*Purpose: Vascularized Composite Allograft (VCA) transplantation has grown and changed rapidly in the past several years. This study investigates VCA waiting list and transplant trends in the U.S.

*Methods: We used OPTN VCA waiting list data from July 3, 2014 through November 15, 2020 and OPTN VCA transplant data from January 1, 1998 through November 15, 2020.

*Results: Since the OPTN implemented the VCA waiting list on July 3, 2014, 99 candidates have been registered on the waiting list through November 15, 2020. VCA candidates were 60.6% female, 79.8% white, and 78.8% under 45 years old, but characteristics varied by organ type. The size of the VCA waiting list increased gradually over several years, largely due to the introduction of uterus transplants. In the past year, however, existing registrations for upper limb and head and neck candidates held steady while uterus registrations declined. New registrations were notably lower in 2020, likely due to the COVID-19 crisis. As of 11/15/20, the OPTN VCA waiting list included 4 head and neck (20%), 6 upper limb (30%), 4 abdominal wall (20%), and 6 uterus (30%) candidates. Median days on the list for those waiting for a deceased donor organ on 11/15/20 was 771 days (IQR: 524.8 – 971.0) – a large increase compared with analyses at the same time in 2019. Median days on the VCA waiting list for those transplanted with a deceased donor organ was 193 days (IQR: 71.25 – 376.5). A total of 109 VCA recipients have received VCA transplants in the US, including 59 since 7/3/14: 8 bilateral upper limb, 5 unilateral upper limb, 10 face, 1 scalp, 2 abdominal wall, 31 uterus (12 deceased donor; 19 living donor), and 2 penis transplants.

*Conclusions: Continued monitoring of VCA trends is needed to support VCA donation and transplantation.

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