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VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Donor Tissue Bank of Donor Tissue Bank of VictoriaVictoria
Inquiry into Organ Donation in Victoria
Stephen Cordner – Director, VIFMStefan Poniatowski – Acting Head, DTBVHelen McKelvie – VIFM in-house Counsel
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Donor Tissue Bank of Victoria• Started by the VIFM, Victoria’s statutory autopsy
provider, in 1990“ Autopsy is a significant event and the community has the right to expect that, if
an autopsy is necessary, subject to law and in accordance with community attitudes, the best use is made of it.” Prof.Stephen Cordner, Director
• TGA licensed and NATA (micro/sero Lab) accredited• Only Multiple (MSK/Skin/Cardiac) Tissue Bank in
Australia• Own in house Tissue Donor Coordinators• Only bank providing skin in Australia
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Which tissues can be donated?
• (Corneas – Lions)• Bone• Tendons• Skin• Heart valves
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Bone GraftingBone Grafting
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Tendon GraftingTendon Grafting
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Black Saturday (2009)Bali (2002)
Skin Skin GraftingGrafting
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Heart Valve GraftingHeart Valve Grafting
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Tissue Donation
• Tissues can be donated• Tissues can be stored
TISSUE BANKSTISSUE BANKS
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Tissue donation and banking
• Donor selection• Consent• Retrieval• Processing• Storage• Distribution
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
DTBV Programs• Deceased Donor
– Donation after death– Multiple tissues– Coronial, DonateLife,
Hospital Referrals– In house donation
within 24 hours death
– Donor transported to DTBV
• Living Donor– Patients undergoing
hip replacements– Hip bone only– Collaborating
hospitals (23)– Part of surgical
procedure in hospital– Tissue transported to
DTBV
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
TISSUE SUPPLIED BY YEAR2003-2011 (Jan to Jun )
0
200
400
600
800
1000
1200
Cardiac 84 82 101 47 69 55 53 22 5
Skin 605 825 833 962 706 720 654 313 117Musculoskeletal 586 596 568 547 579 634 582 625 268
2003 2004 2005 2006 2007 2008 2009 20102011 Jan to Jun
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
TOTAL CADAVERIC 2006 TO 2011
0
20
40
60
80
100
120
TOTAL CADAVERICDONORS
87 106 89 48 59 21
2006 2007 2008 2009 20102011 (Jan-
June)
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
DONORS BY TISSUE TYPE
0
100
200
300
400
500
600
700
NUMBER
OF DONATION
2007 41 65 87 5172008 29 58 62 4712009 11 33 40 5302010 15 18 33 6632011(Jan to Jun)
10 9 14 348
Cardiac Donations
Cadaveric Musculosk
eletal
Skin Donations
Living Donor
Program
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Maximising opportunities in tissue donation – Acts
• Coroners Act 2008 – Reportable deaths are an important source of donors
(sudden deaths otherwise fit and healthy).– The Coroner supports donation, but timing is crucial.– There is no provision in the Coroners Act to support
donation, hence it is always in the wake of identity, cause and circumstances of death.
– Timeliness conflict for establishing contact with Senior NOK (coroner) vs Senior available NOK (DTBV).
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
• DTBV relies entirely on voluntary notification and good will. There is no provision in the Human Tissue Act to require anyone to notify a death or a potential donor to a donation agency.
Maximising opportunities in tissue donation – Acts
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Other issues• Regional capacity – location needs to be
suitable (operating theatre). Limited by movement of the deceased and cost to a suitable facility.
• Regional capacity – Living program limited by reducing transport infrastructure (rail) resulting in inefficient dependence on road couriers.
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Other issues• Increasing public/professional awareness;
normalising after death discussions about the donation process.
• Pressure on hospitals (including cost) to run donation programs; e.g. the living donor program requires the clinic preadmission nurse or doctor to undertake consent and ascertain medical history. These clinics are often understaffed and program relies on the goodwill of a departmental ambassador.
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Other issues
• DTBV operates as cost recovery. In deficit. As donation rates fall, so does income. Majority of costs in staffing. Reduced staffing reduces ability to bank tissue 24/7. No access to ongoing public funds in particular from Health (as Vic’s health system is devolved with ‘services’ commissioned by individual hospitals).
VICTORIAN INSTITUTE OF FORENSIC MEDICINEDONOR TISSUE BANK OF VICTORIA
Thank you!
Leaf Day