Psychosocial Factors Influencing Patients’ Decision Making About Upper Extremity Vca

B. Kuramitsu¹, J. Gacki-Smith¹, A. Ferzola², K. Vanterpool², C. Kunkle³, M. Hewitt³, A. Schultheis³, T. Riggleman³, J. Taylor³, C. Cooney², M. Levan², S. Tintle³, G. Brandacher², E. Gordon¹

¹Northwestern University, Chicago, IL, ²Johns Hopkins University, Baltimore, MD, ³Walter Reed National Military Medical Center, Bethesda, MD

Meeting: 2021 American Transplant Congress

Abstract number: 417

Keywords: Ethics, Patient education, Psychosocial

Topic: Clinical Science » Ethics » Psychosocial and Treatment Adherence

Session Information

Session Name: Adherence, Economics, and Ethics

Session Type: Poster Video Chat

Date: Sunday, June 6, 2021

Session Time: 7:30pm-8:30pm

Presentation Time: 8:10pm-8:20pm

Location: Virtual

*Purpose: The informed consent process for upper extremity (UE) Vascularized Composite Allotransplantation (VCA) has yet to be standardized. Consequently, the information provided to patients about UE VCA varies. Such variation may contribute to people with UE amputations being inadequately informed and under-prepared for decision making about UE VCA. This study examined decision making and psychosocial factors affecting decisions about UE VCA among people with UE amputations.

*Methods: We conducted in-depth interviews among people with acquired UE amputations. Open-ended questions assessed psychosocial factors informing decision making about UE VCA. Thematic analysis was used to analyze qualitative data.

*Results: To date, 12 people completed in-depth interviews (75% participation rate). Most were male (71%) and had a mean age of 49 years. Most had a unilateral amputation (75%) and had undergone amputation a mean of 8 years earlier. Forty-two percent of participants were ‘completely’ or ‘a lot’ willing to pursue VCA. Psychosocial factors influencing decisions to pursue VCA included: expecting an increase in social and physical confidence; seeking independence with activities of daily living; enabling more active involvement as a parent; family or friend enthusiasm; and prosthetic device problems. Psychosocial factors influencing decision making not to pursue VCA included: feeling mentally unprepared for a transplant; having already adapted to life without upper limb(s); concerns about the long-term commitment to taking immunosuppressants; discouragement from family or friends; concerns about the rigorous rehabilitation process; concerns about receiving a graft that appears mismatched in size or skin color; concerns that the transplant may be unsuccessful; concerns about health or limb function becoming “worse off” from the UE VCA; and concerns about logistical barriers to accessing transplant and rehabilitation services.

*Conclusions: Preliminary findings suggest that people with UE amputations hold concerns that diminish their enthusiasm for UE VCA. Addressing patients’ psychosocial concerns may foster informed decision making about UE VCA.

To cite this abstract in AMA style:

Kuramitsu B, Gacki-Smith J, Ferzola A, Vanterpool K, Kunkle C, Hewitt M, Schultheis A, Riggleman T, Taylor J, Cooney C, Levan M, Tintle S, Brandacher G, Gordon E. Psychosocial Factors Influencing Patients’ Decision Making About Upper Extremity Vca [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/psychosocial-factors-influencing-patients-decision-making-about-upper-extremity-vca/. Accessed May 12, 2025.

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