title: Composite tissue allotransplantation in Europe. Logistics and infrastructure of a centre.
abstract: BACKGROUND
  Composite Tissue Allotransplantation (CTA) is a new medical field of growing importance. This paper focuses on the infrastructure and organisation of European CTA centres and discusses the differences between national health systems.
  
  
  METHODS
  Eight European centres (Valencia, Innsbruck, Munich, Lyon, Amiens, Creteil, Wroclaw, Monza) were sent with a specially-designed, standardized, 20-item questionnaire.
  
  
  RESULTS
  Five of the eight centres returned our questionnaire: Munich, Innsbruck, Lyon, Amiens, Wroclaw. Since 1998, CTA has been performed at these centres. In both French centres and the Polish centre public funding is available in addition to the coverage provided by health insurers. In Munich the costs for a double upper-arm transplantation were Euro 150,000 with an additional Euro 50,000-70,000 per year. In Lyon the costs for a singular hand transplantation were Euro 70,000 per year and in Wroclaw (Poland) the costs for a hand or upper arm transplantation were Euro 20,000-30,000. As many as 17 different medical professions are involved in the CTA at the different centres.
  
  
  CONCLUSIONS
  CTA is an innovative promising therapeutic tool that is based on the experiences of solid organ transplantation and profound microsurgical skills. Due to the complexity of the infrastructure, sourcing and the organisation CTA can only be successfully performed at specialized centres. A European network with an international European waiting list and a central coordination for CTA should be established. In order to advance CTA as an important tool in reconstructive surgery we must turn our attention to how the costs will be met, the legal environment for procurement of adequate donors and open ethical questions.
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Reconstructive Surgery, Hannover Medical School, Germany. maxmeyermarcotty@gmx.de
authors.forename: Max
authors.initials: M
authors.lastname: Meyer-Marcotty
authors.forename: Hans
authors.initials: H
authors.lastname: Rennekampff
authors.forename: Max
authors.initials: M
authors.lastname: Haerle
authors.forename: Karsten
authors.initials: K
authors.lastname: Knobloch
authors.forename: Peter
authors.initials: P
authors.lastname: Vogt
mesh_terms: D001132:Arm / Q000637:transplantation; D005060:Europe; D005500:Follow-Up Studies; D063987:Hand Transplantation; D006268:Health Facilities / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends*; D058016:Health Facility Administration; D006801:Humans; D019651:Plastic Surgery Procedures; D016378:Tissue Transplantation / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000941:ethics / Q000331:legislation & jurisprudence