Setting up a Skin Bank

SETTING UP A SKIN BANK

Dr. Sunil KeswaniCosmetic ,Burn Surgeon, & Medical Director,National Burns Centre.

ORGAN DONATION

Most popular organ donation in terms of life-saving is blood and hence most meaningful

Eye donation is fast becoming popular, and one is aware of the possibility to donate eyes after death

Kidneys and liver are donated as well but this is less common due to complexities involved

The next achievable organ donation will be human skin. Hence the concept of SKIN BANK

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SKIN BANKING

THE PURPOSE BEHIND…

SKIN BANKING:

Skin banking is a facility where the skin is collected from eligible deceased donor and processed as per international protocols.

Skin can be stored in the skin bank at 4-80 Celsius up to 5 years.

THE RATIONALITY OF THE PROJECT:

In case of extensive burns, the protective barrier- skin is burnt.

Leading to infection, in most cases becomes fatal.

Patients can be saved if we have enough skin in Skin bank.

MAGNITUDE OF THE PROBLEM

The estimated annual burn incidence in India is approximately 6-7 million per year.

Nearly 1 to 1.5 lac people get crippled and require multiple surgeries and prolonged rehabilitation

Seventy percent of the burn victims are in most productive age group of 15 to 40 years .

most of the patients belong to poor socioeconomic strata.

Source: Indian J Plast Surg. 2010 September; 43(Suppl): S6–S10.

NEED OF SKIN BANK

Lesser hospital stay. Cost of treatment goes down. Reduced pain. Increased survival rate. Results in less scarring

WHY DOES ONE NEED DONATED SKIN AFTER MAJOR BURN??

SKIN

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

National Burns Centre

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SKIN

National Burns Centre

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KINDS OF BURNS

Dry Burns – Flame Scald Burns

National Burns Centre

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Thermal Burns

KINDS OF BURNS (CONTD.)

National Burns Centre

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Chemical Burns – Acid, Alkali

Electrical Burns – Electrical Spark and Electrical

Shock

Radiation Burns – Nuclear, Sunburn, X-Rays

THERMAL BURN PARTIAL AND FULL THICKNESS

National Burns Centre smkeswani@gmail

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CADAVERIC SKIN HARVESTING

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

National Burns Centre

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EXCEPTIONS:

People expired due to:

HIV and HBsAg negative

Skin disease

Cancer

Jaundice

Sexually transmitted disease

Severe infection

National Burns Centre

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PHASES OF SKIN BANKING ESTABLISHMENT

1. SETTING UP THE NECESSARY INFRASTRUCTURES AND EQUIPMENTS.

2. RECRUITING MANPOWER.3. CREATING AWARENESS ABOUT SKIN DONATION.4. RETRIEVAL.5. PROCESSING.6. STORAGE.7. QUALITY MANAGEMENT SYSTEM FOR

CONSISTENT QUALITY. 8. MEDICAL DOCUMENTATION.

Sr. No. Description Approximate cost (INR) Use

1 Furniture &Fixtures 3,00,000 For skin banking facility

2 Bio safety cabinet 3,00,000 For skin processing.

3 Skin Donation Vehicle 5,00,000 For Transportation.

Cold Room 4,50,000 For skin storage5 Sealer 5,000 For Sealing the Bag.

6 Mesher 3,50,000 For Meshing the Skin.

7 Shaking Incubator 1,70,000 For shacking the Skin at particular Temperature.

8 Dermatome 5,50,000 For Harvesting the Skin.

9 Walk in Fridge 5,00,000 For Storing the Skin.

10 Computer & Accessories 75,000 For storing data

11 A/C 75,000 Skin bank processing room and Office

Total Cost 27,75,000

INFRASTRUCTURE COST

INFRASTRUCTURE

Changing Room 50sq.feet

Skin Processing Room 400sq.feet Skin storing Cold Room (Outer View) 100sq.feet

(Administrative office 300sq.feet)

EQUIPMENTS

Shaking incubator

Biosafety cabinet Hot air oven

Sealer

DERMATOME USED FOR SKIN HARVESTING

FULL VIEW OF DERMATOME

PERSONNEL COSTING

Fixed personnel Skin Processing Team2 members- (preferably

biotechnologist/microbiologist) Work- Skin processing Skin donation kit preparation Documentation Quality management . Overall management of skin

bank Salary-Aprox.

(Rs15,000x2)p/m

Floating personnel Skin Donation team-(Existing staff of the hospital)

Team consisting of 4 members1Team leader - Doctor/trained technician.3 Assisting members.- nurses/paramedics.The skin bank has to be in an hospital set -up so as to have enough trained manpower for attending skin donation call 24x7 round the year.The average cost per call cost about Rs.5000(Includes Consumables, transport and incentives to the team )

RETRIEVAL

Clean body with Betadine

Skin Harvesting with the help of Dermatome

Dressing body after harvesting

Skin Ready for harvesting

Skin Processing Trimming the skin sample

SKIN PROCESSING AT SKIN BANK

SKIN PROCESSING-PHASE III

LABELLING AND PRESERVATION

MEDICAL DOCUMENTATION

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 .

National Burns Centre smkeswani@gmail

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OUR EXPERIENCE WITH SKIN DONATION OVER LAST FOUR YEARS IN MUMBAI

Year Number of Donation

Number of Awareness Program Conducted

2010 15 35

2011 54 60

2012-

2013

88

191

126

156

YEAR 2010 YEAR2011 YEAR 2012 YEAR 20130

50

100

150

200

250

YEAR WISE STATISTICS OF SKIN DONATIONS

Jan

Feb

Mar

April

May

June Ju

ly

Augu

stSe

pt OctNov Dec

0

5

10

15

20

25

30

YEAR 2010YEAR 2011YEAR 2012YEAR 2013

COMPARATIVE DATA OF NO. SKIN DONATIONS IN LAST 4 YEARS

•Awareness by using newspapers, Magazines and journals

•Conducting lectures in school, colleges and institutes.

•Community Awareness Programme for Skin Donation.

•With the help of NGO’s.

•By organizing Seminars on Skin Donation.

•Awareness by promoting the burns victims to share their trauma in front of the public (Burn survivor community).

AWARENESS

social worker conducting school education programme

Students attending seminar on Skin donation

STANDEES TO BE PUT ON DISPLAY IN HOSPITALS AND MALLS

AWARENESS MATERIALS

PLEDGE FORM TO BE KEPT AT PUBLIC PLACES

Outer View Inner View

Kangaroo Pouch

Pledge Form to be filled and returned to National burns Centre

Magnetic Sticker to be displayed on Fridge as reminder

Cards for the kangaroo pouch for the Pledge Form

Pocket Card for the skin donor

… spread awareness

Write ups / Articles in Magazines, Bulletins, Newspapers, Journals, and Social Media

… spread awareness

Hoardings including public transport like BEST Buses, Auto rickshaws, trains, etc…

… spread awareness• Conduct lectures in schools, colleges,

institutes• Seminars for general practitioners, general

public

… spread awareness

Call the HOD & TC. of the Hospital you are affiliated with to the seminar

… spread awarenessInclude Skin Donation Awareness during other community programs in urban and rural areas

… spread awarenessArt or talent competition with theme as Skin, Eye, Organ Donation

NAME OF STUDENT- HARESH JAIPRAKASH DHANU NAME OF COLLEGE- L S RAHEJA SCHOOL OF ARTS

1ST PRIZE WINNER

NAME OF STUDENT- CHINAMYEE MUKADAM NAME OF COLLEGE- RACHANA SANSAD COLLEGE OF APPLIED ART AND CRAFT

2ND PRIZE WINNER

NAME OF STUDENT- BHAVEN D FURIA NAME OF COLLEGE- L S RAHEJA SCHOOL OF ARTS

Joint 3rd PRIZE WINNER

CONCLUSION

Half of the burn patients who are dying now can be saved if more skin banks are established in the country to collect more skin for covering extensive burn wound after early excision.

Early removal of dead skin and homografting will lead to quicker healing with less scar.

Thank You