There is a great need to develop, standardize, assess, and validate clinical protocols and standard operating procedures for vascularized composite allotransplantation transplants, with the goal of ensuring responsible, ethical, scientifically-informative and clinically-effective application of face and hand transplantation. This study will advance the field by recommending principles and a framework in order to guide the fair and equitable development of protocols and standard operating procedures, and to help mitigate and resolve conflicts that may arise during this process.