Bridging Lives The Process of Tissue Donation

1. Bridging Lives The Process of Tissue Donation Seung Lee, BS, CTBS Tissue Hospital Services Specialist

2. Tissue Donation Circumstances • 55,659 total referrals in 2009 • Brain Death – 5% • Cardiac Death – 95% • Tissue donation can occur in both • Criteria differs than an organ donor

3. Standards and Regulatory Agencies • U.S. Food and Drug Administration (FDA) – 1993 • Interim Rule • Good Tissue Practices • State of California (other states and countries) • Center for Medicare/Medicaid Services (CMS) • Calling in all deaths • Hospital Agreements with Tissue/Eye Bank

4. Time Limitations • Tissues can become non-viable during the time the family considers the donation option • Refrigeration within 12 hours (15 vs. 24 hours) • Timely referrals allow the family the maximum time available to consult w/ one-another about the opportunity of donation • Domino Effect

5. Tissue Distribution • Tissue is strictly monitored to maintain temperature requirements ranging from 10 degrees Celsius to -196 degrees Celsius • Graft Expiration: • Bone FZ = 5 years FD = 2-3 years • Skin FZ = 5 years Fresh = 14 days • CV FZ = 5 years • Corneas Refrigerated = 7 days

6. Annual Cadaveric Tissue Transplants

7. Autograft vs. Allograft

8. Tissue Donation Potential ◄ Cornea/Eyes Heart Valves Skin Bone Tendons Cartilage Veins ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄ ◄

9. The Gift of Sight A precious gift… A world of darkness …transplanted

10. Skin • Increases burn survival from 17 to 77% • Promotes healing • Temporary coverage • Protects against: • fluid loss • Infection • Decreases pain

11. Full Thickness Burn

12. 2.5 years post-op(Courtesy Dr. Voorhees)

13. Ruptured Omphalocele Courtesy Dr. Schrupp

14. Placement of Acellular Dermis

15. Wound Closure Day 129

16. Tunneling Ulcer Post Debridement

17. Particulate Acellular Dermis

18. 6 Days

19. Bone • Replacement for skeletal defects caused by cancer, trauma, or birth defects • Prevents amputation • 60% of allografts used in spinal surgeries • Allograft provides the matrix for recipient’s bone to grow and resume normal function

20. Engineered Grafts

21. Demineralized Bone with Carrier • Consists of bone matrix and a carrier such as glycerol, collagen, etc.

22. Bone for Spinal Fusion Spinal curvature After bone grafts…

23. Allograft & Host Junction

24. Bone Matrix Injection

25. Kacey Kacey in 2005 • Rode on the Donate Life Float in the 2005 Rose Bowl Parade • Fiancée proposed the night before parade. • Graduated from Nursing School • Got married • Became a spokesperson for Tissue Donation

26. Kacey A Proximal Humerus was correctly matched by size and a medical director approved the graft for a limb-preserving surgical procedure on Kacey.

27. Osteosarcoma Bone Graft into Defect Tumor excision Fixation of Matrix

28. Connective Tissue • Tendons and Ligaments • Replace or strengthen damaged tissues in knees and other joints • Cartilage • Facial reconstruction • Fascia • Uterine & Bladder slings • Hernias

29. Facial Suspension Reestablishment of facial symmetrywith a tissue sling Hemi-facial paralysis (Courtesy Dr. Frodel)

30. Urological Surgeries Bladder Sling Procedures: Fascia is used to lift a bladder that doesn’t have the muscle control to keep in suspended.

31. Vascular Grafts • Coronary bypass surgery • Restores blood flow • Prevents amputation

32. Heart Valves/Pericardium • Replace defective heart valves • Better valve pressure than porcine or mechanical valves • No need for anti-coagulation drugs • Treatment of choice for pediatrics & women of childbearing age

33. Gift of Movement

34. Adam Teller, PTC

35. A Future Without Limits