Small losses of skin are overcome by expendable skin of the patient himself or herself, informs Dr Vispi Jokhi, Medical Director, Masina Hospital
“Burns” is a major public health issue across the world. According to a WHO report, in 2014, more people were victimised to burn injuries than malaria and tuberculosis every year. The treatment requires prolonged hospitalisation, intensive care and multiple corrective surgeries, leading to immense suffering and economic hardships. However, with the advancements in technology, more hospitals are working on setting up a specialised burn unit, reducing the death and disability caused due to burn injuries.
Burn wounds not only cause physical damage, but can also have a psychological, social and economic effect on the victim. Medically, loss of skin removes the protective barrier against bacterial invasions and makes the patient vulnerable to infections. Loss of proteins compromises the immune status and makes early cover mandatory.
Small losses of skin are overcome by expendable skin of the patient himself or herself. The skin donated and processed from the deceased, however, is used for the burn victims where skin loss is extensive. The grafts from the donated skin acts as a sterile dressing material which enables the body to heal itself from below the graft. Conventionally, if donated skin is unavailable, the treatment is hampered in terms of the ability to cover extensive areas quickly. The easy availability of inexpensive donated skin reduces the number of surgeries and the incidence of infection. It also reduces the antibiotics and parenteral nutrition requirement significantly.
The final difference for the patient is early recovery, reduced infection rates, reduced morbidity and mortality. Along with this, the beneficiaries have resultantly lesser scars, contractures and minimal permanent disfigurement.
The concept of skin donation after death is not new. The first skin bank was established in the USA around 1950. Masina Hospital, Mumbai, is a pioneer of a specialised burn unit treatment. Masina Skin Bank project is a coming together of many professional bodies, namely Burns unit Masina Hospital and its specialist Plastic Surgeons, OCT Therapies and Research; Meer Foundation and volunteers from Tarun Mitra Mandal. The skin bank which is over a year old has added a new dimension to the burns care offered in Masina Hospital. This is in tune with our endeavour to provide the highest quality of care to burn victims.
Who can donate skin after death?
There are no specific requirements in terms of sex, age or blood group. However, donor should not be suffering from any STDs, HIV, hepatitis B or C, Septicemia, skin cancer or any other skin diseases. Also, donor should not have had any blood transfusion in past two years before skin donation.
When can a person donate skin?
Donation should be done within 6-8 hours after the donor has died.
Is the next of kin’s consent for skin donation valid if taken after the donor’s death?
Yes, the next of kin’s consent is valid for skin donation.
Does the body of the deceased donor need to be taken to a hospital for skin donation procedure to be carried out?
No. A team of eligible and trained personnel from the skin bank will be sent to the donor’s house.
From which part of the body skin is harvested?
Skin is harvested from both the legs, both the thighs and the back.
Is the entire thickness of the skin harvested?
No, only 1/8th portion of the skin is harvested.
Is there any bleeding or disfigurement to the body?
No, there will be no bleeding as such. However, there can be little secretion of body fluids which will be handled and bandaged neatly.
How long does it take for the skin donation procedure to be carried out completely?
Just the harvesting of the skin will take only 30-45 minutes. The whole procedure including harvesting, bandaging and cleaning might take up to 1-2 hours.
Who performs the skin harvesting procedure?
Skin harvesting is carried out by a collection team consisting of one doctor, one nurse and one attendant.
Do we need to provide any documents to the skin bank team when they arrive?
Yes, consent form, death certificate and medical records, if any, of the donor.
Skin and eye donation : similarities and differences
A combined skin and eye bank gives every individual an opportunity to donate a tissue which can help someone in the future. Many consider skin to be a tissue. However, just like the eyes, it is an organ. Both can be donated after death and the pre-conditions for donation are almost identical. However, in the case of eyes, while the whole eyeball is taken, only the cornea is used, where the 1/8th layer of the skin that is taken is used completely. We are certain that skin donation will become as commonplace as eye donation in the near future. Besides this cadaveric donation of bones, heart valves and Dura Mater are possible, and our skin bank is planning to evolve into a tissue bank. So far, Masina Hospital has received 70 skin donations and the grafts available have been used on the patients and those from another centre in South Mumbai.