*Purpose: Vascularized Composite Allograft (VCA) transplantation is a rapidly changing field.

*Methods: Since the Organ Procurement and Transplantation Network (OPTN) implemented the VCA waiting list on July 3, 2014, 95 candidates have been registered on the waiting list through November 15, 2019.

*Results: VCA candidates were 38.9% male, 78.9% white, and 78.9% under 45 years old, but characteristics varied by organ type (Table 1). The VCA waiting list initially was mostly upper limb and face candidates, but uterus candidates have made up about half of the list since late 2018 (Figure 1a). As of 11/15/19, the OPTN VCA waiting list included 7 head and neck (31.8%), 4 upper limb (18.2%), 3 abdominal wall (13.6%), 7 uterus (31.8%), and 1 candidate waiting for upper limb and face (4.5%). Median days on the list for those waiting for a deceased donor organ on 11/15/19 was 541 days (IQR: 205.8 – 626.5; Figure 2b). A total of 104 VCA recipients have received VCA transplants in the US (Figure 1b), including 54 since the OPTN VCA waiting list was implemented on 7/3/14. These 54 include 8 bilateral upper limb, 5 unilateral upper limb, 7 face, 1 scalp, 2 abdominal wall, 29 uterus (11 deceased donor; 18 living donor), and 2 penis transplants. Median days on the VCA waiting list for those transplanted with a deceased donor organ was 160 days (IQR: 64.8 – 376.5; Figure 2a).

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

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