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GURU SPEAK
Year : 2019  |  Volume : 27  |  Issue : 1  |  Page : 3-4

Challenges in setting up a skin bank at GMC Nagpur


Department of Plastic, Reconstructive and Maxillofacial Surgery, GMC, Nagpur, Maharashtra, India

Date of Web Publication17-Jan-2020

Correspondence Address:
Dr. Surendrakumar B Patil
Department of Plastic, Reconstructive and Maxillofacial Surgery, GMC, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_29_19

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How to cite this article:
Patil SB. Challenges in setting up a skin bank at GMC Nagpur. Indian J Burns 2019;27:3-4

How to cite this URL:
Patil SB. Challenges in setting up a skin bank at GMC Nagpur. Indian J Burns [serial online] 2019 [cited 2020 Feb 29];27:3-4. Available from: http://www.ijburns.com/text.asp?2019/27/1/3/275905



Skin allograft has been found to be an extremely useful and lifesaving temporary skin cover in the management of extensive burn patients. Since the first clinical use of skin allograft by Girdner in 1881, the skin has proved an important adjuvant dressing in the management of burn wounds. Skin banking methods have also evolved over the years.[1] The evolution is mainly seen in different preservation techniques. Currently, there are about three different techniques in use, namely glycerol preservation, deep freezing, and cryopreservation.[2],[3],[4],[5] Although the developing world shares the maximum burden of extensive burn patients, there are very few skin banks in developing countries such as India. There is a huge gap in demand and supply of the required allograft skin, with more and more skin banks needed in various parts of India.[6] A country such as India which records more than a million burn cases annually had only one functioning skin bank till 2009.[7] Looking at the needs of the entire country, the National Burn Center (NBC, a tertiary care burn center) developed a sustainable skin banking model in Mumbai, which could be easily replicated in other parts of India and abroad. Using this model and using the help of organizations such as Rotary, a skin bank was set up at Orange City Hospital which has recently been transferred to us at GMC Nagpur. The burn unit was also run by the General Surgery Department which was recently transferred to the Plastic Surgery Department at GMCH with two surgery residents posted under burns. The challenge started with identifying the space required for the skin bank in the confines of the burn ward. Two rooms were identified and designated the skin bank; thereafter, a floor plan was made and handed over to the Electrical and Public Works Department to replicate the skin bank at Orange City Hospital, Nagpur. Till these tasks are completed, there are a few challenges ahead before the department has a fully functional skin bank.

  1. Creating awareness about the skin donation in Nagpur among doctors and paramedics and laypeople both adults and children. The doctors themselves are not aware of the benefits of skin banking. Hence, the department is planning to conduct awareness programs to tackle the same. India falls under the opt-in category in organ donation. Hence, to become an organ donor, individuals need to enroll their names. Hence, the key to getting maximum donations is awareness. We have to include it in organ donation forms, which we are coordinating with the Zonal Transplant Coordination Committee (ZTCC)
  2. Changing mindsets: Convincing people that a fully functional skin bank and tissue culture laboratory at GMC Nagpur can be a reality 1 day
  3. Tackling religious beliefs: Fighting society and convincing the hard-headed clerics in society that skin banking does not go against any religion and is for the benefit of other patients which by itself is the cornerstone of any religion
  4. Breaking taboos, myths, and false beliefs: Fighting the belief that cadavers will be disfigured and maimed after the skin donation. In India, harvesting teams are different for different organs. Hence, if eye donation has been done before the skin donation, then, the skin can only be harvested from the legs and thighs. This is due to the fact that the chances of bleeding from eye sockets are esthetically unacceptable to the relatives, making them reluctant to continue with the procedure
  5. Finding suitable institutions doing a fair bit of acute burn care and interested in working hard with no or little monetary returns
  6. Motivating the residents in the plastic surgery as well as the general surgery department and making them believe that burn care is not “fighting a lost battle.” Also reiterating that cadaveric skin is a good and cheap alternative to other dressing materials such as collagen sheets. Motivating the skin harvesting team which has to function round the clock to collect the skin and to store it according to protocols also forms an essential part of skin banking
  7. Setting up the infrastructure in terms of equipment and trained personnel. Skin harvesting is performed by a skin donation team consisting of one doctor/biotechnologist, two nurses, and one attendant. To run the skin bank, a minimum of 6–8 trained persons are required: one manager, one quality systems manager, and four people for processing the skin and a counselor for the relatives
  8. Sending the personnel working at the skin bank for training programs at NBC, Airoli, according to the memorandum of understanding signed with them
  9. Maintaining high standards and quality management of the skin bank and following and adhering to the approved international protocols and standard operating procedures
  10. Conducting internal audits on a regular periodic basis quarterly and external audits annually
  11. Linking up with eye banks and other tissue banks and other nongovernmental organizations working in the field of eye and skin, organ donation organization such as ZTCC, Mohan Foundation, Sunday friends, and Tata Tissue Bank. I expect help from these organizations in conveying the importance and need of skin donation to the families of the diseased individuals
  12. Presentation of skin bank data and results of the use of allografts at burn meetings, plastic surgery meetings, or conferences
  13. Associating with the American and European Association of tissue banks for understanding the way forward and the future of skin banking
  14. Convincing other departments such as pathology and microbiology to work extra to perform laboratory testing of the skin and the blood of the donor without any monetary gain and adding to their financial burden. This will be a challenge in a government institute such as GMC, Nagpur
  15. Trauma center: To date, five bodies have been donated for the purpose of organ donation via the trauma center in GMC, Nagpur. We will have to develop a coordinated effort to encase these bodies under our skin donation program.


All these challenges require time, finances, relentless effort, and the pursuit of excellence. To surmount all these challenges will take time, especially in a government college such as GMCH, Nagpur.

There may be a delay

But, be not impatient in delay

Be as one who understands

When the spirit rises and commands

Even the Gods are ready to obey

The river seeking for the sea

Confronts the dam and precipice

Yet knows it can never fail or miss

YOU WILL BE WHAT YOU WILL TO BE

YOU WILL DO WHAT YOU SET OUT TO DO.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pianigiani E, Ierardi F, Cherubini Di Simplicio F, Andreassi A. Skin bank organization. Clin Dermatol 2005;23:353-6.  Back to cited text no. 1
    
2.
Mackie DP. The Euro Skin Bank: Development and application of glycerol-preserved allografts. J Burn Care Rehabil 1997;18:S7-9.  Back to cited text no. 2
    
3.
Ross A, Kearney JN. The measurement of water activity in allogeneic skin grafts preserved using high concentration glycerol or propylene glycol. Cell Tissue Bank 2004;5:37-44.  Back to cited text no. 3
    
4.
Vuola J, Pipping D. Maintaining a glycerolized skin bank-a practical approach. Burns 2002;28 Suppl 1:S31-3.  Back to cited text no. 4
    
5.
Liangpeng G, Zhenggen H, Hong W. In: Marcia S, editor. Skin Graft Preservation, Skin Grafts — Indications, Applications and Current Research. InTech; 2011.  Back to cited text no. 5
    
6.
Kumar V. Skin bank – The need of hour for burn treatment. Indian J Burns 2018;26:1-2.  Back to cited text no. 6
  [Full text]  
7.
Keswani SM, Mishra MG, Karnik S, Dutta S, Mishra M, Panda S, et al. Skin banking at a regional burns centre – The way forward. Burns 2018;44:870-6.  Back to cited text no. 7
    




 

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