{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:02:41Z","timestamp":1779692561902,"version":"3.53.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:p>Vascularized composite allotransplantation (VCA) has transitioned from an experimental endeavor to a clinically viable option for patients with complex tissue loss. While advances in microsurgery, immunosuppression, and perioperative care have improved graft survival, long-term success remains contingent upon psychosocial integration and robust ethical governance. These developments are reshaping not only clinical outcomes but also the conceptual foundations of transplantation. VCA uniquely challenges traditional paradigms, as it is primarily life-enhancing rather than life-saving, thereby intensifying ethical scrutiny regarding risk\u2013benefit proportionality. Psychosocial factors such as identity reconstruction, body wholeness, personal autonomy, adherence, and long-term mental health are central determinants of graft success. Concurrently, innovations such as AI-driven allocation systems, big data analytics, and digital monitoring introduce novel ethical concerns related to autonomy, transparency, data governance, and equity. A key objective of this mini-review is to critically examine how emerging technological innovations in VCA intersect with psychosocial processes and bioethical principles, and to outline a framework for their responsible integration into clinical practice. It argues that technological progress must be embedded within a patient-centered approach that prioritizes lived experience, relational ethics, and trust. The integration of person-centered care models, longitudinal assessments, and interdisciplinary \u201cteam science\u201d approaches is essential for ensuring that innovation translates into meaningful, equitable, and ethically sustainable improvements in patient outcomes Ultimately, the future of VCA depends on aligning biomedical innovation with psychosocial resilience and ethical legitimacy, ensuring that reconstructive success translates into meaningful improvements in quality of life and providing access to these transplants for all patients in need.<\/jats:p>","DOI":"10.3389\/frtra.2026.1869486","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:04:42Z","timestamp":1779689082000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The integration of psychosocial care, ethical governance, and patient-centered research in current and future approaches in the field of vascularized composite allotransplantation"],"prefix":"10.3389","volume":"5","author":[{"given":"Martin","family":"Kumnig","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Center for Advanced Psychology in Plastic and Transplant Surgery, Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hopfgartner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Center for Advanced Psychology in Plastic and Transplant Surgery, Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Brandacher","sequence":"additional","affiliation":[{"name":"Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck","place":["Innsbruck, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"524","DOI":"10.5500\/wjt.v6.i1.91","article-title":"Psychosocial aspects of vascularized composite allotransplantation","volume":"21","author":"Kumnig","year":"2016","journal-title":"Curr Opin Organ Transplant"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1586\/ern.09.42","article-title":"The psychological management of facial transplantation","volume":"9","author":"Clarke","year":"2009","journal-title":"Expert Rev Neurother"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1323387","DOI":"10.3389\/frtra.2023.1323387","article-title":"Review of machine perfusion studies in vascularized composite allotransplant preservation","volume":"2","author":"Duru","year":"2023","journal-title":"Front Transplant"},{"key":"B4","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1097\/MOT.0000000000001107","article-title":"Advances in machine perfusion and preservation of vascularized composite allografts","volume":"28","author":"Muss","year":"2023","journal-title":"Curr Opin Organ Transplant"},{"key":"B5","doi-asserted-by":"publisher","first-page":"eaax8429","DOI":"10.1126\/sciadv.aax8429","article-title":"In situ recruitment of regulatory T cells promotes donor-specific tolerance in VCA","volume":"6","author":"Fisher","year":"2020","journal-title":"Sci Adv"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2775","DOI":"10.3390\/jcm14082775","article-title":"Ethics and algorithms to navigate artificial intelligence\u2019s emerging role in organ transplantation","volume":"14","author":"Salybekov","year":"2025","journal-title":"J Clin Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1055\/s-0044-1786991","article-title":"Computerized surgical planning in face transplantation","volume":"38","author":"Shah","year":"2024","journal-title":"Semin Plast Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1002\/path.4635","article-title":"The role of genetically engineered pigs in xenotransplantation research","volume":"238","author":"Cooper","year":"2016","journal-title":"J Pathol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1097\/MOT.0000000000001028","article-title":"Vascularized composite allotransplantation: emerging psychosocial issues in VCA","volume":"27","author":"Kumnig","year":"2022","journal-title":"Curr Opin Organ Transplant"},{"key":"B10","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12910-023-00983-0","article-title":"Should artificial intelligence allocate livers for transplant? Public attitudes and ethical considerations","volume":"24","author":"Drezga-Kleiminger","year":"2023","journal-title":"BMC Med Ethics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1045144","DOI":"10.3389\/fpsyg.2022.1045144","article-title":"Psychosocial and bioethical challenges and developments for the future of vascularized composite allotransplantation: a scoping review and viewpoint of recent developments and clinical experiences in the field of vascularized composite allotransplantation","volume":"13","author":"Kumnig","year":"2022","journal-title":"Front Psychol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1037\/a0021167","article-title":"Psychological and psychosocial aspects of the transplant experience\u2013A practice review","volume":"47","author":"Rainer","year":"2010","journal-title":"Psychotherapy"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e096403","DOI":"10.1136\/bmjopen-2024-096403","article-title":"Organ procurement coordinators\u2019 experiences with family refusals in cadaveric organ donation: a qualitative analysis","volume":"15","author":"Karata\u015f","year":"2025","journal-title":"BMJ Ioen"},{"key":"B14","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1146\/annurev-bioeng-062824-121925","article-title":"Designer organs: ethical genetic modifications in the era of machine perfusion","volume":"27","author":"Filz Von Reiterdank","year":"2025","journal-title":"Annu Rev Biomed Eng"},{"key":"B15","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.ajt.2025.10.011","article-title":"Ethical and psychosocial issues with perfusion technology for organ transplantation: a scoping review","volume":"26","author":"Blazier","year":"2025","journal-title":"Am J Transplant"},{"key":"B16","doi-asserted-by":"publisher","first-page":"10621","DOI":"10.3389\/ti.2022.10621","article-title":"Ethics of early clinical trials of bio-artificial organs","volume":"35","author":"Bunnik","year":"2022","journal-title":"Transpl Int"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1007\/s11136-011-0054-x","article-title":"Implementing patient-reported outcomes in clinical practice: a review of the options and considerations","volume":"21","author":"Snyder","year":"2012","journal-title":"Qual Life Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1735113","DOI":"10.3389\/fimmu.2025.1735113","article-title":"Recent progress in pig-to-human kidney xenotransplantation","volume":"16","author":"Tao","year":"2025","journal-title":"Front Immunol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"12592","DOI":"10.3389\/ti.2024.12592","article-title":"Clinical pig heart xenotransplantation\u2014where wo we go from here?","volume":"37","author":"Cooper","year":"2024","journal-title":"Transpl Int"},{"key":"B20","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/bmb\/ldx043","article-title":"Xenotransplantation-the current status and prospects","volume":"125","author":"Cooper","year":"2018","journal-title":"Br Med Bull"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e1515","DOI":"10.1097\/TXD.0000000000001515","article-title":"Ethical and psychosocial factors in the decision-making and informed consent process for upper extremity vascularized composite allotransplantation: a mixed-methods study","volume":"9","author":"Gordon","year":"2023","journal-title":"Transplant Direct"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e1515","DOI":"10.1097\/TXD.0000000000001515","article-title":"Ethical and psychosocial factors in the decision-making and informed consent process for upper extremity vascularized composite allotransplantation: a mixed-methods study","volume":"9","author":"Gordon","year":"2023","journal-title":"Transplant Direct"},{"key":"B23","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1016\/j.apmr.2025.05.014","article-title":"Measuring health-related quality of life in upper extremity vascularized composite allotransplantation: development of new patient-reported outcome items for hand transplant","volume":"107","author":"Tyner","year":"2026","journal-title":"Arch Phys Med Rehabil"},{"key":"B24","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1016\/j.apmr.2023.01.001","article-title":"Identifying health-related quality of life domains after upper extremity transplantation","volume":"104","author":"Tulsky","year":"2023","journal-title":"Arch Phys Med Rehabil"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1016\/j.mayocp.2022.02.003","article-title":"The chauvet workgroup: a resource for the psychosocial aspects of reconstructive transplantation","volume":"97","author":"Kumnig","year":"2022","journal-title":"Mayo Clin Proc"},{"key":"B26","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1111\/tri.12220","article-title":"An overview of psychosocial assessment procedures in reconstructive hand transplantation","volume":"27","author":"Kumnig","year":"2014","journal-title":"Transpl Int"}],"container-title":["Frontiers in Transplantation"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1869486\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:04:42Z","timestamp":1779689082000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frtra.2026.1869486\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":26,"alternative-id":["10.3389\/frtra.2026.1869486"],"URL":"https:\/\/doi.org\/10.3389\/frtra.2026.1869486","relation":{},"ISSN":["2813-2440"],"issn-type":[{"value":"2813-2440","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"article-number":"1869486"}}