Algorithm for total face and multiorgan procurement from a brain-dead donor

P. S. Brazio, R. N. Barth, B. Bojovic, A. H. Dorafshar, J. P. Garcia, E. N. Brown, S. T. Bartlett, E. D. Rodriguez

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Procurement of a facial vascularized composite allograft (VCA) should allow concurrent procurement of all solid organs and ensure their integrity. Because full facial procurement is time-intensive, "simultaneous-start" procurement could entail VCA ischemia over 12 h. We procured a total face osteomyocutaneous VCA from a brain-dead donor. Bedside tracheostomy and facial mask impression were performed preoperative day 1. Solid organ recovery included heart, lungs, liver, kidneys, and pancreas. Facial dissection time was 12 h over 15 h to diminish ischemia while awaiting recipient preparation. Solid organ recovery began at 13.5 h, during midfacial osteotomies, and concluded immediately after facial explantation. Facial thoracic and abdominal teams worked concurrently. Estimated blood loss was 1300 mL, requiring five units of pRBC and two units FFP. Urine output, MAP, pH and PaO2 remained normal. All organs had good postoperative function. We propose an algorithm that allows "face first, concurrent completion" recovery of a complex facial VCA by planning multiple pathways to expedient recovery of vital organs in the event of clinical instability. Beginning the recipient operation earlier may reduce waiting time due to extensive recipient scarring causing difficult dissection. The authors detail a full-face and thoracoabdominal organ procurement and present an algorithm for "face first, concurrent completion" that ensures the integrity of all organs by coordinating multiple surgical teams based on continual reassessment of donor status.

Original languageEnglish (US)
Pages (from-to)2743-2749
Number of pages7
JournalAmerican Journal of Transplantation
Issue number10
StatePublished - Oct 2013
Externally publishedYes


  • Composite tissue transplantation
  • face transplantation
  • multiorgan donor
  • organ and tissue procurement
  • organ protection and preservation
  • organ sharing

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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