Today I hope to explain and or clarify how tissue donation occurs. This will include both the hospital and coroner’s role in the process. From there we will discuss what tissues are recovered… who uses these tissues… and the need for these donated tissues.
For the nurses attending today, you have most likely heard at 1 time or another from the hospital development folks at Lifebanc, ”All deaths need to be called into us within 1 hour of asystole” . Your call could be the difference between a death and a donor. When you call to report the death, our call center will ask some basic demographic questions, and do some initial screening which will discuss whether or not the patient had already made known his or her wishes to be a donor. The call center then will screen the case with our Tissue Administrator on Call and it will be decided whether or not to pursue for donation. If it is going to be a potential case, you will be asked to fax over a portion or possibly the entire chart. We know this is sometimes a grueling process, especially when you may not even have a chart, a run sheet or even a next of kin. This part of the screening is a key factor for us and without it we would not be able to continue. Other important information is whether or not this a coroner’s case and if a funeral home has been selected. We will ask if this is a Coroner’s case and then we will contact the coroner of the county involved. Ultimately the Coroner has the right to allow or refuse a recovery. Currently we are engaged in a partnership with 2 county coroner offices:....Cuyahoga County and Mahoning County. These are 2 pilot programs in the state of Ohio offering auto release on bodies and we in turn provide any needed blood/ urine/ tissue samples as well as pictures if needed and any pertinent post mortem exam findings. The outcome of these two cooperating offices has provided over 40 tissue donors alone last year from CCCO and with MCCO being new this year, they have already referred over 40 cases and we have recovered 4 tissue donors just since April. Once it is determined we are going to pursue for donation, our Donor Referral Coordinators (DRCs) contact the next of kin…if it is a binding donor, they do a disclosure and a medical/ social history with them. If it is not a binding donor, they must obtain a complete informed consent and then a med/soc history. The DRCs spend countless hours on the phones with families doing so much more than “getting information”. They listen to stories about their spouses, their children, their parents or their partners…there are tears, laughter and anger too sometimes. The DRCs also set up the ORs, the transport of the bodies and the recovery teams.
Lifebanc answers for the Cleveland Eye Bank and we frequently share information regarding our donors. Lifebanc has recently began training for eye recovery as well to maximize corneal transplantation.
Currently Lifebanc is recovering long bone from the upper and lower extremities as well as hemipelvis. The first picture you are looking at is a femoral allograft. The second is an xray showing a patient with an osteosarcoma of the distal femor. The the third is the end result of the tumor being exised and an allograft being surgically transplanted. This patient was considered for an above the knee amputation, and she is now walking and has made a complete recovery. After each tissue recovery, the donor is respectfully reconstructed prior to sending to the funeral home or the coroner’s office.
Currently our Tissue Recovery technicians are successfully recovering patellar tendons as well anterior and posterior tibialis tendons. Like any other surgery, these are done by sterile technique. Our techs can recovery at our recovery suite in the Cuyahoga County Coroner’s office or in a partner hospital’s OR. This greatly dependant upon donor activity and last seen alive time.
Our staff recovers saphenous veins (from men only due to diameter) and we will discuss the need for these vessels shortly.
The top left picture is a sample of split thickness skin which has been recovered. This is a very thin layer of tissue recovered with a dermatome, the instrument seen on the right. Lifebanc also recovers full thickness skin and this is done by a free hand method.
Full thickness differs from split thickness in use and method of recovery. This tissue is typically recovered in a free hand method using a scalpal. Our tissue recovery techs have undergone extensive training for this type of recovery.
Orthopaedic surgeons use many forms of donated bone. This include demineralized bone, bone powder, wedges, dowels, pegs and screws. They may also use the cortical segments for structural repairs and these come from the shafts, the pelvis, and long bones. These same surgeons will use soft tissue grafts of pateller ligaments, achilles tendones, fascia lata, and rotator cuff for repair of like tissues. Cartilage is also used especially for meniscus repair which would be an osteoarticular segment. The use of allograft is a matter of huge interest for orthopaedic surgeons, due to the advantages with its use, such as decreased surgical time, larger grafts and no donator site morbidity.
Dentists and oral surgeons may use bone putty and cancellous bone cubes or cancellous bone powder for reconstruction or repair in dental practices.
Corneal transplants are very common in the United States; about 40,000 are performed each year. The chances of success of this operation have risen dramatically because of technological advances, such as less irritating sutures, or threads, which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.
Remember the slide with the saphenous vein?…this will be a crucial part of a coronary bypass graft. And the heart for valves that was recovered will resolve life threatening valve issues or pulmonary anomalies.
This surgery was done by Dr. Michael Obeng, a reconstruction surgeon in Youngstown. He has taken cases like the one you see above because nobody else would or could. He takes cases regardless of the ability to pay, or the hopelessness of the case. He is what I refer to as a medical missionary and travels the world healing and rebuilding devastating injuries and conditions. He uses a great deal of full thickness skin in his practice, and states these were made possible because someone cared enough to donate.
As we discussed at the beginning, this is truly a partnership and we rely heavily upon the hospital to make the initial referral, to call the death in, to answer our questions, to fax us the chart and to give us the Next of Kin contact information. Your efforts make it possible help save a burn victim in the burn unit. Your work gave the man or woman in your Coronary ICU a second chance because the cardio thoracic surgeon used donated saphenous veins. And your extra time made it possible for the breast cancer survivor to have reconstructive surgery and she is healing on your med/surg floor. This is a genuine continuum of time, health, healing and life… and for this we thank you.
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