Composite tissue transplantation is a new field in reconstructive surgery that has shown to be effective either in limb and face transplantation. However since the first successful hand transplant 10 years ago and the face transplant 4 years ago their is a very limited development of this kind of transplant in the US and in other countries. Our study was carried out to investigate a major cause of limitation in transplant which is organ refusal. MATERIAL AND METHOD: In a retrospective study a questionnaire was sent to all the organ procurement organisations in France where 7 hand transplant and 2 faces transplant had already been realized. This questionnaire was retrospective on the 2008 year where no CTA was realized but 1340 donor were identified and harvested. Five simple questions were asked for hand and face transplant: -Do you think CTA transplant id efficient ans should be continued? -During the past year have you asked specifically for CTA to a family? -During the past year if you have asked specifically for CTA to a family was the family surprised by your question and/or did they show any reluctance in the acceptance of other organ harvesting? -How do you think such question should be asked? -What do you think should be done to have an enhancement of the acceptance rate? RESULTS: Out of 120 questionnaires 73 gave an answer. Only 52 answered that they believe that CTA was effective. CTA harvest was asked only 7 time to families. Even if all refused the harvest of hand or face, 6 accepted the harvest of tissue of non visible area. No family expressed any reluctance or surprise to the question. All questionnaire revealed the same approach in organ procurement by asking first the organ than the tissue and at last face or hand. All suggested that more information to the organ procurement agencies should be done and more specifically in the reanimation department. All suggested that body reconstitution was a key element. CONCLUSION The future of CTA is directly dependant of our capacity of obtaining consent for face and hand transplant. A department involved in CTA should be ready to make commitment to information to all other people involved in transplantation process. Information to the public oriented only on the result and on recipient is not sufficient. Beside the fear of internal organ refusal because of CTA harvesting is not relevant.