A presentation about basics in tissue banking and regulations in transplantation of human organs and tissue act.

1. TISSUE BANKING
Dr.A.KISHORE KUMAR

2. CONTENTS
 HISTORY
 TYPES OF DONORS
 TISSUE TRANSPLANT TRANSMISSIBLE
DISEASES & PREVENTION
 RISK REDUCTION PROCEDURES
 TISSUE PROCESSING
 HUMAN TISSUE STORAGE
TEMPERATURE & DURATION
 TRANSPLANTATION OF HUMAN TISSUE
& ORGANS ACT
 COVID-19 & RISK MANAGEMENT IN A
TISSUE BANK.

3. HISTORY
1869 - Reverdin described skin graft in clinical practice for Ist time.
1871 - George Pollock used his own skin along with patient’s skin for coverage of
a burn wound.
1881 - Girdner Ist reported successful use of Cadaver allograft in burn wound.
1881 - William Macewen used bone allograft from tibia of child suffering from
rickets & used it for reconstruction of a humeral shaft of another young boy.
1903 - Wentscher reported that skin graft stored in refrigerator after harvesting,
retain their viability for 3-14 days.
1948 - Baxter - Research in prolonging the viability of graft, by storage below 0°C
1949 - George Hyatt of US navy established its Ist tissue bank at Maryland.
1964 - Skin bank was started at Safdarjang Hospital, New Delhi for storage of
skin and amnion.
1988 - Tata Memorial Hospital Tissue Bank was setup in Mumbai.

4. TISSUE BANK
 An entity that provides or engages in one or more services involving tissue
from living or deceased persons for transplantation purposes. These
services include obtaining authorization and/or informed consent, assessing
donor eligibility, recovery, collection, acquisition, processing, storage,
labeling, distribution and dispensing of tissue.

5. 20% floor area-storage space. Adequate segregation of non-sterile, clean & sterile zones with separate access.
Movement in sterile zone should be unidirectional. Separate air conditioning for all 3 zones.
Sterile area should be equipped with high efficiency particulate air filter and positive air pressure ventilation and
preferably should have class 10000 clean room.
An in-house microbiology, serology, tissue typing and cell culture laboratory

6. LIVING DONORS
 Renewable tissue, such as gametes, extraembryonic tissue, and milk.
 Except for autografts, which can be expanded by culturing for use on
burned patients, skin is usually recovered from deceased donors.
 Cartilage - cultured for autologous transplant in knee repair.
 Bone - form of a femoral head, or a tibial plateau that is removed & would
otherwise be discarded (e.g., a total hip or knee replacement with a
prostheses).

7. DECEASED DONORS
 Tissues such as bone, eyes, and skin can be collected up to 24 hrs after
cessation of the donor’s cardiac and respiratory functions, depending on
the temperature and environment in which the donor body is stored.
 Judged deceased by both cardiorespiratory and neurologic criteria.
 Availability of health professionals trained in how to approach the next of
kin or other authorizing person on the subject of donation.

8. TISSUE TRANSPLANT-TRANSMISSIBLE DISEASES &
THEIR PREVENTION
 Well-publicized case, 48 organ or tissue recipients received an organ or
tissue from a single donor who, although he had no apparent risk for HIV
infection according to medical history, proved to have been recently infected
with HIV and in the window period before HIV-1 antibody could be detected
by the assays in use at the time
 All 4 organ recipients became infected with HIV, but majority of tissue
recipients did not.
 Vessel grafts - transmission of rabies to 2 recipients in 2004.
 Transmission of malignancy via tissue transplantation has not been
reported, but is thought to be possible.

9. Infectious diseases reported to have been transmitted by deceased
donor allografts
Agonal bacteremia -
endogenous bacteria, such as
normal intestinal flora, begin to
disperse throughout the body
after cessation of
cardiopulmonary functions, as
the putrefaction process
begins. Accelerated in
• Sepsis,
• Rhabdomyolysis, or
• Cocaine overdose
before death.

10. RISK REDUCTION PROCEDURES
(1) Information obtained during interviews with family member(s)
& healthcare providers;
(2) Available medical records;
(3) Findings of a physical assessment;
(4) Results of an autopsy, if performed; &
(5) Results of blood tests for infectious disease markers

11. DONOR HISTORY SCREENING
 Absence of systemic infection or any infectious or malignant disease
transmissible by tissues & of behavioral risks for HIV infection or viral
hepatitis.
 Malignancy generally disqualifies the donor, unless the malignancy is
non-metastatic or not known to metastasize to the tissue to be
recovered (e.g., virtually no cancer is known to metastasize to the eye
or skin), and there is no suspicion of direct regional spread.
 Bone - used for weight-bearing functions;
 no metabolic bone disease or
 connective tissue disorder; &
 no exposure to toxic substances that could accumulate in the tissue to be
recovered.

12.  Cardiac tissues are screened for a history of significant valvular disease
or cardiac infection, and
 Vascular donors - ineligible if H/o diabetes, vasculitis, varicose veins, or
significant atherosclerosis
 Skin - areas exhibiting signs of a skin infection, or where a rash, nevus,
or tattoo is present, are avoided.
 Cornea donors cannot have a history of refractive corneal procedures,
such as radial keratotomy.
 EBAA & AATB standards, tissue recovery sites in deceased donors are
evaluated for trauma & infection.
 Donors of reproductive cells or tissues are screened for evidence or risk
of inheritable diseases, and there are age restrictions.
 Extraembryonic tissue such as amnion and umbilical vein require the
delivery to be full term; meconium staining of amniotic fluid is not
acceptable, and there can be no current pelvic or vaginal infection in the
mother.

14. DONOR EXCLUSION CRITERIA

15. INDICATIONS FOR TISSUE ALLOGRAFTS

16. TISSUE RECOVERY
 Aseptically in an operating room, an autopsy room, or other suitable
location where aseptic procedures can be performed.
 Tissues are often cultured at recovery, then individually packaged in
sterile wraps, labeled with a unique donor identifier, placed on wet ice
& sent without delay to tissue banks that will process them.
INFECTIOUS DISEASE TESTING
 HIV-1,HIV-2 antibodies, HCV antibody, hepatitis B surface antigen
(HBsAg) & syphilis
 Pretransfusion/preinfusion blood samples to avoid false-negative
results caused by hemodilution

17.  Tissue from living donors, such as semen donors, is preserved &
quarantined until the donor is retested for HIV & hepatitis viruses in
order to rule out seroconversion during the period of storage.
 Additionally, both semen & oocyte donors must be found negative for
Neisseria gonorrhea & C. trachomatis & are usually tested for carriage
of one or more genetic disorder, as indicated by donor racial & ethnic
background.
 Specific testing for rare genetic disorders if the recipient couple seeks
a donor known to be negative for a particular gene mutation.

18. TISSUE STERILIZATION
 Tissue sterilization - killing or elimination of all microorganisms from allograft
tissue, whereas disinfection refers to the removal of microbial contamination.
 AAMI defines Sterility Assurance Level (SAL) as the probability that an
individual device, dose, or unit is nonsterile (i.e., one or more viable
microorganisms being present) after it has been exposed to a validated
sterilization process. SAL is generally applied only to the level of possible
contamination with bacteria or parasites.
 In contrast to log reduction of viruses determined in
assessments of virus reduction methods, SAL is an
absolute determined by the ability of the method to
eradicate or reduce microorganisms, the susceptibility of
organisms that may be present to the sterilization method
applied, and the maximal bioburden that could occur in the
initial material.
 Ex, a SAL of 10-6 means that there is less than a 1 in
1,000,000 chance of a viable microorganism remaining after
the sterilization procedure.

19.  FDA requires that medical devices be sterilized using a method
validated to achieve a SAL of 10-6
 Allografts will not tolerate methods usually applied to metal and
plastic medical devices because such treatment would impair the
mechanical and biologic properties necessary for clinical utility.
 Sterilization of tissues has been accomplished by several methods,
including heat, chemicals, ethylene oxide gas, supercritical CO2,
and gamma or electron beam irradiation
γ-irradiation
 Cobalt-60 source
 γ-rays penetrate bone effectively and work by generating free
radicals, which may have adverse effects on collagen and limit
utility in soft tissues unless performed in a controlled dose fashion
at ultra-low temperature.
 Minimal bacteriocidal level of γ-irradiation is 10 to 20 kGy.

20. TUTOPLAST
BioCleanse
H2O2 &
isopropyl
alcohol

21. • Clearant process – avoids negative
effects of γ-irradiation, employing
DMSO & PEG. The process subjects
tissue to 50 kGy of radiation - the
tissue’s biomechanical properties are
retained.
• Soft tissues - an antibiotic mixture
containing gentamicin, amphotericin B
& primaxin is added, and then washed
out to a nondetectable conc. The
Musculoskeletal Transplant
Foundation claims a SAL of 103 for its
products.

22. General principles of tissue preservation and clinical use
 Lyophilized and cryopreserved human tissue - serve a structural
purpose & maintenance of cell viability is not necessary.
• Extracellular matrix, whether
transplanted containing viable cells or
devoid of them, is repopulated
through the ingrowth of metabolically
active recipient cells.
• In some tissues, such as cornea, a
single layer of viable donor cells is
important & this requirement
necessitates maintenance of the
tissue in culture medium at
refrigerated temp.

23. BONE
 Provision of acetabular & proximal femoral support for replacement of failed
prosthetic hip joints, packing of benign bone cysts, fusion of the cervical or
lumbar spine to correct disk disease or scoliosis, restoration of alveolar bone in
periodontal pockets, reconstruction of maxillofacial deficits, and replacement of
bone that has been resected because of a bone malignancy, such as
osteosarcoma.
FROZEN BONE
 Wide variety of shapes and sizes from deceased donors, or as a femoral head
or tibial plateau obtained from a living donor undergoing total joint replacement.
 Risk of viral transmission
 Alloimmunization(HLA,BG,BMP)from exposure Ags on the attached connective
tissues, marrow, and blood, no affect on graft’s efficacy.
 Removal of extraneous tissue, stored up to 5 yrs at 40 °C or colder
 In absence of cryopreservation,does not maintain cellular viability.
 Structural support that depends on an intact calcified extracellular matrix or is
used as filler to promote new bone formation.

24. LYOPHILISED BONE
 Deceased donor bone – placed on ice for transport to storage
in a freezer and maintained frozen at -40 °C or colder, and
then can later be sent to a tissue processor with dry ice as a
refrigerant.
 Wet ice and expedited directly to the processing tissue
bank,within 72 hours of recovery, it is frozen at -40°C or
colder until processing.
 Removal of surface tissues and internal fat, blood, and
marrow by means of mechanical agitation, high-pressure
water jets, or alcohol.
 Computer-guided milling - clinically useful shapes and sizes.
 Bone allografts are lyophilized to a residual moisture content
of <6% or 8% & packaged into jars, peel packs or “boat”
packaging
 DBM with approved polymer carriers results in moldable
grafts that are user friendly for the surgeon.

25. EAR OSSICLES
 Congenital, traumatic, or post-infectious damage.
 Removal of the temporal bone en bloc or as a core with a bone-plug
cutter.
 Stored temporarily, for months if frozen, or upto 2 weeks if preserved
in formalin; the tympanic membrane and ossicular chain are then
dissected.
 Ossicles have been stored for up to 2 mths in cialit ,& for up to 1yr
year at RT in buffered formaldehyde.
 Alternatively, ossicles are dissected at the time of collection,
lyophilized & then sterilized by γ-irradiation.
 Lyophilized ossicles can be stored at ambient temp for up to 5 yrs

26. CONNECTIVE TISSUE - CARTILAGE & MENISCUS
 Non-weight-bearing uses such as nasal reconstruction - graft provides structural
support & need not be viable.
 Costal cartilage can be recovered for this use. Sterilized by γ-irradiation & stored in
saline at refrigerated temp, or it can be lyophilized and stored at ambient temp
 Articular cartilage can be transplanted to weight-bearing articular surfaces to replace
focal cartilage defects caused by trauma or degenerative disease.
 In weight-bearing applications, chondrocytes must survive the collection and
preservation process and remain viable, producing normal cartilage matrix to
maintain mechanical properties. Stored at refrigerated temp in electrolyte solutions
for up to 1 month, or have been frozen in 10% glycerol or 15% DMSO and stored at
70°C or colder
 Menisci are C-shaped disks of fibrocartilage interposed between the femoral
condyle and tibia – essential for knee mechanics and biochemical functions –
cryopreserved.

27. TENDON & LIGAMENT
 Allografts may be indicated for multiple ligament knee injuries, anterior
cruciate ligament revisions, or posterior cruciate ligament
reconstruction, and when extensor mechanisms are impaired (as with
previous tendon tears).
 Avoid the morbidity associated with autograft.
 Adequate autograft tissue - not available
 In vitro biomechanical properties of tendons do not seem to be greatly
affected by freezing, lyophilizing, or ethylene oxide sterilization.
 Sterilized by γ-irradiation.

28. FASCIA LATA
 Suspend the upper eyelid to correct ptosis,covering for bone grafts in dental
surgery, to replace injured anterior cruciate ligaments.
 Lyophilization, resulting in a residual moisture of <6% or 8%,the graft is then
sterilized by γ-irradiation - upto 5 years at ambient temp.
DURA MATER
 Closure of dural defects caused by resection of tumor or the repair of
traumatic injury
 Lyophilization,Ethylene oxide & γ-irradiation are effective
 ANA recommended using 1N NaOH for 1hr or steam autoclaving for 1hr at
132 °C as standard sterilization procedures for CJD-infected tissue or
contaminated materials.
 H/o clinical dementia or other central nervous system disorders - not
accepted
 Reconstituted freeze-dried dura mater is thick and strong, holds suture well,
and is incorporated into normal surrounding tissue without rejection.

29. SKIN
 Early excision of burned tissue and covering of the wound with deceased
donor skin allograft has shortened hospitalization and decreased mortality
more than has any other treatment.
 Provides temporary coverage and acts as a barrier against loss of water,
electrolytes, protein and heat. It reduces opportunities for the invasion of
bacteria and speeds re-epithelialization.
 Unhealed skin defects (decubitus ulcers, autograft skin sites, pedicle flap
sites, and traumatically denuded areas).
 Decellularized (mechanically and chemically treated) skin - use of a
collagen matrix that can be implanted and be remodeled within the site
with the recipient’s own cells.
 Fresh skin can be stored in medium at 1 to 10 °C for upto 14 days

30.  Cryopreservation is performed within 2 to 3 days after recovery.
 Prepared as strips,Covered in fine-mesh gauze and laid flat, packaged &
then cryopreserved with glycerol or DMSO at a conc of 10% or 15%
 Cryogenic damage is minimized by controlling the rate of freezing to
between 1 & 5 °C/minute.
 Heat sinks involve aluminum plates combined with styrofoam-insulated
boxes; these are placed directly into a 70 °C mechanical.
 AATB standards permit frozen storage in a mechanical freezer at -40°C or
colder, in the vapor phase of liquid nitrogen, or submerged in liquid
nitrogen.
 Skin for use in burn - not preserved by lyophilization clinical efficacy.

31. OCULAR TISSUE
 M/C indications for corneal transplantation are keratoconus, Fuchs
dystrophy, post–cataract surgery corneal edema, and corneal
regrafting.
 Donor cells in the avascular full-thickness cornea graft enjoy long-term
survival without the aid of histocompatibility matching because the
recipient site is also almost completely avascular. Because of the
avascularity of the cornea, routine immunosuppression is
accomplished with topical corticosteroids.
 Descemet’s stripping endothelial keratoplasty (DSEK), which
transplants only the innermost portion of the cornea; the tissue
adheres to the host cornea with the use of an air bubble.

32.  Failure rate of 5% to 10% might be improved by HLA matching.
 Possibility of alloimunization - repeat grafting
 Ocular tissue can be recovered by enucleation or by in situ excision of the
cornea, with a rim of sclera.
 Preferable that recovery - within 10 hrs after death.
 M/C storage of the cornea, with attached rim of sclera, at 4 °C in a
modified tissue culture medium.
 Commonly used is Optisol-GS ,which contains dextran (as an osmotic
agent), chondroitin sulfate, gentamicin, and streptomycin. Stored at 2 to 8
°C, can maintain endothelial viability for as long as 14 days, and can
maintain functional integrity for eutopic graft applications not requiring
visual acuity for even longer storage periods.
 Grafts are usually used within 7 days.
 Sclera is usually preserved in 70% ethyl alcohol; such a method yields a
shelf-life as long as 2 years.

33. CARDIAC TISSUE
 Human heart valve(HV)allografts do not require recipient anticoagulation,
have a lower incidence of thromboembolism, and appear relatively
resistant to infection
 Because anticoagulation is unnecessary, human valve allografts are the
graft of choice for children, females of childbearing potential, and patients
with cardiac infection in the aortic root
implantation is more technically difficult.
availability is limited, especially for pediatric use.
clinical results with transplantation of xenograft tissue valves have improved,
 HV from newborns or small children offer unobstructed blood flow through
such a small annulus.
 Also, the tissue’s pliability renders human allografts adaptable to the
ingenuity of cardiothoracic surgeons who repair congenital defects by
using allografts to replace underdeveloped or otherwise defective valves
or outflow tracts, or to construct valves and tracts that may be absent.

34.  Recovered aseptically, immersed in a sterile isotonic solution within a sterile
container, placed on wet ice, and transported expeditiously to a tissue proc
essing facility.
 The pulmonic and aortic valves, along with their intact outflow tracts and/or
small pieces of these conduits, are dissected free of the heart within 48 hrs
of donor asystole, and then placed in tissue culture medium amended with
a low-dose antibiotic cocktail
 Initial exposure to antibiotic solutions for 12 to 24 hours. Cryopreservation
then follows, using a 10% DMSO solution tissue culture medium that often
is amended with 10% fetal calf serum. Freezing - using a computer -
assisted controlled rate of -1 °C/minute to -40 °C. Valves generally are
stored in the vapor phase of liquid nitrogen.
 Aorta and iliac arteries - same methods as HV. Aortic arch is preserved with
the aortic valve intact;

35.  Arterial or venous segments of vascular organs may be recovered in order
to provide a source of vascular “conduits” for use in organ transplants
when the organ’s attached vessels are damaged or inadequate.
 Cryopreservation of allograft vessels is similar to that of cardiac allografts -
retain venous endothelial cells during recovery, processing & preservation,
but these cells are rapidly sloughed off the lumen after the vein is
transplanted into the high-pressure arterial system
 Although not proven to be necessary for successful clinical outcome or to
prevent alloimmunization, ABO- and Rh-compatible allograft valves and
vessel conduits are usually requested.

36. PERIPHERAL NERVE
Treated with Chondroitinase,inhibit
both aberrant growth and
retrograde regeneration.

37. PARATHYROID GLAND
• Hyperparathyroidism - single parathyroid adenoma, but in 10% of cases,
generalized parathyroid hyperplasia is found.
• Postoperatively, the lack of parathyroid hormone can result in permanent
hypocalcemia in 5% of patients
• Autotransplantation of a small amount of parathyroid tissue is performed during total
parathyroidectomy.
• Sternocleidomastoid muscle, flexor muscle groups, or subcutaneous tissue of the
forearm.
• Remaining parathyroid tissue can be
divided, placed in vials containing chilled
tissue culture medium, and then
cryopreserved using autologous serum,
RPMI, and DMSO. The excess tissue then
can be frozen under controlled conditions
and stored in liquid nitrogen at 196°C.
• Cryopreservation - maintains cell viability
and graft function

38. REPRODUCTIVE TISSUE - SEMEN
 Cryopreserved semen can be stored by a man, termed a
client depositor, who may become sterile as a
consequence of therapy for testicular malignancy or for
another reason, for later use with his wife or other
“intimate partner,” or even with a gestational carrier
 Each ejaculate can be separated into several vials or
straws for separate storage that can be retrieved and
thawed for use when needed.
 Offering of a selection of donors facilitates the matching of
donor’s hair and eye color, race, and other genetically
determined characteristics with those of the intended
father or co-parent or with those of both parents.

39.  STD, including HIV infection, can be transmitted by donor
semen to women undergoing artificial insemination.
Cryopreservation permits extended storage and the
retesting of donors at least 6 months after the donation of
specimens to be released
 Glycerol - standard cryoprotectant, with storage in liquid
nitrogen. Freezing methods - control the rate of
temperature decline, & to prevent thermal shock by cooling
the semen, slowly, in air or in a waterbath,to 5 °C before
initiation of the actual freezing process. This takes place in
the vapor phase of liquid nitrogen, or in a programmable
controlled-rate freezing device. After freezing, semen can
be stored in the liquid phase of liquid nitrogen indefinitely.
 Cryopreservation of semen does not influence the
frequency of abortions or multiple births, or the infant’s
gender, body size, or intelligence.

40. Extraembryonic tissue preservation and
transplantation
• Amnion & Umbilical vein.
• Fetal amnion - smooth, slippery,
glistening membrane lining the fluid-
filled space surrounding the fetus, has
been used as a covering for
nonhealing chronic leg ulcers, burns,
and raw surfaces following
mastectomy, and in major oral cavity
reconstruction and vaginoplasty.
• Amnion - used as a pelvic
peritoneum substitute following pelvic
exenteration and as a source of
replacement enzymes for infants with
inborn errors of metabolism

42. HUMAN TISSUE STORAGE CONDITIONS & DURATION

43. Donor–recipient matching
• For most tissues, donor–recipient HLA matching is not
necessary and is rarely done.
• Tissues such as bone, fascia, tendon, cartilage, and dura mater
are not preserved or transplanted in a viable state; rather, they
serve as a support or matrix that the recipient’s own cells can
enter and gradually replace. Immunologic rejection, therefore, is
not a significant concern, and matching of blood group or HLA
antigens is considered
• ABO matching is important to the success of vascularized organ
grafts
• Alloimmunization to RhD, Fya, & Jkb red cell antigens following
transplantation of frozen unprocessed bone has been reported.
• Consequently, frozen unprocessed bone allografts usually are
matched with the donor for the D antigen if the recipient is a
female of childbearing potential, in addition to being matched for
ABO group.

44. Transplantation of Human Organs and Tissues Act
• Passed in 1994
• Aimed at regulation of removal, storage, and transplantation of human organs for therapeutic purposes and
for prevention of commercial dealings in human organs.
Regulatory Bodies
Advisory committee
• Chairpersonship of administrative expert not below the rank of the Secretary to the State Government &
• 2 medical experts who possess a PG medical degree and at least 5 yrs’ experience in the field of organ or
tissue transplantation.
• Period of 2 years to aid and advise the appropriate authority
Appropriate authority
• Regulates living-donor transplantation by reviewing each case to ensure that the living donor is not
exploited for monetary considerations and to prevent commercial dealings in transplantation.
• Inspects and grants registration to hospitals for transplantation
Authorization committee may be at state or hospital level(>25 transplants per year).
Medical practitioner officiating as Chief Medical Officer
Two senior registered medical practitioners chosen - called members
Secretary of health or director health or nominee
Two senior persons of high integrity, credibility, and social standing (preferably one female) who may be
doctors, lawyers, chartered accountants, judges, police personnel, etc.

46. Authorization Committee
 Evaluates that there is no commercial transaction between the recipient and the donor;
 Prepares an explanation of the link between them and the circumstances which led to the
offer being made;
 Examines the reasons why the donor wishes to donate;
 Examines the documentary evidence of the link, for example, proof that they have lived
together, etc.;
 Examines old photographs showing the donor and the recipient together;
 Evaluates that there is no middleman or tout involved;
 Evaluates financial status of the donor and the recipient by examining appropriate
evidence of their vocation and income for the previous three financial years and any gross
disparity between the status of the two is evaluated in the backdrop of the objective of
preventing commercial dealing;
 Ensures that the donor is not a drug addict; and
 Ensures that the near relative or if near relative is not available, any adult person related to
donor by blood or marriage is interviewed regarding awareness about his or her intention
to donate an organ or tissue, the authenticity of the link between the donor and the
recipient, and the reasons for donation, and any strong views or disagreement or objection
of such kin is also recorded.

47. TYPES OF DONORS
Living donors
 May be living-related donors, spousal donors, or other than near-related donors.
Near-related donors include parents, siblings, and children.
 Documentary evidence of relationship
 HLA matching or DNA fingerprinting(NABL lab).
Spousal donor
 Where the proposed transplant is between a married couple, documents such as
marriage certificate and marriage photograph are kept for records along with
number and age of children and a family photograph birth certificate of children
containing the particulars of parents
Swap donation
 If in a family (family number 1), you have a donor and recipient who are near
related but their blood group is incompatible, i.e., donor is A+ and recipient is B+,
and in another family (family number 2), the donor is B+ while the recipient is A+,
the donor of family number 1 can donate to recipient 2, and donor 2 can donate to
recipient 1.
 Swap transplant should be carried out simultaneously, so there is no donor
reneging.
 Donor reneging means that one of the donors backs out from donation.

48. FOREIGN DONORS - permission from a senior embassy official of the country of
origin
DECEASED DONOR
Deceased donation can be either after brain death (brain stem death) or after cardiac
death. Brain death is defined as cessation of activities of brain stem and it is a clinical
diagnosis. It is generally declared in patients on ventilator where Glasgow Coma
Score (GCS) shows 3/15.
Among all recipients listed for transplants from deceased donors, priority will be given
in following order:
(i) those who do not have any suitable living donor among near relatives;
(ii) those who have a suitable living donor available among near relatives, but the
donor has refused in writing to donate;&
(iii) those who have a suitable living donor available and who has also not refused to
donate in writing.
The sequence of allocation of organs shall be in the following order:
State list, Regional list, National list, Person of Indian origin, Foreigner.

55. • Delimitation of strict clinical criteria for donor selection,
• Use of RT-PCR for screening donors.
• Determination of protective measures for the health professionals involved.
• Symptoms of suspected COVID-19 such as severe acute respiratory syndrome
and/or previous contact with confirmed cases as criteria for refusal
• Glycerolation to preserve tissue, and glycerol has been shown to possess
decontaminating and virucidal actions - could effectively inactivate Coronaviridae-
type viruses,
• Ionizing irradiation as a complementary sterilization method had demonstrated
effectiveness in inactivating other coronaviruses (SARS-CoV and MERS-CoV)but its
effect on SARS-CoV-2 is still unknown.
• Irradiate all stored lots collected in 2020 with a 25 kGy radiation dose.

56. ALGORITHM TO FOLLOW FOR DECEASED DONATION

57. THANK YOU