BlueCross BlueShield of Tennessee Medical Policy Manual

Hand and/or Face Transplantation (Composite Tissue Allotransplantation)


Composite tissue allotransplantation (CTA) is the transfer of a composite of different tissues from one person to another person. Tissues may include skin, connective tissue, muscle, bone, and/or nerve. Composite tissue allotransplantation procedures are complex and involve a series of operations using a rotating team of specialists. It has been proposed for individuals who have suffered severe disfiguring facial trauma. The CTA procedure may be referred to by the more common lay term, face transplant. It has also been proposed as a restorative procedure in individuals with hand amputations who are dissatisfied with the appearance or function of a prosthetic hand.

Unlike most solid organ transplantations (e.g., kidney and heart transplants), composite tissue allotransplantation is not life-saving. CTA is viewed in context of quality of life. CTA is not without risk including the potential challenges associated with life-long immunosuppression and graft loss. Potential adverse impact on quality of life must be considered in the event that transplant outcome does not meet expectations both in aesthetics and/or function. To date, only a limited number of individuals worldwide have undergone the procedure and data are not sufficient to determine whether the potential benefits outweigh the potential risks (e.g., surgical complications, long-term immunosuppression, opportunistic infections).




American Society of Reconstructive Microsurgery and the American Society of Plastic Surgeons. (2006). Facial transplantation- guiding principles. Retrieved November 1, 2016 from

Aycart, M., Kiwanuka, H., Krezdorn, N., Alhefzi, M., Bueno, E., Pomahac, B., & Oser, M. (2017). Quality of life after face transplantation: outcomes, assessment tools, and future directions. Plastic and Reconstructive Surgery, 139 (1), 194-203. Abstract retrieved October 12, 2017 from PubMed database.

Barret, J. (2013). From partial to full-face transplantation: Total ablation and restoration, a change in the reconstructive paradigm. International Journal of Surgery, 12, 109-112. (Level 2 evidence)

BlueCross BlueShield Association. Evidence Positioning System. (8:2018). Composite tissue allotransplantation of the hand and face (7.03.13). Retrieved August 16, 2019 from  (10 articles and/or guidelines reviewed)

Breidenbach, W.C., Meister, E.A., Becker, G.W., Turker, T., Gorantla, V.S., Hassan, K., & Kaplan, B. (2016). A statistical comparative assessment of face and hand transplantation outcomes to determine whether either meets the standard of care threshold. Plastic and Reconstructive Surgery, 137(1), 214e-222e. Abstract retrieved January 7, 2016 from PubMed database.

Fischer, S., Kueckelhaus, M., Pauzenberger, R., Bueno, M., & Pomaha, B. (2015). Functional outcomes of face transplantation. American Journal of Transplantation, 15, 220-233. (Level 4 evidence)

Infante-Cossio, P., Barrera-Pulido, F., Gomez-Cia, T., Sicilia-Castro, D., Garcia-Perla-Garcia, A., Gacto-Sanchez, P., et al. (2013). Facial transplantation: a concise update. Med Oral Patol Oral Cir buccal, 18 (2), e263-e271. (Level 2 evidence)

National Institute for Health and Care Excellence (NICE). (2011, March). Hand allotransplantation. Retrieved November 1, 2016 from




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