skin donation and skin banking by dr. sunil keswani, national burns centre, airoli

Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com 1

DR SUNIL KESWANIPlastic SurgeonNational Burns Centre,Mumbaiwith EURO SKIN BANK,Netherlands

SKIN DONATION AND SKIN BANKING

WE MAKE A

LIVINGBY WHAT WE GET,BUT WE MAKE A

LIFEBY WHAT WE

GIVE. Sir Winston Churchill

2Dr. Sunil Keswani, National Burns Centre, www.burns-

india.com, nbcairoli@gmail.com

gift a life…..organ donation

3Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com

Organ Donors Per Million4

Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, nbcairoli@gmail.com

India records 70 lakh burn injury cases annually Of which 1.4 lakh people die every year. Around 70% of all burn injuries occur in the

most productive age group (15-35 yrs). Around four out of five burnt cases are women

and children. As many as 80% of cases admitted are a

result of accidents at kitchen-related accidents.

Source: Union Ministry of Health (Govt. of India) Reported by Times of India

The body’s first line of defense

Is water proof and prevents infection from entering the body

When severely damaged, the defense mechanism breaks down

If untreated, bacterial infection, dehydration, loss of protein and electrolytes takes place

Ultimately the victim dies

When skin is damaged it either Heals on its own or Needs donor skin or a graft

This grafted skin provides comfort and prevents fluid loss and infection

‘SAVES THE LIFE OF A BURN VICTIM’

Permanent skin cover: Autograft – From the victim’s unaffected

Temporary skin cover:Homograft – Live DonorAllograft – Cadaver DonorXenograft – Porcine Pigs and Bovine Cows

Most preferred donor skin

Only the superficial layers of the skin are harvested from thighs and back

No disfigurement

No bleeding

No matching is required

Can be harvested in 45 minutes

Should be harvested within 6 hours after death

People expired due to:

HIV and Hepatitis negative

Skin disease

Cancer

Active Jaundice

Sexually transmitted disease

Severe infection

Retrieval

Processing

Storage

Distribution

Medical documentation

Donated skin is a boon to patients with burns

TOTAL SIX TO EIGHT PERSONS REQUIRED FOR SKIN BANK.

MANAGER. QUALITY SYSTEMS MANAGER. FOUR PERSONS FOR PROCESSING SKIN

TWO TEAMS FOR SKIN RETRIEVAL IN EACH THREE MEMBERS.

PROTOCOL FOR RETRIEVAL : SHAVING AND CLEANING WITH

WATER SCRUBBING WITH BETADINE SCRUB SHOWER WASH DRAPING WITH STERILE SHEET CLEANING WITH STERILIUM LUBRICATING WITH PARAFFIN PROCURING SKIN OF DIFFERENT

THICKNESS PRESERVING HARVESTED SKIN IN

50% GLYCEROL KEEPING IT IN REFRIGERATOR FOR 2

HRS.AT 4-6 °C

TO CHECK HARVESTED SKIN AND TO LUBRICATE IT PROPERLY.

PUT ALL PIECES OF SKIN IN 85% GLYCEROL. SHAKE THE SKIN WITH 85% GLYCEROL FOR 3

HRS. AT 33°C. IN SHAKING INCUBATOR. AFTER 3 HRS, KEEP IN FREEZER UPTO 8°C

FOR 4-6 WEEK TILL SEROLOGICAL REPORTS (RED LABEL) COME.

• AFTER 4-6 WEEKS, TAKE OUT THE SKIN FROM FREEZER INTO BIOSAFETY CABINET.

• MAKE THE STRIPES SYMMETRICAL .• GRADE THE THICKNESS SKIN TO 2, 2+,

3,3+, 4, EACH WILL BE 3.5 CM IN WIDTH (MINIMUM).

• PUT EACH STRIPS INTO THE CONTAINER WITH 85 % GLYCEROL, WHICH WILL BE READY FOR USE.

• SEND REMAINING CUT PIECES TO RESEARCH LAB.

REQUIRED MATERIALS FOR RETRIEVAL

Cleaning with Betadine

Dermatome with blade

DRESSING THE BODY AFTER SKIN HARVESTING

Skin Processing RoomSkin Processing Room

Cold Room (Outer View)Cold Room (Outer View)Biosafety cabinet to maintain

sterility during skin processing Biosafety cabinet to maintain

sterility during skin processing

Shaking incubator for lubricating skin in glycerol

MESHING OF THICK SKIN (2+,3,3+,4) IN THE MESHER.

MESHED AND UNMEHSED SKIN PRESERVED IN SMALL STERILE CONTAINER CONTAING 85% GLYCEROL. AND

STORED IN FREEZER AT 4-8°C.

KEEP THE SKIN (GPA) IN SKIN BANK AT 4-8 °C AND DO MICROBIOLOGICAL TESTING EVERY THREE MONTHS

Donor registration verification. Serological investigation verification after

death. Documentation of different phase of skin

processing in skin bank . Documentation of recipient name and hospital

and Doctor concerned. Record of rejected skin during the processing if

the any serological finding ,microbiological test report are awaited .

Mumbai city alone needs 2000 skin donations a year i.e. 5 a day!!

Present supply is 5 a month!!

So many patients are DYING

So many precious human lives could have been saved if ENOUGH donor skin was available

Who performs the Skin Harvesting procedure?

Skin Harvesting is performed by Skin donation Team consisting of one Doctor, two Nurses and one attendant

How the skin is harvested?A special instrument called DERMATOME harvests skin, it

is a battery-operated instrument made exclusively for skin harvesting only

Where and how much time the whole Skin Donation procedure takes?

Skin Bank Team will come to the donor’s home, hospital or morgue wherever the donor is kept. We don’t need to shift the donor to the operating room, hospital or ambulance. The whole procedure takes only about 30 – 45 minutes. 34

From which part of the body skin is harvested?

Skin is harvested from both the legs, both the thighs and the back

Is entire thickness of the skin is harvested?NO, there are total 8 layers of skin; we harvest only the

1/8th layer i.e. the uppermost layer of the skin is only harvested

Is their any bleeding or disfigurement to the body?

No, there is no bleeding from the site where skin if harvested from and there is no disfigurement to the body also. After the procedure we bandage the parts from where skin is harvested in a proper way

Is the consent for skin donation is taken before the skin harvesting procedure?

Yes, a doctor will take consent of the next of kin of the donor and also a witness is required to sign the consent form before we start the procedure. The whole procedure will be explained to you by the Doctor before start of the procedure

Do we have to pay the Skin Donation Team?

No, you don’t have to pay anything to the Skin Donation Team, selling & buying organs is illegal

Do we need to produce any documents to the Skin Bank Team when they arrive?

Yes, you need to produce the DEATH CERTIFICATE and its photocopy that will be evaluated by the Team Doctor before starting the procedure 36

How will my donation be used?After the skin is harvested, skin will be evaluated,

processed, screened at our skin bank, and then supplied to the Burns Surgeon for transplanting on burn patients

How do you preserve the skin & how long it can be preserved?

We preserve skin in 85% glycerol solution, it is stored between 4-5 degree Celsius and it can be stored for a period of 5 years

Is there any kind of Donor-Recipient matching required for skin transplant?

No, any one’s skin can be transplanted on any one, there is no blood matching, no color matching, no age matching required. Once all the blood reports are negative the donor skin can be transplanted freely 37

Is it compulsory to pledge or register ourselves with the skin bank if we wish to donate skin?

No, it’s not compulsory to pledge or register, even if you have not registered harvesting can be carried out once a call is made in time.

If you register, a Skin Donor I.D Card is provided to you along with a Skin donation Magnetic Sticker, “I AM A SKIN DONOR” Pocket card for future references.

You can register online on www.skindonation.in

If we want to call the Skin Bank Team for a skin donation call what should we do?

You can call us on the 24 hours SKIN DONATION HELPLINE NUMBER 27793333. There is a team on stand by 24 hours; a skin donation team will carry out the call irrespective of time

Awareness in social communities

Awareness in corporate offices

Volunteer in Operation Restore

Awareness in schools and colleges

Participate in the Organ Donation Week

And, finally

take the

decision to

donate when

the ‘Time’

comes39

Free availability of skin grafts could help in keeping the victim alive

If anyone truly wishes to help burn patients, please consider post-mortem skin donations, much like you might consider donation of other organs

No religion explicitly prohibits organ donation

Do inform your family as your next of kin will be asked to make the final decision about you becoming a donor, even if you are registered.

It is important that he or she is aware of your wishes before an emergency arises

Skin Bank is a service. It is not a product. It can only work with the cooperation and coordination of the people, for the people.

National Organ Transplant Act prevents the purchase and sale of donor organs.

“You give but little when you give of your possessions. It is only when you give of yourself that you truly give”

-Kahlil Gibran The Prophet

Do visit us and see our facilities

www.skindonation.in

skinbanknbc@gmail.com

Skin Donation Helpline:

022 2779 3333

Partnering NBC are

Amsterdam 44Dr. Sunil Keswani, National Burns Centre, www.burns-

skin donation and skin banking by dr. sunil keswani, national burns centre, airoli

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