265.6 The Posterior Tibial Artery Flap as a Sentinel Flap in Face Transplant: Maximizing Solid Organ and Composite Tissue Allotransplant Team Coordination Hatem Amer 2 , Marissa Suchyta 1 , Brian Carlsen 1 , Karim Bakri 1 , Samir Mardini 1 1 Plastic Surgery, Mayo Clinic, Rochester, MN, United States; 2 Nephrology, Mayo Clinic, Rochester, MN, United States. Facial vascularized composite tissue procurement has unique logistical challenges and requires immense coordination with the solid organ pro- curement teams. [1] One aspect of the procedure is the procurement of a sentinel flap. Sentinel flaps are utilized in some centers for remote-site re- jection monitoring in facial vascularized composite tissue allotransplanta- tion, thus minimizing biopsies of the facial graft. Routine biopsies are performed on the sentinel flap and the facial allograft is biopsied only when the histopathology of the graft demonstrates a Grade I rejection or higher. [2] Harvesting the sentinel flap is an added challenge, especially since it is ideal to harvest prior to aorta cross-clamp to minimize ischemia time and prevent thrombus. Reported flaps used as sentinel flaps are the radial forearm flap, which have generally been inset into the groin of the recipient. [3] However, the radial forearm flap harvest places the procuring surgeon in the midst of the solid organ procurement teams, thus poten- tially complicating solid organ harvesting. We present our experience with the use of the posterior tibial artery flap as a sentinel flap in facial vascularized composite tissue allotransplantation. This flap is an ideal donor sentinel flap due to its location far from both the face transplant and solid organ procurement teams, its reliable vascular pedicle, and its ease of harvest. [4] We demonstrate the first utilization of this flap and believe that the use of this flap could maximize the ability for solid organ transplant teams to simultaneously perform solid organ harvesting while the sentinel flap is being raised, thus enabling a more streamlined pro- cess and better coordination in composite tissue allotransplantation. References: 1. Chim H, Amer H, Mardini S, Moran SL. Vascularized composite allo- transplant in the realm of regenerative plastic surgery. Mayo Clinic Proceed- ings; 2014: Elsevier; 2014. p. 1009-20. 2. Sis B, Mengel M, Haas M, et al. Banff ’09 meeting report: antibody mediated graft deterioration and implementation of Banff working groups. American journal of transplantation. 2010;10(3):464-71. 3. Kueckelhaus M, Fischer S, Lian CG, et al. Utility of sentinel flaps in assessing facial allograft rejection. Plastic and reconstructive surgery. 2015; 135(1):250-8. 4. Mardini S, Salgado CJ, Chen H-C, Yazar S, Ozkan O, Sassu P. Posterior tibial artery flap in poliomyelitis patients with lower extremity paralysis. Plastic and reconstructive surgery. 2006;117(2):640-5. 315.1 International Initiative to Enhance the Organ Donation and Transplantation Systems in the Black Sea Area: The BSA Project Estephan Arredondo 1 , Marta López-Fraga 2 , Marie-Odile Ott 2 , Karl-Heinz Buchheit 2 , Karim Laoubdia 3 , Pavla Brezoysky 4 , Alessandro Nanni Costa 5 , Efstratios Chatzixiros 5 , Ana França 6 , Beatriz Dominguez 7 , Maria Paula Gómez 1 , Chloë Ballesté 1 , Martí Manyalich 1 1 DTI Foundation, Barcelona, Spain; 2 European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France; 3 Agence de la Biomédecine-ABM, Saint-Denis, France; 4 Koordinační Středisko Transplantací, Prague, Czech Republic; 5 Centro Nazionale Trapianti-CNT, Roma, Italy; 6 Autoridade para os Serviços de Sangue e da Transplantaçao- ASST, Lisboa, Portugal; 7 Organización Nacional de Trasplantes, Madrid, Spain. Background: The Council of Europe (CoE) launched in 2011 a three-year collaboration project that aimed to battle organ shortage and improve the ac- cess to transplant health services in the Council of Europe BSA member states (Armenia, Azerbaijan, Bulgaria, Georgia, Moldova, Rumania, Russian Federation, Turkey and Ukraine) through the development of safe and ethical Donation and Transplantation (D&T) programmes. Objective: To support the development of D&T programmes through close inter-state cooperation between national health organisations and relevant stakeholders. Methodology: Focused in the level of development of D&T in each Black Sea Area (BSA) member state, the following working packages (WP) were established: a) WP1: Coordination of the Project (CoE), b)WP2: Development and implementation of an effective legislative and financial framework (Czech Republic and France), c)WP3: Establishment of National Transplant Authori- ties (Italy and Portugal), d)W4 Clinical Practices (Spain and DTI Foundation). Data collection, surveys and experts visits were performed to get first- hand information in each participant country at national, regional and hospital level by detecting problems and proposing solutions. Results: Data analysis showed a positive impact of the project repre- sented by a tendency to raise the D&Trates in all the countries. (Azerbaijan raised 7,3%, Armenia decreased 0.7%, Georgia Raised 3,3%, Bulgaria raised 0,9%, Moldova raised 2,5%, Ukraina raised 0,8% and Turkey raised 1,6%) Figure 1. In addition, the Project recommendations have been assimilated in the strategic plans of the participant countries. Conclusions: The increase of the donation rates is a result of an imple- mentation of legislative, organizational and institutional recommendations performed by the CoE, the efforts of the Ministry of Health (MOH) of each country and synergies with other European projects placed in the BSA area. BSA project made possible to analyse, assess and compare the different legal and organizational systems of the BSA countries. As a consequence of the outcomes, BSA countries should invest themselves in the implemen- tation of the recommendations resulting from this project in order to achieve their organ donation and transplantation system self-sufficiency. FIGURE 1. S50 Transplantation ■ August 2017 ■ Volume 101 ■ Number 8S-2 www.transplantjournal.com Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.