Transplant Tissue Update

1. Transplant Tissue Update Keith Larson, CTBS, CEBT Lifesharing Recovery Manager

2. Lifesharing • Founded in 1984 as a Division of UCSD Medical Center • One of 58 Regional Federally Designated Non-Profit OPO and Tissue Recovery Bank • Affiliated with 26 donor hospitals and 4 local transplant centers in San Diego/Imperial Counties • 1,700 San Diego patients/112,000 patients nationwide • Work closely with 2 Medical Examiners offices, Funeral homes, Nursing homes, Hospices and local San Diego Eye Bank • Most of the Tissue recoveries take place here at the MEO-Lifesharing has a dedicated Recovery Suite. • Lifesharing has approximately 60 employees • RN's/Tissue Recovery Staff are Unionized

3. What is Tissue Donation and why the need: • Over 20,000 deaths annually • 9.8 registered DMV potential donors • Lifesharing recovered 420 Tissue Donors last year • Approx 1,500,000 allografts transplanted worldwide each year for a variety of life-saving and life-enhancing surgeries: • 36 million Americans with debilitating musculoskeletal conditions who could benefit from an allograft. • Partner with 7 different Tissue Processors (i.e. Allosource, Lifecell, LifeNet, MTF, etc). Also store/distribute frozen/freeze dried grafts for some of these tissue processors here in San Diego. • Partner with UCSD Whole Body Donation – donor can be a tissue and whole body donor

4. Referral to Recovery-Non MEO

5. Lifesharing is Notified of Death

6. Initial Review

7. Authorization is confirmed / Obtained

8. If A MEO Case: • Lifesharing and the San Diego Eye Bank review the MEO death reports twice a day. • If a potential donor then NOK is contacted by a Family Services Coordinator • If NOK gives authorization, and the case is a possible Autopsy case, then the MEO investigator is contacted and a Pre/Post Autopsy request form is faxed. • Then once authorization is received either Lifesharing or the San Diego Eye Bank we evaluate how to proceed with tissue recovery.

9. Recovery

10. Tissues Recovered Corneas Mandible Costal Cartilage Heart for valves Humerus Ribs Vertebrae Elbow Radius/Ulna Ilium Femur Fascia Femoral V/A Patellar Tendon Tibia Saphenous vein Fibula Tibialis tendons Ankle

11. Tissue Uses Mandible/ Hemi Mandible Whole, Proximal, Chips, DBM Cancellous Chips Elbow, Whole Joint Wedges, Dowels, Chips Fascia BTB, Proximal, Dowels, Chips, Shafts, DBM, Hamstrings Proximal/Distal, Dowels, Heads, Shafts, Chips, DBM Shaft, Chips, DBM Ankle, Whole Joint

12. Tissue Uses: Applications: Bones: spinal fusions, congenital defects, reconstruction due to trauma, cancer, tumors, disease & fractures Tendons: replacement ACL, PCL, Achilles tendons. Skin: grafts for burn victims, abdominal wall repairs, hernia repair, pelvic floor reconstruction, facial reconstruction, breast reconstruction following mastectomy. Blood vessels: replaces damaged arteries and veins. Heart valves: replaces damaged or defective heart valves Benefits:  Restores appearance, mobility & decreases pain, prevent amputation  Restores Mobility  Promotes healing, reduces scarring and restores abdominal wall.  Increase circulation, limb salvage  Improve heart function, allows a child to grow into graft

13. Specialty Grafts • Right 5th Metacarpal and 1st Phalange –to repair finger of a 15 yr. old girl who suffered a traumatic injury playing soccer-recover from a male/female between the ages of 15-45 yrs-no autopsy • Rt/Lft Elbow En-Bloc-male donors, no autopsy • Shoulder, Clavicle, Humeral Head • Tremendous need for Infant Heart Valves and Juvenile Cartilage grafts-Full Term Birth to 13th birthday • With some grafts No autopsy because some grafts are processed fresh and released +/- 21 days. They are mixed w/stem cells to expedite bone growth. Used for sports medicine injuries!

15. Skin Recovery Freehand Graft Recovery Dermatome Recovery

16. Improved Surgical Repair

17. Ruptured Omphalocele Courtesy Dr. Schrupp

18. Placement of Acellular Dermis

19. Wound Closure

20. Co-joined Twins

21. Acellular Dermis Silos

22. Top LifeSharing Hospital Tissue Usage: 2009 - 2011

23. The Facts • Donor families incur no expense for donation • Donation is consistent with the life-preserving traditions of most major religions • Donation is a sterile aseptic procedure. Open casket funeral are possible-anyone can be a eye donor for Tx or Research • You do not have to match blood, age or gender to be a tissue donor • Tissue cannot be bought or sold • Donor families tell Lifesharing donation makes sense out of tragedy and helps their grieving

24. Follow -Up • Follow-up letter is sent to the NOK to inform them if the donation took place or not. • We offer twice a year a ‘Day of Remembrance’ at a local funeral home for the families who donated. • Sometimes the donor families may want to meet the recipients of Organs donated.

25. THINGS TO CONSIDER • Do not rule patient out as donor candidate before calling the Donor Referral Line “1-888-4A-DONOR” • A Lifesharing Coordinator will discuss options when timing is appropriate. • Communication is key – Keep us informed if a Family Member wishes to donate!

26. Remember… One organ and tissue donor can save the lives of 8 people and enhance the lives of 60 people

27. Questions?

29. What is Tissue Donation and why the need: • Surgical recovery of donated tissue for safe and sterile transplant into a recipient • Approx 1,500,000 allografts transplanted each year for a variety of life-saving and life-enhancing surgeries: • 36 million Americans with debilitating musculoskeletal conditions who could benefit from an allograft. • Partner with 7 different Tissue Processors (i.e. Allosource, Lifecell, LifeNet, MTF, etc).  Over 20,000 deaths annually  420 tissue donors last year