CLINICAL UTILISATION

  • Donated Amnion
  • Donated Skin
  •  Donated Bone
    • Satellite Bone Donation Programme
      • Benefits of Membership

DONATED AMNION

Beneficiaries of Donated Amnion
Amnion is an excellent biological dressing which mimics skin. Banked amnion is used as a temporary, external wound cover to promote healing in chronic ulcers, unresponsive bedsores, abscesses, skin graft donor sites and wounds, including those following dermabrasion and laser treatment, as well as leprosy lesions. The use of amnion in the treatment of full and partial thickness burns has special appeal in this part of the world, as despite advances in burn management the mortality rate continues to be high and the search for an economical and easily available dressing to control burn wound infection continues. As compared to conventional dressings healing with amnion dressings is faster and more economical and convenient. Amnion can also be used in orbital and ocular surface reconstruction helping patients recover their sight. 

Banking of Amnion
Amnion available from the TMH Tissue Bank is processed, freeze-dried and irradiated. Processing closes the sero-diagnostic window for HIV while freeze-drying and irradiation permit the supply of sterile amnion off-the-shelf.  These ready-to-use packs may be conveniently stored at room temperature for up to 3 years.

DONATED SKIN

Beneficiaries of Skin Donation
In patients with severe burns, damaged skin must be replaced as early as possible, ideally with the patient's own skin. In practice however, this is not always possible. The patient’s general condition may be poor or in patients with extensive burns donor sites may be unavailable.
In such patients donated skin can make the difference between life and death. It serves as a temporary biological dressing promoting healing of the wound bed prior to grafting the patient's own skin. It prevents the loss of precious body fluid, protein and blood and acts as a barrier, keeping out microbes which would otherwise cause infection, septicaemia and eventually death. Donated skin can also be used for hernia repair, reconstruction of the bladder and pelvic floor, as well as to provide skin cover in surgeries when the patient’s own tissues are inadequate as in breast reconstruction following mastectomy.

Banking of Skin
Skin is usually recovered from deceased donors as "split-thickness grafts". This means that the skin graft is taken to include the epidermis and a small portion of the underlying dermis. Potential skin donors are evaluated on an individual basis by visual assessment of skin condition and medical status. Live donors may sometimes donate skin as in the case of patients undergoing abdominoplasty or amputations. 

Skin is usually recovered from deceased donors as "split-thickness grafts". This means that the skin graft is taken to include the epidermis and a small portion of the underlying dermis. Potential skin donors are evaluated on an individual basis by visual assessment of skin condition and medical status. Live donors may sometimes donate skin as in the case of patients undergoing abdominoplasty or amputations. 

DONATED BONE

Beneficiaries of Donated Bone
Bone is among the most transplanted tissues in the world, second only to blood. The ideal bone transplant is the patient's own bone, known as an autograft. However, acquiring an autograft requires an additional incision which leads to increased operating time, blood loss, and ultimately, prolonged recovery time and higher hospital costs. Not only does this secondary surgery damage the patient's normal structures but it also carries its own risk of complications.

The use of donated tissues, or allografts, avoids all these problems, and has the additional advantage of providing tissue in quantity. This is particularly useful when there are massive defects to be reconstructed or in children where the amount of available autograft is limited and retrieving it may even damage the child's growth.

1.
 How is bone used?
 

Donated bone is used in a number of ways. Generally bone is morsellised (broken into smaller bits) and used to fill cavities in a patient’s bone, which may have been caused due to disease or trauma.  It can be used for reconstructing skeletal defects or to provide structural support during fracture healing particularly when the bones do not unite on their own. Often it is used to reinforce bone that has been weakened, as in patients with osteoarthritis and those needing total knee or hip replacement. Small segments of bone are used to correct deformities in the spine, for instance in children suffering from tuberculosis, while bone powder is used by dentists to treat defects in the jaw bones.

In patients with cancer, morsellised bone is used to enhance the recipient’s bone stock by packing it into the large defects resulting after the removal of tumours.  Long bones may be used to replace cancerous bone. TMH is the one of the few hospitals in the country where limb salvage surgeries with restoration of limb function are being done routinely using indigenously produced allografts.  Without the bone transplants the limb may have to be amputated, or an expensive imported prosthesis may have to be used which would require repeated revision surgeries.
   
2
 What happens to the bone after transplantation?
 

Once the bone is accepted by the recipient it is slowly converted into new living bone and incorporated into the body as a functional unit. The transplanted bone stimulates the recipient’s cells to begin producing new bone, itself acting as a scaffold for new bone formation. New bone cells produced by the recipient creep into this scaffold in a process called ‘creeping substitution’. The donated bone is slowly resorbed. This process occurs over many years.
   
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