skin donation and skin banking by dr. sunil keswani, national burns centre, airoli
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 1
DR SUNIL KESWANIPlastic SurgeonNational Burns Centre,Mumbaiwith EURO SKIN BANK,Netherlands
SKIN DONATION AND SKIN BANKING
WE MAKE A
LIVINGBY WHAT WE GET,BUT WE MAKE A
LIFEBY WHAT WE
GIVE. Sir Winston Churchill
2Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]
gift a life…..organ donation
3Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Organ Donors Per Million4
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
5Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]
6Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]
India records 70 lakh burn injury cases annually Of which 1.4 lakh people die every year. Around 70% of all burn injuries occur in the
most productive age group (15-35 yrs). Around four out of five burnt cases are women
and children. As many as 80% of cases admitted are a
result of accidents at kitchen-related accidents.
Source: Union Ministry of Health (Govt. of India) Reported by Times of India
7Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]
The body’s first line of defense
Is water proof and prevents infection from entering the body
When severely damaged, the defense mechanism breaks down
If untreated, bacterial infection, dehydration, loss of protein and electrolytes takes place
Ultimately the victim dies
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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When skin is damaged it either Heals on its own or Needs donor skin or a graft
This grafted skin provides comfort and prevents fluid loss and infection
‘SAVES THE LIFE OF A BURN VICTIM’
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Permanent skin cover: Autograft – From the victim’s unaffected
area
Temporary skin cover:Homograft – Live DonorAllograft – Cadaver DonorXenograft – Porcine Pigs and Bovine Cows
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Most preferred donor skin
Only the superficial layers of the skin are harvested from thighs and back
No disfigurement
No bleeding
No matching is required
Can be harvested in 45 minutes
Should be harvested within 6 hours after death
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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People expired due to:
HIV and Hepatitis negative
Skin disease
Cancer
Active Jaundice
Sexually transmitted disease
Severe infection
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Retrieval
Processing
Storage
Distribution
Medical documentation
Donated skin is a boon to patients with burns
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 15
TOTAL SIX TO EIGHT PERSONS REQUIRED FOR SKIN BANK.
MANAGER. QUALITY SYSTEMS MANAGER. FOUR PERSONS FOR PROCESSING SKIN
TWO TEAMS FOR SKIN RETRIEVAL IN EACH THREE MEMBERS.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 16
PROTOCOL FOR RETRIEVAL : SHAVING AND CLEANING WITH
WATER SCRUBBING WITH BETADINE SCRUB SHOWER WASH DRAPING WITH STERILE SHEET CLEANING WITH STERILIUM LUBRICATING WITH PARAFFIN PROCURING SKIN OF DIFFERENT
THICKNESS PRESERVING HARVESTED SKIN IN
50% GLYCEROL KEEPING IT IN REFRIGERATOR FOR 2
HRS.AT 4-6 °C
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 17
TO CHECK HARVESTED SKIN AND TO LUBRICATE IT PROPERLY.
PUT ALL PIECES OF SKIN IN 85% GLYCEROL. SHAKE THE SKIN WITH 85% GLYCEROL FOR 3
HRS. AT 33°C. IN SHAKING INCUBATOR. AFTER 3 HRS, KEEP IN FREEZER UPTO 8°C
FOR 4-6 WEEK TILL SEROLOGICAL REPORTS (RED LABEL) COME.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 18
• AFTER 4-6 WEEKS, TAKE OUT THE SKIN FROM FREEZER INTO BIOSAFETY CABINET.
• MAKE THE STRIPES SYMMETRICAL .• GRADE THE THICKNESS SKIN TO 2, 2+,
3,3+, 4, EACH WILL BE 3.5 CM IN WIDTH (MINIMUM).
• PUT EACH STRIPS INTO THE CONTAINER WITH 85 % GLYCEROL, WHICH WILL BE READY FOR USE.
• SEND REMAINING CUT PIECES TO RESEARCH LAB.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 19
REQUIRED MATERIALS FOR RETRIEVAL
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 20
Cleaning with Betadine
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Dermatome with blade
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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DRESSING THE BODY AFTER SKIN HARVESTING
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Skin Processing RoomSkin Processing Room
Cold Room (Outer View)Cold Room (Outer View)Biosafety cabinet to maintain
sterility during skin processing Biosafety cabinet to maintain
sterility during skin processing
Shaking incubator for lubricating skin in glycerol
Shaking incubator for lubricating skin in glycerol
26Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 27
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 28
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 29
MESHING OF THICK SKIN (2+,3,3+,4) IN THE MESHER.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 30
MESHED AND UNMEHSED SKIN PRESERVED IN SMALL STERILE CONTAINER CONTAING 85% GLYCEROL. AND
STORED IN FREEZER AT 4-8°C.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 31
KEEP THE SKIN (GPA) IN SKIN BANK AT 4-8 °C AND DO MICROBIOLOGICAL TESTING EVERY THREE MONTHS
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected] 32
Donor registration verification. Serological investigation verification after
death. Documentation of different phase of skin
processing in skin bank . Documentation of recipient name and hospital
and Doctor concerned. Record of rejected skin during the processing if
the any serological finding ,microbiological test report are awaited .
Mumbai city alone needs 2000 skin donations a year i.e. 5 a day!!
Present supply is 5 a month!!
So many patients are DYING
So many precious human lives could have been saved if ENOUGH donor skin was available
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Who performs the Skin Harvesting procedure?
Skin Harvesting is performed by Skin donation Team consisting of one Doctor, two Nurses and one attendant
How the skin is harvested?A special instrument called DERMATOME harvests skin, it
is a battery-operated instrument made exclusively for skin harvesting only
Where and how much time the whole Skin Donation procedure takes?
Skin Bank Team will come to the donor’s home, hospital or morgue wherever the donor is kept. We don’t need to shift the donor to the operating room, hospital or ambulance. The whole procedure takes only about 30 – 45 minutes. 34
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
From which part of the body skin is harvested?
Skin is harvested from both the legs, both the thighs and the back
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
Is their any bleeding or disfigurement to the body?
No, there is no bleeding from the site where skin if harvested from and there is no disfigurement to the body also. After the procedure we bandage the parts from where skin is harvested in a proper way
35Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]
Is the consent for skin donation is taken before the skin harvesting procedure?
Yes, a doctor will take consent of the next of kin of the donor and also a witness is required to sign the consent form before we start the procedure. The whole procedure will be explained to you by the Doctor before start of the procedure
Do we have to pay the Skin Donation Team?
No, you don’t have to pay anything to the Skin Donation Team, selling & buying organs is illegal
Do we need to produce any documents to the Skin Bank Team when they arrive?
Yes, you need to produce the DEATH CERTIFICATE and its photocopy that will be evaluated by the Team Doctor before starting the procedure 36
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
How will my donation be used?After the skin is harvested, skin will be evaluated,
processed, screened at our skin bank, and then supplied to the Burns Surgeon for transplanting on burn patients
How do you preserve the skin & how long it can be preserved?
We preserve skin in 85% glycerol solution, it is stored between 4-5 degree Celsius and it can be stored for a period of 5 years
Is there any kind of Donor-Recipient matching required for skin transplant?
No, any one’s skin can be transplanted on any one, there is no blood matching, no color matching, no age matching required. Once all the blood reports are negative the donor skin can be transplanted freely 37
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Is it compulsory to pledge or register ourselves with the skin bank if we wish to donate skin?
No, it’s not compulsory to pledge or register, even if you have not registered harvesting can be carried out once a call is made in time.
If you register, a Skin Donor I.D Card is provided to you along with a Skin donation Magnetic Sticker, “I AM A SKIN DONOR” Pocket card for future references.
You can register online on www.skindonation.in
If we want to call the Skin Bank Team for a skin donation call what should we do?
You can call us on the 24 hours SKIN DONATION HELPLINE NUMBER 27793333. There is a team on stand by 24 hours; a skin donation team will carry out the call irrespective of time
38Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]
Awareness in social communities
Awareness in corporate offices
Volunteer in Operation Restore
Awareness in schools and colleges
Participate in the Organ Donation Week
And, finally
take the
decision to
donate when
the ‘Time’
comes39
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
Free availability of skin grafts could help in keeping the victim alive
If anyone truly wishes to help burn patients, please consider post-mortem skin donations, much like you might consider donation of other organs
No religion explicitly prohibits organ donation
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Do inform your family as your next of kin will be asked to make the final decision about you becoming a donor, even if you are registered.
It is important that he or she is aware of your wishes before an emergency arises
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Skin Bank is a service. It is not a product. It can only work with the cooperation and coordination of the people, for the people.
National Organ Transplant Act prevents the purchase and sale of donor organs.
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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“You give but little when you give of your possessions. It is only when you give of yourself that you truly give”
-Kahlil Gibran The Prophet
Dr. Sunil Keswani, National Burns Centre, www.burns-india.com, [email protected]
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Do visit us and see our facilities
www.skindonation.in
Skin Donation Helpline:
022 2779 3333
Partnering NBC are
Amsterdam 44Dr. Sunil Keswani, National Burns Centre, www.burns-
india.com, [email protected]