Tissue Banking: Can we do better?

 One of the important things I have realised in the last few years is the concept of Tissue banking. The very concept of using tissues and banking them comes from the assumption that after we die the body is simply an inanimate mass of flesh and we need not have any relation or attachment to it. However over the years the attachment to the body has been a part of the culture of different generations. The mummification of bodies in the Egyptian tradition is one extreme from which different religions and traditions have made their customs and rituals accordingly. While we can go on and on about the reasons and evolution of the methods of disposal of dead bodies, one thing is clear that all of us living in this world cling to dear life and are mostly attached to our physical bodies. So as in life when death occurs we tend to not want to let go of the physical presence of our loved ones and miss them enormously. Most of us want to see the body and pay our respects to the body of our loved ones notwithstanding the quality of our relationship with the person while he or she were alive. 

It has been an important realization from Vedantic learning that there is body and spirit. Notwithstanding the E=MC2 equation which suggests that matter and energy are interchangeable and one is the same as the other except in different form Vedanta suggests that beyond matter and energy there exists an unchanging, everlasting, omnipotent spirit or Brahman which is the underlying substratum which pervades all of the universe. This distinction though known is hard to actually internalize in our day to day lives where we in our waking state we think that the body mind intellect apparatus is the reality which is validated by our experiences in the waking world. So Vedanta has a neat division of three states of Consciousness which we call the Waking, Dream and Deep sleep which relate to gross, subtle and causal aspects of the body mind intellect apparatus with which we deal all our life. All of us live in this external waking world and think that this is all that we experience and this is all we need to experience and there is nothing beyond this state. However, all of us dream and in our dream we totally transform but even so hard it may be to believe but this too is possibly a resultant of our accumulated experiences or tendencies  within us. So when we see a dream we have no doubt that is is as real as the waking state. But as soon as we wake up we accept that the dream state was false and temporary. However, if this is true we should also accept that in our dream state the waking state is equally untrue. It is extremely hard to reach this conclusion as the name form and experience is more tangible and repetitive than the sleep consciousness. So the third stage of consciousness is the deep sleep stage where there is no gross or subtle body and this is related to causal body. Finally since all these three states are impermanent the enquiry of the Advaita Vedanta philosophy leads us to the fourth stage of consciousness called Turiya which is the Bhraman ic existence ever present and permanent. Once this conclusion is reached or accepted the ability of the family to accept the dead body as a mass of flesh is possible and makes one ready to give the body up and allow its parts or whole to be utilized for, clinical, nonclinical and educational use. 

While this concept has greatly evolved in the West and USA in particular feel that we have done some work towards this and if we can collaborate and work the day is not far when tissue banking can become a bigger venture than at present in Mumbai. Most of us are aware about eye donations but the concept of skin donation is relatively alien to many. Having experimented with various methods of skin cover for burn injury victims Masina Hospital has pioneered a made in India skin bank which has created Indian standards and protocols for harvesting which are developed by our own expertise. So now we have good success to show in terms of the number of skin donations and our ability to store harvest and utilize skin leading to reduced morbidity. The information and FAQ's for skin donation are as follows: 

1. Who can donate skin after death? 

There are no specific requirements in terms of sex, age or blood group. However donor should not be suffering from any STDs, HIV, hepatitis B or C, Septicemia, skin cancer or any other skin diseases. Also donor should not have had any blood transfusion in past two years before skin donation. Age and other co-morbidities like Diabetes Hypertension etc are not excluded.       

2. When can a person donate his/her skin? 

Donation should be done within 6-8 hours of donor’s death.  

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

Yes, the next of kin of the donor can give the doctor the consent.  

4. Does the body of the deceased donor need to be taken to a hospital for skin donation procedure to be carried out? 

No. A team of eligible personnel from the skin bank will be sent to the donor’s house.  

5. From which part of the body skin is harvested? 

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

6. 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. 

7. Is there any bleeding or disfigurement to the body? 

No, there will be not bleeding as such. However, there can be little secretion of bodily fluids which will be handled and bandaged neatly. 

8. How long does it take for the skin donation procedure to be carried out completely? 

Just the harvesting of the skin will take only 30-45 minutes. The whole procedure including harvesting, bandaging and cleaning might take up to 1-2 hours. 

9. Who performs the Skin Harvesting procedure? 

The Skin Harvesting is carried out by the Collection Team consisting of one Doctor, one Nurses and one attendant. 

10. Do we need to provide any documents to the Skin Bank Team when they arrive? 

Yes, consent form, death certificate & medical records, if any of the donor. 

11. How is the skin harvested? 

By using a special instrument called DERMATOME designed for the purpose of Skin donation.  

12. What happens to my donated Skin? 

Donated skin is used for the treatment of patients with severe major burns which helps in preventing infection, reduce pain and mechanical protection and thus accelerating the process of healing/recovery and save a life.The skin can also be used to cover areas of lost skin after trauma, diabeties or any other reason. Our skin bank and research center is working to expand the frontiers of skin utilization through scientific research. 

 13. How do I get more information regarding tissue donation? 

Contact Masina Skin Bank for more details. Our Help Line number 1800 266 0711

Can one expand the horizons of tissue banking? Yes it is possible to do so.

One can harvest bones, tendons, heart, ossicles of the ear, pericardium. The uses in different fields is possible like reconstructive tendon and bone repair etc. As yet we have not evolved to a state where families give up the body completely. After these harvestings the body is returned in a non mutilated state to the body for final rites.

However, the challenge is to get trained man power to do this in a quick and efficient manner consistently and create the awareness among the citizens and professional to take these trends to their logical conclusion. The development of a mobile operation theater can help if the remaining two problems of awareness and use of the finished products which should be utilizable and priced well.

I urge readers to come forward and help in this noble venture.

Vispi Jokhi