Examination

We believe that life is a gift to share. Our services provide the gift of life through tissue donation and transplantation.

The TMH Tissue Bank is a non-profit service dedicated to the supply of safe, reliable and cost-effective human tissues for transplantation. Conceived as part of a programme of the International Atomic Energy Agency (UN) to promote the use of radiation for upgrading healthcare in the Asia-Pacific Region, it was established in 1988, at a time when Tissue Banks were almost unheard of in India, and few existed in Asia. A pioneer in the field, it is the first tissue bank in India to use radiation for the sterilisation of biological tissues, and in 2004 became India’s only Tissue Bank with an ISO 9001:2000 Certified Quality Management System. Currently it banks gamma-irradiated, human amnion (the inner membrane of the sac that encloses the foetus in the womb), skin and bone, and promotes and co-ordinates the development of tissue banks using radiation sterilisation of grafts.

Profile - Tissue Banking is a multidisciplinary service requiring compliance with statutory regulations, stringent quality control and continuous interaction with professionals and the community.

Profile - Tissue Banking is a multidisciplinary service requiring compliance with statutory regulations, stringent quality control and continuous interaction with professionals and the community.

At the TMH Tissue Bank we are committed to respecting the gift of donated tissue and meeting the demands of transplanted tissue by:

Networking with government agencies and existing organ donation programmes to establish regulations and standards for tissue banking;

Creating public and professional awareness of the need for tissue donation, as well as the use and benefits of allografts;

Maintaining the highest ethical, legal and medical standards for the donation and provision of tissue;

Facilitating the tissue donation process by making available resources and specialised services to tissue recovery agencies;

Implementing international standards of Quality Assurance through good manufacturing practices for the retrieval, processing and storage of grafts;

Providing allografts to patients of all economic strata;

Meeting the needs of transplanting surgeons through ongoing follow-up;

Promoting the development of tissue banks in the country.

Training - Tissue Banking requires a proper understanding of the legal, ethical, medical and social aspects, design and layout, and quality control.

Training - Tissue Banking requires a proper understanding of the legal, ethical, medical and social aspects, design and layout, and quality control.

Our experience of setting up India's first multi-tissue bank, inclusive of its design, protocols and clinical applications, constitutes part of the IAEA Multi-media Distance Learning Package, the first of its kind for tissue bank operators, managers and doctors, introduced in 1997. Additionally, assistance in the form of hands-on training, consultation and project proposals is provided for setting up tissue banks and/or tissue retrieval centres in different parts of the country. Presently TMH has helped/is helping establish such facilities at Government hospitals in Jodhpur, Chennai, Mumbai and Nasik.

As part of its commitment to create professional awareness about quality assurance, promote the establishment of more tissue banks, and facilitate the formulation of national standards and regulations, in 2006 the Tissue Bank conducted the 11th International Conference of the Asia Pacific Association of Surgical Tissue Banks with the theme: “Issues on Tissues”. This was the first time that this multidisciplinary conference was held in India, and it attracted 161 delegates from different parts of India and 51 international delegates.

Public and professional awareness programmes to promote tissue donation also form an intrinsic part of the Tissue Bank activities since the number of grafts produced is directly related to the donor pool.

Research - Clinical studies are required to evaluate the efficacy of the grafts

Research - Clinical studies are required to evaluate the efficacy of the grafts

A number of studies are conducted to evaluate the efficacy of the grafts in different clinical conditions and to develop new products.

Events - Tissue Banking Events

Events - Tissue Banking Events

5th WORLD CONGRESS ON TISSUE BANKING in conjunction with the 12th INTERNATIONAL CONFERENCE OF THE ASIA PACIFIC ASSOCIATION OF SURGICAL TISSUE BANKS

Dates : 2nd June to 6th June 2008

Venue : KUALA LUMPUR, MALAYSIA.

For more information on the Congress please visit the website:

www.wctb08.com

Tissue Donation - Tissue donation involves the donation of surgical residues or tissues from a recently deceased person.

Tissue Donation - Tissue donation involves the donation of surgical residues or tissues from a recently deceased person.

Becoming A Donor
The Donation Experience
The removal, storage and transplantation of human organs for therapeutic purposes is regulated by the Transplantation of Human Organs Act, 1994. As required by this Act, the TMH Tissue Bank is registered with the Maharashtra State Health Authorities.
The tissues are recovered from deceased donors, or living donors who donate unwanted surgical residues. All donated tissues are processed, sterilised and preserved after appropriate screening and consent of the donors.
BECOMING A DONOR
A single organ and tissue donor can potentially help up to 50 (often more) people to live more functional lives. Hundreds of thousands of patients can benefit from tissue transplants. At TMH, thanks to the generosity and goodwill of our donors and the support of the staff of our donor hospitals, over the years, donated skin and amnion have helped save the lives of critically burned patients. Donated amnion has also helped patients recover their sight. Donated bone has benefited thousands of children and adults crippled by congenital defects or disfigured and disabled by accidents or disease.

The availability of safe and clinically effective grafts has also stimulated a radical change in the approach to surgical treatment resulting in innovative techniques with enhanced health benefits to patients. This has been reflected in the increasing demand for grafts. In the past two decades patients in 106 hospitals in Mumbai and 31 hospitals from 11 other States in India have benefited from TMH grafts.
To meet this growing need it has become necessary to expand our donor services, and YOU can help us.

You can help to put a stop to unnecessary pain and despair and save lives. You can help us improve the quality of life for someone recovering from cancer or incapacitated with burns. You can help the blind to see and those crippled by disease to lead more productive lives.

All it takes is a personal choice to be a donor.

To facilitate the donation of tissues during surgical procedures do consider the following:
• When you or a relative/friend undergo a hip or knee replacement surgery talk to the surgeon about the possibility of donating the discarded bone. Although the bone is no longer useful for the patient, other people may benefit from it. Volunteer to send it to the tissue bank.
• As you or a relative/friend welcome a newborn into this world, remember to gift life to another by donating the unwanted amnion along with a blood sample for the necessary tests.
Consider the possibility of donating tissues after death. Since donating the tissues of a family member who has died can be a difficult decision especially when the wishes of the deceased with regard to such a donation are not known, it is important to:
• Discuss the possibility of such a donation with your family members.
• Share with them why you believe that tissue donation is consistent with your life values and feels like the right thing to do.
• Explain how tissue donation can help to put a stop to unnecessary pain and despair and improve the quality of life for someone recovering from cancer or incapacitated with burns, blindness or disease.
• Have at least one family member witness your signature on an organ/tissue donation card.
After death your body becomes the property of your legal next-of-kin. The ultimate decision to donate the tissues of the deceased remains with the next-of-kin even in the presence of a signed tissue donor card. Knowing how you feel however, makes it easier for them to reach beyond their own suffering to say that “yes” at the moment of your death. Evidence shows that up to 96% of relatives agree to donation if they already know the individual’s wishes, compared to only 58% when the family has not previously discussed the issue.

Remember, your generosity could even save a life.

To help you make an informed decision and discuss tissue donation with your family, here are some facts about becoming a donor:
1. Is there a difference between tissue and organ donation?
Tissue donation is a simpler process than organ donation. Organ (heart, liver, kidney, etc.) donation is possible only after brain death, which is defined as the complete cessation of all functions of the brain. Brain death is a medical diagnosis which can only be ascertained by a team of certified doctors. In brain dead donors, mechanical support (i.e. ventilator) is required so that the circulation of blood is maintained to continue the viability of the organs for a short period of time after the death of the patient. The donor is usually kept in the intensive care unit. As such the death must occur in a hospital where the necessary support systems are in place. The donor and recipient must be carefully matched according to their blood type, and the transplant must take place within a few hours.
Tissue donation from non-living donors may occur either after brain death, or cardiac death (the cessation of the heart). It does not require the donor to be on mechanical support systems and consequently any death is an occasion for potential donation. The time factor too is not as critical as for organ donors as tissues may be recovered within 15 hours after death, or longer if the body has been refrigerated. Blood-typing is not required for tissue transplants. There are no problems of rejection and anti-rejection drugs are not required to be used in tissue recipients.

2 Will the donation of tissue / refusal to donate tissue alter my medical treatment?
In the case of a living donor, only tissue that would ordinarily be removed and discarded is banked.
For deceased donors the doctor who declares death is not a member of the tissue recovery team and is different from the transplant surgeon. Organs and tissue donation occurs only after all efforts to save life have been exhausted and the patient is declared legally dead.

3. What are the kinds of tissues that can be donated?
Living donors can donate amnion after the birth of their babies. Skin may be donated after certain surgeries like abdominoplasties. Bone can be donated after hip and knee replacement surgeries where the osteoarthritic bone is removed and replaced with a metallic implant.
Deceased donors can donate tissues such as bone, cartilage, ligaments, tendons, fascia lata (the thin covering of the muscles), heart valves, blood vessels and skin.

4. What will tissue donation entail?
In the case of a living donor, if your tissue is suitable for donation and the hospital is a participant in our tissue donation programme, you will be asked questions on your past and present medical history. This will include questions about HIV/AIDS. Your blood will be tested for HIV/AIDS, Hepatitis B and C, and Syphilis at the time of your surgery. A second blood test may be required six months later. You will also be asked to sign a consent form for your permission to bank your tissue and to perform the blood tests.
If you are donating tissues after your death you can fill a donor card available with the Tissue Bank preferably in the presence of a relative. At the time of your death your family will be asked questions about your medical and social history. This will include questions about HIV/AIDS and high risk behaviour. Your blood sample will be tested for HIV/AIDS, Hepatitis B and C, and Syphilis and your next-of-kin will be asked to sign a consent form for banking the necessary tissues and to perform the blood tests.

5. Will tissue donation disfigure the body of the donor?
The donor is respected at all times. Tissues are procured in a manner similar to that used during surgery. The procedure can take anywhere between 1-6 hours and must occur within 24 hours of the time of death. Care is taken to reconstruct the body after retrieval of tissues and visible areas are left unmarked as far as possible to enable an open coffin funeral.

6. When is the donor’s blood tested?
When living donors donate their bone, a small sample of blood is taken during the operation. A second blood test may also be requested six months after the surgery. When women donate their amnion, a blood sample is taken within seven days of the delivery.

In the case of a deceased donor, the blood is tested at the time of tissue retrieval.

7. Are there any costs involved in tissue donation?
No, there is no charge to the donor's family. The cost of the blood tests is borne by the Tissue Bank.

8. Is there any payment for donation?
No, The Transplantation of Human Organs Act, 1994, makes it illegal to buy and sell human organs and tissues. Tissue donation is similar to any donation. It is inspired by the desire to benefit people in need.

9. Can anyone be a tissue donor?
All potential tissue donors have to be medically screened and undergo blood tests prior to acceptance to rule out infectious diseases. The majority of deceased donors are otherwise healthy and relatively young people who have died in accidents or as a result of a heart attack or stroke.

10. Can organ donors also donate tissues?
Yes, organ donors can also be tissue donors and help many more people. In these multiple donors the organs are recovered first. If the eye is being donated this is retrieved next followed by the other tissues.

11. Is the identity of the donor made known to the recipient?
The identity of the donor is kept confidential at all times.

12. Can one change one’s mind about donation?
Yes. Since in India, the next-of-kin gives the final permission for tissue donation, it is necessary to inform your family of your change of mind, and revoke any written statement indicating consent to donate tissues.

13. Are there any age limits or medical conditions that can prevent one from being a donor?
The surgeon or recovery team decides at the time of tissue recovery whether the tissue can be banked. The age limit is different for different tissues. All donors are screened to rule out infectious diseases, and tissues will only be procured if the donor meets the tissue bank criteria.

THE DONATION EXPERIENCE
In the case of living donors, the Tissue Bank's Transplant Co-ordinator or the attending surgeon makes them aware of the benefits of donated tissue and offers them the opportunity of donating their discarded tissue.
In the case of a deceased donor, the Tissue Bank's Transplant Co-ordinator contacts the family of the person who has recently died, within a few hours, since the time limit for tissue retrieval is limited. The next-of-kin are made aware of the possibility of donating tissues. This interaction is conducted with the utmost tact and consideration, as potential donors usually die in unexpected and tragic ways (accidents, heart attacks), and this is an extremely stressful time for the family. Whatever the decision, it is respected, and at no time is there any attempt to coerce the relatives.

 

Becoming a Donor - Becoming a tissue donor is a simple procedure but requires some formalities to be fulfilled.

Becoming a Donor - Becoming a tissue donor is a simple procedure but requires some formalities to be fulfilled.

The Donation Experience

The removal, storage and transplantation of human organs for therapeutic purposes is regulated by the Transplantation of Human Organs Act, 1994. As required by this Act, the TMH Tissue Bank is registered with the Maharashtra State Health Authorities.

The tissues are recovered from deceased donors, or living donors who donate unwanted surgical residues. All donated tissues are processed, sterilised and preserved after appropriate screening and consent of the donors.

BECOMING A DONOR

A single organ and tissue donor can potentially help up to 50 (often more) people to live more functional lives. Hundreds of thousands of patients can benefit from tissue transplants. At TMH, thanks to the generosity and goodwill of our donors and the support of the staff of our donor hospitals, over the years, donated skin and amnion have helped save the lives of critically burned patients. Donated amnion has also helped patients recover their sight. Donated bone has benefited thousands of children and adults crippled by congenital defects or disfigured and disabled by accidents or disease.

The availability of safe and clinically effective grafts has also stimulated a radical change in the approach to surgical treatment resulting in innovative techniques with enhanced health benefits to patients. This has been reflected in the increasing demand for grafts. In the past two decades patients in 106 hospitals in Mumbai and 31 hospitals from 11 other States in India have benefited from TMH grafts.

To meet this growing need it has become necessary to expand our donor services, and YOU can help us.

You can help to put a stop to unnecessary pain and despair and save lives. You can help us improve the quality of life for someone recovering from cancer or incapacitated with burns. You can help the blind to see and those crippled by disease to lead more productive lives.

All it takes is a personal choice to be a donor.

To facilitate the donation of tissues during surgical procedures do consider the following:

When you or a relative/friend undergo a hip or knee replacement surgery talk to the surgeon about the possibility of donating the discarded bone. Although the bone is no longer useful for the patient, other people may benefit from it. Volunteer to send it to the tissue bank.

As you or a relative/friend welcome a newborn into this world, remember to gift life to another by donating the unwanted amnion along with a blood sample for the necessary tests.
Consider the possibility of donating tissues after death. Since donating the tissues of a family member who has died can be a difficult decision especially when the wishes of the deceased with regard to such a donation are not known, it is important to:

Discuss the possibility of such a donation with your family members.

Share with them why you believe that tissue donation is consistent with your life values and feels like the right thing to do.

Explain how tissue donation can help to put a stop to unnecessary pain and despair and improve the quality of life for someone recovering from cancer or incapacitated with burns, blindness or disease.

Have at least one family member witness your signature on an organ/tissue donation card.
After death your body becomes the property of your legal next-of-kin. The ultimate decision to donate the tissues of the deceased remains with the next-of-kin even in the presence of a signed tissue donor card. Knowing how you feel however, makes it easier for them to reach beyond their own suffering to say that “yes” at the moment of your death. Evidence shows that up to 96% of relatives agree to donation if they already know the individual’s wishes, compared to only 58% when the family has not previously discussed the issue.

Remember, your generosity could even save a life.

To help you make an informed decision and discuss tissue donation with your family, here are some facts about becoming a donor:

1.
Is there a difference between tissue and organ donation?

Tissue donation is a simpler process than organ donation. Organ (heart, liver, kidney, etc.) donation is possible only after brain death, which is defined as the complete cessation of all functions of the brain. Brain death is a medical diagnosis which can only be ascertained by a team of certified doctors. In brain dead donors, mechanical support (i.e. ventilator) is required so that the circulation of blood is maintained to continue the viability of the organs for a short period of time after the death of the patient. The donor is usually kept in the intensive care unit. As such the death must occur in a hospital where the necessary support systems are in place. The donor and recipient must be carefully matched according to their blood type, and the transplant must take place within a few hours.

Tissue donation from non-living donors may occur either after brain death, or cardiac death (the cessation of the heart). It does not require the donor to be on mechanical support systems and consequently any death is an occasion for potential donation. The time factor too is not as critical as for organ donors as tissues may be recovered within 15 hours after death, or longer if the body has been refrigerated. Blood-typing is not required for tissue transplants. There are no problems of rejection and anti-rejection drugs are not required to be used in tissue recipients.

2
Will the donation of tissue / refusal to donate tissue alter my medical treatment?

In the case of a living donor, only tissue that would ordinarily be removed and discarded is banked.

For deceased donors the doctor who declares death is not a member of the tissue recovery team and is different from the transplant surgeon. Organs and tissue donation occurs only after all efforts to save life have been exhausted and the patient is declared legally dead.

3.
What are the kinds of tissues that can be donated?

Living donors can donate amnion after the birth of their babies. Skin may be donated after certain surgeries like abdominoplasties. Bone can be donated after hip and knee replacement surgeries where the osteoarthritic bone is removed and replaced with a metallic implant.

Deceased donors can donate tissues such as bone, cartilage, ligaments, tendons, fascia lata (the thin covering of the muscles), heart valves, blood vessels and skin.

4.
What will tissue donation entail?

In the case of a living donor, if your tissue is suitable for donation and the hospital is a participant in our tissue donation programme, you will be asked questions on your past and present medical history. This will include questions about HIV/AIDS. Your blood will be tested for HIV/AIDS, Hepatitis B and C, and Syphilis at the time of your surgery. A second blood test may be required six months later. You will also be asked to sign a consent form for your permission to bank your tissue and to perform the blood tests.

If you are donating tissues after your death you can fill a donor card available with the Tissue Bank preferably in the presence of a relative. At the time of your death your family will be asked questions about your medical and social history. This will include questions about HIV/AIDS and high risk behaviour. Your blood sample will be tested for HIV/AIDS, Hepatitis B and C, and Syphilis and your next-of-kin will be asked to sign a consent form for banking the necessary tissues and to perform the blood tests.

5.
Will tissue donation disfigure the body of the donor?

The donor is respected at all times. Tissues are procured in a manner similar to that used during surgery. The procedure can take anywhere between 1-6 hours and must occur within 24 hours of the time of death. Care is taken to reconstruct the body after retrieval of tissues and visible areas are left unmarked as far as possible to enable an open coffin funeral.

6.
When is the donor’s blood tested?

When living donors donate their bone, a small sample of blood is taken during the operation. A second blood test may also be requested six months after the surgery. When women donate their amnion, a blood sample is taken within seven days of the delivery.

In the case of a deceased donor, the blood is tested at the time of tissue retrieval.

7.
Are there any costs involved in tissue donation?

No, there is no charge to the donor's family. The cost of the blood tests is borne by the Tissue Bank.

8.
Is there any payment for donation?

No, The Transplantation of Human Organs Act, 1994, makes it illegal to buy and sell human organs and tissues. Tissue donation is similar to any donation. It is inspired by the desire to benefit people in need.

9.
Can anyone be a tissue donor?

All potential tissue donors have to be medically screened and undergo blood tests prior to acceptance to rule out infectious diseases. The majority of deceased donors are otherwise healthy and relatively young people who have died in accidents or as a result of a heart attack or stroke.

10.
Can organ donors also donate tissues?

Yes, organ donors can also be tissue donors and help many more people. In these multiple donors the organs are recovered first. If the eye is being donated this is retrieved next followed by the other tissues.

11.
Is the identity of the donor made known to the recipient?
The identity of the donor is kept confidential at all times.

12.
Can one change one’s mind about donation?

Yes. Since in India, the next-of-kin gives the final permission for tissue donation, it is necessary to inform your family of your change of mind, and revoke any written statement indicating consent to donate tissues.

13.
Are there any age limits or medical conditions that can prevent one from being a donor?

The surgeon or recovery team decides at the time of tissue recovery whether the tissue can be banked. The age limit is different for different tissues. All donors are screened to rule out infectious diseases, and tissues will only be procured if the donor meets the tissue bank criteria.

THE DONATION EXPERIENCE

In the case of living donors, the Tissue Bank's Transplant Co-ordinator or the attending surgeon makes them aware of the benefits of donated tissue and offers them the opportunity of donating their discarded tissue.

In the case of a deceased donor, the Tissue Bank's Transplant Co-ordinator contacts the family of the person who has recently died, within a few hours, since the time limit for tissue retrieval is limited. The next-of-kin are made aware of the possibility of donating tissues. This interaction is conducted with the utmost tact and consideration, as potential donors usually die in unexpected and tragic ways (accidents, heart attacks), and this is an extremely stressful time for the family. Whatever the decision, it is respected, and at no time is there any attempt to coerce the relatives.

 

Clinical Utilisation of Banked Tissue - The grafts from our bank benefit a wide variety of patients.

Clinical Utilisation of Banked Tissue - The grafts from our bank benefit a wide variety of patients.

CLINICAL UTILISATION

Donated Amnion
Donated Skin
Donated Bone
Satellite Bone Donation Programme
Benefits of Membership
DONATED AMNION

Beneficiaries of Donated Amnion
Amnion is an excellent biological dressing which mimics skin. Banked amnion is used as a temporary, external wound cover to promote healing in chronic ulcers, unresponsive bedsores, abscesses, skin graft donor sites and wounds, including those following dermabrasion and laser treatment, as well as leprosy lesions. The use of amnion in the treatment of full and partial thickness burns has special appeal in this part of the world, as despite advances in burn management the mortality rate continues to be high and the search for an economical and easily available dressing to control burn wound infection continues. As compared to conventional dressings healing with amnion dressings is faster and more economical and convenient. Amnion can also be used in orbital and ocular surface reconstruction helping patients recover their sight.

Banking of Amnion
Amnion available from the TMH Tissue Bank is processed, freeze-dried and irradiated. Processing closes the sero-diagnostic window for HIV while freeze-drying and irradiation permit the supply of sterile amnion off-the-shelf. These ready-to-use packs may be conveniently stored at room temperature for up to 3 years.

DONATED SKIN

Beneficiaries of Skin Donation
In patients with severe burns, damaged skin must be replaced as early as possible, ideally with the patient's own skin. In practice however, this is not always possible. The patient’s general condition may be poor or in patients with extensive burns donor sites may be unavailable.
In such patients donated skin can make the difference between life and death. It serves as a temporary biological dressing promoting healing of the wound bed prior to grafting the patient's own skin. It prevents the loss of precious body fluid, protein and blood and acts as a barrier, keeping out microbes which would otherwise cause infection, septicaemia and eventually death. Donated skin can also be used for hernia repair, reconstruction of the bladder and pelvic floor, as well as to provide skin cover in surgeries when the patient’s own tissues are inadequate as in breast reconstruction following mastectomy.

Banking of Skin
Skin is usually recovered from deceased donors as "split-thickness grafts". This means that the skin graft is taken to include the epidermis and a small portion of the underlying dermis. Potential skin donors are evaluated on an individual basis by visual assessment of skin condition and medical status. Live donors may sometimes donate skin as in the case of patients undergoing abdominoplasty or amputations.

Skin is usually recovered from deceased donors as "split-thickness grafts". This means that the skin graft is taken to include the epidermis and a small portion of the underlying dermis. Potential skin donors are evaluated on an individual basis by visual assessment of skin condition and medical status. Live donors may sometimes donate skin as in the case of patients undergoing abdominoplasty or amputations.

DONATED BONE

Beneficiaries of Donated Bone
Bone is among the most transplanted tissues in the world, second only to blood. The ideal bone transplant is the patient's own bone, known as an autograft. However, acquiring an autograft requires an additional incision which leads to increased operating time, blood loss, and ultimately, prolonged recovery time and higher hospital costs. Not only does this secondary surgery damage the patient's normal structures but it also carries its own risk of complications.
The use of donated tissues, or allografts, avoids all these problems, and has the additional advantage of providing tissue in quantity. This is particularly useful when there are massive defects to be reconstructed or in children where the amount of available autograft is limited and retrieving it may even damage the child's growth.

1.
How is bone used?

Donated bone is used in a number of ways. Generally bone is morsellised (broken into smaller bits) and used to fill cavities in a patient’s bone, which may have been caused due to disease or trauma. It can be used for reconstructing skeletal defects or to provide structural support during fracture healing particularly when the bones do not unite on their own. Often it is used to reinforce bone that has been weakened, as in patients with osteoarthritis and those needing total knee or hip replacement. Small segments of bone are used to correct deformities in the spine, for instance in children suffering from tuberculosis, while bone powder is used by dentists to treat defects in the jaw bones.

In patients with cancer, morsellised bone is used to enhance the recipient’s bone stock by packing it into the large defects resulting after the removal of tumours. Long bones may be used to replace cancerous bone. TMH is the one of the few hospitals in the country where limb salvage surgeries with restoration of limb function are being done routinely using indigenously produced allografts. Without the bone transplants the limb may have to be amputated, or an expensive imported prosthesis may have to be used which would require repeated revision surgeries.

2
What happens to the bone after transplantation?

Once the bone is accepted by the recipient it is slowly converted into new living bone and incorporated into the body as a functional unit. The transplanted bone stimulates the recipient’s cells to begin producing new bone, itself acting as a scaffold for new bone formation. New bone cells produced by the recipient creep into this scaffold in a process called ‘creeping substitution’. The donated bone is slowly resorbed. This process occurs over many years.

Satellite Bone Donation Programme -

Satellite Bone Donation Programme -

BANK WITH US FOR LIFE :

The TMH Tissue bank has a bone donation programme that enables individuals undergoing surgery to donate tissues which would ordinarily be discarded. Participating in our tissue donation programme benefits affiliated surgeons and their patients. Tissues are made available first to the members of our bone donation programme and then to non-member clients. This policy assures appropriate incentives for recovery efforts and encourages proactive involvement by physicians in hospital and public education about donation.

Bone donated in this way is procured after appropriate screening of the donor by one of the surgeons participating in our bone donation programme and the written consent of the donor. The donated tissue is then transported to the TMH Tissue Bank along with a blood sample of the donor for serological testing.

Donated Femoral Heads

Individuals with osteoarthritis who are undergoing a primary hip replacement, and who are otherwise healthy, or those undergoing treatment for a femoral neck fracture, donate the bone that is removed in the course of their surgery. This bone which is normally discarded when replaced with a prosthetic implant, is salvaged and processed for transplantation.

Donated Tibial Slices

Similarly, tibial shavings from total knee replacement surgery for osteoarthritis, or bone wedges from tibial osteotomies are donated and preserved in the Tissue Bank.

Donated Long bones

Bone is also procured from limbs that are donated following amputations after proper medical assessment.

Benefits of Membership

Surgeons participating in our bone donation programme derive the following benefits:

Surgeons participating in our bone donation programme derive the following benefits:
Priority access to bone allografts.
Access to customised allografts on request.
Surgeons interested in participating in our bone donation programme may please contact the Tissue Bank for further information

Quality Assurance - Quality and safety are priorities at the TMH Tissue Bank which is registered with the State Health Authorities and has an ISO 9001:2000 certified quality management system.

Quality Assurance - Quality and safety are priorities at the TMH Tissue Bank which is registered with the State Health Authorities and has an ISO 9001:2000 certified quality management system.

Quality and safety are priorities for the TMH Tissue Bank, and a number of measures have been taken to fulfil these objectives.

Our quality systems are ISO 9001:2000 certified thereby guaranteeing the implementation of our quality policy and standard operating procedures which are designed to ensure that our grafts are reliable and free from transmissible disease. Some of the steps we take to ensure this high quality are:

Screening of potential donors on the basis of their medical history.
Serological testing of blood to exclude AIDS, Hepatitis B and C and Syphilis.
Microbiological analysis of the donated tissue in the case of deceased donors.
Cleaning and processing of all tissue.
Irradiation of the processed tissue at ISOMED, the Government of India Radiation Plant with ISO 9002 certified processes.
Extensive documentation to monitor the tissue from retrieval, through processing and sterilisation to transplantation.
Follow up with surgeons using the grafts.
The Bank itself is well equipped and its layout and design permit the separation of various procedures enabling the control of environmental contamination. The tissues are processed using aseptic techniques, and the environment of the Bank is regularly monitored. Processed tissues are packaged under laminar airflow and sterilised by gamma radiation. Sterility tests are conducted periodically to check the validity of the irradiation process

Frequently Asked Questions - Tissue Banking is a relatively unknown field in India and there are many questions regarding its role as an adjunct to healthcare.

Frequently Asked Questions - Tissue Banking is a relatively unknown field in India and there are many questions regarding its role as an adjunct to healthcare.

1.What is an autograft / allograft / graft?

Bone or tissue transplanted from one part of the body to another part in the same person is called an autograft. Bone or other tissue transplanted from one person to another is called an allograft. The term "graft" is used to refer to both autografts and allografts

2.What is a tissue bank?

A tissue bank is a facility that is capable of providing on demand, a spectrum of fresh or preserved biological tissues for transplantation. These tissues must be of predictable clinical function and free from transmissible disease. A Tissue Bank thus engages in the retrieval, processing, preservation, storage and/or distribution of donated tissue.

3.What is a non-profit Tissue Bank?

A non-profit Tissue Bank is a facility that is operated for the benefit of the community and caters to patients of all economic strata. All proceeds are reinvested in the Tissue Bank. There are no shareholders.

4.What is the need for a tissue bank?

Ideally, the best replacement tissue following trauma, disease or surgery, is the patient's own tissue. However, using banked tissues has certain advantages. They eliminate the risks and the expense of the additional incision necessary for acquiring an autograft. They also avoid the creation of a permanent defect in the tissue recovery site which sometimes could give rise to major complications. Further, since allografts do not damage normal structures they provide the surgeon with a variety and quantity of tissue which otherwise may not be available. This is especially so in children who do not have enough tissue to meet their surgical needs and in patients who are already medically compromised.

The use of tissues from the TMH Tissue Bank also results in a considerable saving as the grafts are available for a nominal processing fee which is a fraction of the cost of imported grafts. In addition, hospital and medical expenses are brought down with the use of banked tissues due to reduced surgical time, faster recovery and a shorter hospital stay.

The use of biological dressings like amnion reduces pain and hastens healing. It also avoids frequent changes of dressings and reduces analgesic and antibiotic use thereby contributing to the financial saving.

5.What are the kinds of tissues that are usually banked?

Tissues such as bone, cartilage, ligaments, tendons, fascia lata (the thin covering of the muscles), heart valves, blood vessels, skin and amnion are currently being banked the world over.

6.Where are allografts used?

Bone may be morsellised (broken into smaller bits) and used to fill cavities in a patient’s bone or may be used as a long segment to replace deceased or damaged bone. It may help to correct deformities, provide structural support and strengthen weakened bone as in patients with osteoarthritis and those needing total knee or hip replacement. In some patients it may prevent the amputation of a limb.

Tendons and ligaments may be used to reconstruct damaged ones thus strengthening the joint and assisting the patient in walking and running.

Cryopreserved fascia lata can be used as a replacement for dura mater in neurosurgeries, as a supportive covering or for reconstructive repair.

Skin and amnion may be life-saving for critically burned patients. Amnion can be used to help restore sight in certain conditions. Banked skin can also be used for hernia repair, reconstruction of the bladder and pelvic floor, as well as to provide skin cover in surgeries when the patient’s own tissues are inadequate as in breast reconstruction following mastectomy.

Heart valve allografts are used to replace or repair damaged ones and offer the chance of an active life for many, especially children. They offer certain advantages over mechanical and porcine valve substitutes and do not require the use of postoperative anticoagulants which are associated with a substantial risk of spontaneous bleeding and embolism. Saphenous and femoral veins from the legs are used in cardiac by-pass surgery for patients who have suffered cardiovascular (heart) disease.

7.How are allografts obtained?

Allografts may be obtained either from living or deceased donors. Donated amnion, the membrane which is expelled along with the baby at birth, is recovered after deliveries. Donated bone can be obtained after surgical procedures like hip or total knee replacement for osteoarthritis. A variety of tissues can be recovered after death from a donor after the necessary screening, and written consent from the next-of-kin.

8.How safe are allografts? What about disease transmission?

In order to render the allografts safe, the donors are screened for infectious diseases and diseases of unknown origin. The donor’s blood is tested for HIV/AIDS, Hepatitis B and C, and Syphilis. If any of these tests prove to be positive the donated tissue is not used. In addition, at the TMH Tissue Bank the tissues are subjected to heat and chemical treatment to further reduce the risk of disease transmission, and finally sterilised with ionising radiation. Although there is some theoretical risk for disease transmission as is the case also in blood donation, the use of allografts that have undergone donor screening, serological testing, processing and irradiation has a significantly reduced risk.

9.How are allografts preserved in the Tissue Bank?

At the TMH Tissue Bank donated tissue is cleaned of blood and in the case of bone the soft tissue and bone marrow is removed. The tissues are then subjected to heat and chemical treatment and then stored in -80ºC freezers. They are finally freeze-dried to remove 95% of their water content, double packed in a sterile environment and sterilised by exposing them to gamma radiation. These grafts are available in ready-to-use packs that have a shelf life of 3 years. They can be conveniently stored at room temperature and even mailed. Sometimes bone is irradiated in the frozen state without freeze-drying. Such bone must be stored at -80ºC.

10.How effective are allograft transplants?

Tissues like amnion and skin that are used as biological dressings are for the most part used externally and are temporary covers. As healing takes place they peel off on their own.

Bone allografts are usually effective, facilitating the formation of new bone and reducing the percentage of repeat procedures. However, there are cases where the grafts do not perform as expected. This can be due to a variety of reasons which include the patient's age, lifestyle, primary medical condition, the time taken for surgery, and the number of surgical procedures already performed. Allograft struts are known to have the potential problem of non-union and fracture, as incorporation is slow, often taking up to a year. The situation could be aggravated with postoperative radiation and chemotherapy. According to the literature, the risk of post-operative infection in patients who will require an allograft is between 4% and 13.2%. In a preliminary study done at the TMH which was published in an international journal, the infection rate using our bone grafts was within this range.

11.Are there any problems of rejection of the graft as in the case of organ transplants ?

There are no problems of rejection as the transplantation antigen is destroyed during processing. Tissue typing is therefore not necessary, and anti-rejection drugs are not required to be used in the recipient of the allografts.

12.Is it safe to use radiation for the sterilisation of allografts?

Radiation sterilisation is a simple and safe process. It involves the exposure of the tissues to gamma radiation from a Cobalt-60 source, for a predetermined time so as to receive a prescribed dose. It has been established as an efficient and convenient technique for achieving a high level of sterility in medical supplies, medicinal products, in vitro diagnostic products and food products and its use has been extended to the sterilisation of grafts. Tissues sterilised in this way do not become radioactive and are completely safe.

13.If you are a non-profit organisation why do you charge for tissues?

The donation and banking of tissues has significant costs associated with it. The fee charged covers the cost of the resources and infrastructure necessary for retrieval of tissues (recovery team salaries, operating room time, supplies, transportation, etc.), tests to ensure the tissue's safety, processing and quality control, research to develop more effective grafts, and awareness campaigns to promote tissue donation and utilisation.

Related Links - The need for banked tissues is a global one forging links across nations.

Related Links - The need for banked tissues is a global one forging links across nations.

Asia Pacific Association of Surgical Tissue Banks http://www.apastb.net
American Association of Tissue Banks http://www.aatb.org
Australasian Tissue Banking Forum http://www.atbf.org.au
European Association of Tissue Banks http://www.eatb.de
International Atomic Energy Agency http://www.int-tissuebank.com
Latin American Association of Tissue Banks http://www.alabat.net
The need for banked tissues is a global one forging links across nations.

Contact Us - Our team, address and contact numbers.

Contact Us - Our team, address and contact numbers.

Dr. Astrid Lobo Gajiwala
Head, Tissue Bank
Tissue Bank,
Tata Memorial Hospital,
Dr. Ernest Borges Marg, Parel, Mumbai 400 012.
INDIA.

For requests for allografts and details regarding tissue donation contact:

Telephone: 091-22-2417 7000 Ext. 4122 / 4112
Fax: 091-022-414 6937
Email Address: tissuebank@tmc.gov.in