such is in the best interests of the donor.

Investigation of risk acceptance in facial transplantation.

BACKGROUND: The surgical techniques necessary to transplant a human face are well established, and the early success of human hand transplants suggests that the immunological hurdles of transplanting human facial tissues have largely been overcome. Therefore, it is the ethical barriers that pose the greatest challenge to performing facial transplantation. At the center of the ethical debate is the question, "Do the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving a face transplant?" In this study, the authors answer this question by assessing the degree of risk individuals would be willing to accept to receive a face transplant. METHODS: To quantitatively assess risks versus benefits in facial transplantation, the authors developed the Louisville Instrument for Transplantation, or LIFT, which contains 237 standardized questions. Respondents in three study populations (healthy individuals, n = 150; organ transplant recipients, n = 42; and individuals with facial disfigurement, n = 34) were questioned about the extent to which they would trade off specific numbers of life-years, or sustain other costs, in exchange for receiving seven different transplant procedures. RESULTS: The authors found that the three populations would accept differing degrees of risk for the seven transplant procedures. Organ transplant recipients were the most risk-tolerant group, while facially disfigured individuals were the least risk tolerant. All groups questioned would accept the highest degree of risk to receive a face transplant compared with the six other procedures. CONCLUSIONS: This study presents an empirical basis for assessing risk versus benefit in facial transplantation. In doing so, it provides a more solid foundation upon which to introduce this exciting new reconstructive modality into the clinical arena.