The CTS Tissue Donation Process

Community Blood CenterCommunity Tissue Services

The CTS Tissue Donation Process

Community Tissue Services – Boise, ID


CTS Overview CTS is a not-for-profit 501 (c)(3) company

established in 1964 to provide blood products to the Dayton community

Dayton Regional Tissue Bank established as a Division of CBC in 1986 in response to the needs of local surgeons for allograft tissue

Name changed to Community Tissue Services in 1995 to reflect growth into communities across the nation (and internationally)

Community-focused, emphasis on quality service and tissue products

Currently CTS is the fifth largest tissue bank in the United States


Eye/Tissue Branch Organizations

Community Tissue Services – covers the state of Oregon, Southern Washington, and SW Idaho.

Idaho Lions Eye Bank – covers all of southern Idaho.

Intermountain Donor Service – covers SE Idaho.

Northwest Eye and Tissue – covers Northern Idaho


Referral Process

Refer all deaths to the 1-800 donor hotline. Procurement agency will triage donor

suitability with hospital staff. Staff will be told what tissues can be

donated. Only designated trained requestor may

approach the family for donation. Consent outcome is reported to agency for

recovery coordination.


Recovery Coordination Timelines Tissue recovery coordination begins

immediately after receiving the triage information. We need consent and med/soc prior to recovery. No refrigeration occurred start within 15

hours from death. Refrigeration occurred start within 24

hours from death. Due to shorter recovery timelines,

eye and organ donation would have already occurred.


CTS Staff Involved in Recovery

Tissue recovery team consists of a coordinator/circulator and two recovery technicians.

Technicians are notified by Coordinator to come in for the recovery. Must be able to arrive within 1 hour of the call.


What Tissues can be donated?• Skin

– Posterior back, anterior and posterior legs

• Bone– Humerous, Femur, Tibia, Fibula, Patella, Calcaneous

• Tendon/Ligament– Anterior & posterior tibilalis, gracilis, semitendinosus,

patellar, achilles, peroneus

• Vascular/Cardiac– Saphenous vein, Femoral vein/artery, Heart for valves,

Pericardium, Costal Cartilage


How long does a recovery take?

Depends on the number of tissues that will be recovered

Each graft has particular age limits assigned if a donor falls within all graft age limits then all grafts are recovered

The average recovery time is 4-8 hours, not including team/donor transportation.


Skin Retrieval

Consideration of length/width requirements

Lubrication Skin traction Depth of graft: 0.012 to

0.018 in. Adjustment of dermatome

setting Pressure and speed Blade change


Bone and Soft Tissue Recovery

Initial incisions are made and the skin and fat are dissected away from the underlying muscle.

Each graft is recovered separately according to strict sequencing to eliminate the chance of cross contamination.

The techs are required to change their gloves and surgical blade between each graft.

Each graft is swabbed with two culture swabs and two different medias are inoculated and incubated to promote growth.

The grafts are individually bagged, wrapped and labeled. All grafts recovered are then placed in another bag,

wrapped, and placed in a shipping container and sent to Dayton for quarantine.


What Happens to Tissue Next?

Tissue is frozen and remains in quarantine until all donor screening criteria is complete.

Once transplant safety has been determined (thorough QA, QC, and Medical Director review)the tissue is sent to processing and made into surgery-ready grafts.


Processing Information Aseptic technique Cut and shaped into grafts Debrided to remove muscle and connective tissue Treated with agents to reduce bacterial and viral

bioburden Antibiotics Hydrogen Peroxide Alcohol Sterile water Allowash™

Cut and shaped into grafts Packaged for final storage



Storage Methods Room temperature

Ambient temperature or cooler Common storage for lyophilized and air dried grafts

Wet Ice Zero degrees Celsius Temporary storage for transport

Refrigeration 1 to 10 degrees Celsius Storage for fresh tissues

Frozen Short term storage up to six months (-20 to -40 degrees

C) Long term storage up to five years (-40 degrees C or

colder for bone)


Distribution of Tissue Distribution staff receive requests for specific tissue

grafts from hospitals & surgical centers Provided to qualified clinicians From tissue bank to dispensing service which is

responsible for: Receipt Maintenance Delivery to Clinician

Distributed with package insert for handling instructions and information

30,809 tissue grafts from CTS-P recovered donors placed by Distribution in 2009!


Examples of Processed Tissue Grafts – Bone transplants

Cancellous Blocks – Used for spinal fusion

Crushed Cancellous – Used for space filling

Cancellous Cubes-Used for reconstructive surgeries


Examples of Processed Tissue Grafts – Bone transplants

Cortical Struts – Used for spinal fusion or to replace cancerous bone

Fibula Segments and Rings - Used for cervical disk fusion


Examples of Processed Tissue Grafts

Femur Grafts – Used for hip surgery

Patella Ligament- Used for ligament repairs (ex: ACL replacement)

Connective Tissue

• Commonly used in Commonly used in orthopedic surgeries (ex: orthopedic surgeries (ex: athletic related injuries)athletic related injuries)


Skin Grafts Thickness of a sunburn

peel

Biological bandage Reduces infection

Helps to maintain temperature & fluid balance

Used to treat severe burn victims Just one burn victim can

utilize skin grafts from 10 to 15 donors

Skin graft being meshed (processing)

Example of a skin graft donor site halfway through the initial healing stage


Questions?

Amanda DeRoche CTBS(AATB)

Documents

The CTS Tissue Donation Process