[Composite Tissue Allotransplantation (CTA): organ or tissue transplantation?]

Plastic surgery has a long tradition in transplantation issues. Skin transplantation has been introduced by plastic surgeons Padgett and Brown. The first kidney transplantation was performed by Dr. Murray, a plastic surgeon. Composite tissue allotransplantation (CTA) is an evolving new field with transplantation of hand, vascularised knees or partial faces. With the European Union (EU) directive 2004/23/EC come into effect with the German tissue law at August 1, 2007 one has question the classification of transplantation of the hands, arms or the face as tissue or organ transplantation. While solid organs are allocated based on the German Deutsche Stiftung Organspende (DSO) and EuroTransplant, this is not the case for tissues. While for example thoracic organ procurement is performed in heart-beating organ donors with established hemodynamics, this is not the case for tissues, either. Given the complexity of a hand or a face as a sample of bones, muscles, nerves, vessels, and skin this has to be taken into account for example in comparison to a cornea as a tissue graft. As such, Dr. Siemionow has proposed a face to be regarded as an organ when comparing it to a kidney. Currently, allocation procedures as well as procurement issues in CTA are much more similar to organ- rather than tissue transplantation. Thus, we believe that CTA of hands or partial faces has more similarities to organ than to mere tissue transplantation.