The process of donation, including the selection of donors and transplant coordination, is an extremely relevant issue in the success of VCA programmes and in the final functional and aesthetic outcome in face transplantation. A multiple organ donation is expected, with stable haemodynamic status, although there is no contraindication for the utilisation of vasopressors. The face tissues are extremely well vascularised; thus, priority should be paid to the maintenance of good perfusion to internal organs.

There are different specific issues that must be taken into consideration, which makes donation in composite tissues much more difficult than solid organ transplantation. As in any other solid organ transplant process, any biological parameter must be evaluated and matched to obtain good outcomes. For optimal results, many other considerations must be taken into account: skin colour, anatomical landmarks, gender, race, age and anthropomorphic information/measurements. The latter is very relevant, the face and the structures to be transplanted have a three-dimensional fashion in special the bones of the face skeleton and similar structures should be sought. A perfect match between face donor structures and those found in the recipient is the final goal of the donor evaluation. The same measurements that were performed in the recipient during the evaluation process should be explored in every donor that may appear during the search (Table 7.1).

Every effort should be made to obtain X-ray imaging, although the circumstances of the patient (intensive therapy unit [ITU] admission, haemodynamic instability, other injuries, etc.) may not allow transportation of the patient to the radiology department. Transplant coordinators are involved in the whole process of donation and transplantation; in those patients, especially those affected of traumatic head injury, that are transferred to the department for their injuries, a face CT scan should be performed to make the required measurements and matching.

Organ and tissue donation legal status differs among countries. In some countries, all citizens are considered potential donors unless they have informed on the contrary; meanwhile, in other countries only people that have expressed their will for donation will be considered as donors. In any case, VCA is considered a clinical experimental treatment, and special and individual informed consent is required. Consent for donation follows similar guidelines. Consent for organ donation does not imply consent for tissues and composite vascularised tissues. A specific consent for this type of the donation must be obtained. During the informed consent process, the donor’s family and relatives have to be informed regarding the specifics of the operation, type of tissues and structures that will be transplanted and the results of such donation in the body of the donor.

Vascularised composite tissue allotransplantation is not invisible (Fig. 7.1). Non-vascularised tissue donation is much more difficult than organ donation. Society is not as conscious as with solid organs of the real necessity of these tissues (corneas, skin, blood vessels, bones, etc.) for the general health and the recovery of some diseases. When it comes to VCA donation, the issue is much more problematic: it is not longer a question of plain tissue donation from hidden anatomic parts, but a donation of parts of the body, fully comparable to solid organs. The real difference is that VCA donation is no longer “invisible”. Faces or limbs will be removed with its consequences on the mourning and presentation of the cadaver. It is mandatory to perform a prosthetic reconstruction of the cadaver (face masks or limb prosthesis) to provide dignity to the donation process and release the body in the best possible appearance (Fig. 7.2). Donor’ relatives are informed of all these special issues in VCA donation and are requested to sign an individualised informed consent that covers all the relevant information on tissue donation, consequences on the donor, type of expected defect, face structures that will be transplanted and type of restoration.