Bone Banks and Banking

Well Blood Banks, Eye Banks and Sperm banks(specially after Vicky Donor) are quite well known and are present in almost all major Govt. and private Hospitals. Existence of Bone banks is not quite popular specially among non medical people, but Bone Banks are also maintained in some Hospitals. As for blood its said "DONATE BLOOD, SAVE LIVES" , for bone donations its said "DONATE BONES, SAVE LIMBS"

Bone banking

Bone is the second most commonly transplanted tissue, second only to blood. It has been estimated that over 200-300 thousand people world wide receive bone transplant every year, more than 25 times the number of people undergoing kidney transplant and 100 times the number who undergo cardiac transplant.
The main indications for bone transplant include malignancies, failed replacements, spinal surgery and massive bone loss following trauma, preventing possible amputation or expensive surgery, enabling surgeons to save the affected limb and prevent handicap.
Bone can be harvested from the recipient also, however, it has the disadvantages of an additional operation to harvest the graft, donor site pain and increased blood loss, in addition to increased operating time. Also, the quantity of the graft which can be taken out for implantation at another site in the body is limited. Transplanting bone from a bone bank gives practically unlimited quantity of the bone for the reconstructive surgery with fewer incisions, less pain and thereby decreased morbidity. The bone from the bank remains the only practical option in cases where a whole segment of the diseased bone has to be removed and replaced.
The number of people who require banked bone is rising every year. Asian Countries like Sri Lanka, Indonesia, Malaysia have set up many tissue banks to cater the increasing demands. Ironically in India with 100 crores of population, which has the documented history of earliest transplantation by Sushruta, almost 2500 years ago, has only few recognized bone banks among them two of the oldest are located in Mumbai, TATA Memorial Hospital and AIIMS,New Delhi.
In India, The application and processing of human tissues for transplantation is covered by the Transplantation of Human Organs Act, 1994 and must be registered with the State Health Authorities.
Some of the important points for running a Bone Bank:
1. Donors. Bone may be retrieved from patients undergoing total hip arthroplasty (live donors) or from cadavers. Femoral heads are a suitable source of cancellous bone whereas cadaveric bone is best used to supply large structural allografts. The age range from which cadaveric donors should be selected is 18–45 years. The lower age limit ensures skeletal maturity and avoids problems with open epiphyses. The upper age limit is imposed to exclude donors with osteoporosis or cartilage degradation.

2. Consent. Informed consent is obtained from live donors undergoing total hip replacement, and from the next of kin in cases of cadaver donation. This includes consent to obtaining blood for HIV testing.

3. Procurement. Femoral heads are retrieved in the operating theatre under sterile conditions. Cadaveric bone may be retrieved under sterile conditions and stored directly, or under non-sterile conditions if secondary sterilization is planned. Bone may be removed up to 24 hours after death provided the cadaver
has been kept cold in the mortuary. Grafts are cleaned of soft tissue, measured, individually wrapped and labelled. A swab soaked in dimethylsulphoxide may help preserve the articular cartilage.

4. Screening. The history may exclude a number of potential donors with transmissible disease. Blood tests include HIV, hepatitis B and C, VDRL and cytomegalovirus. Live donors need a second HIV blood test at least 6 months after procurement to detect seroconversion of previously negative donors. This
will be replaced by the polymerase chain reaction blood test for HIV antigen when it becomes more readily available. Swabs are taken from all grafts and cultured for organisms.

5. Storage. Allografts may be stored at -20°C for up to 6 months or at -80°C for up to 5 years. Sterilized and freeze-dried allografts may be stored at room temperature indefmitely

6. Sterilization. Grafts may be retrieved sterile and stored in a freezer (freshfrozen): these require no further sterilization. Contaminated grafts or grafts not procured under sterile conditions require secondary sterilization. Irradiation is the commonest method employed. A dose of 25 kGy will kill Bacillus subtilis
(the reference organism for sterilization) and HIV. Other sterilization methods use ethylene oxide or heat but these may further reduce the osteoinductive capacity of the allograft.

7. Re-implantation. The graft is allowed to thaw and is soaked in antibiotic solution. Prophylactic antibiotics should be given to the recipient. At reimplantation the allograft is swabbed again to ensure sterility and to act as a guide to antibiotic treatment should infection ensue. Rhesus-positive grafts should not be given to rhesus-negative women of child bearing age.

8. Documentation. Strict documentation is essential. All grafts must be clearly labelled. Blood and microbiology results must be reviewed before release of the graft for transplantation.
 In India, we are in need of more Bone Banks to cater the growing needs of Bone grafting. Its time Govt should consider setting up more Bone Banks.

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