Bone Banks & Bone Donation

Vinod Agarwal, Mahesh Pant

Bone donation can improve the quality of life for recipients and in some cases save life. Bones are the most commonly transplanted tissues second only to blood. It has been estimated that over 200-300 thousand people around the globe 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.

The donated bones can be used to cure patients with birth defects, bone injuries, cancer and infections. Earlier, such diseases could be successfully treated only if living donors were willing to donate parts of their bones to a patient. Furthermore, the option was not viable if the requirement pertained to a long segment of bones like that of the thigh.

We have heard of blood banks before. But now bone banks have also come into existence. There are several patients in our country suffering from serious bone-related ailments. Some of the serious and critical cases include those that are suffering from bone tumors. Moreover, several patients require reconstructive surgeries such as bone or hip replacement which result from accidents or old age.

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 including India have set uptissue banks to cater the increasing demands. Ironically in India with 130 crores of population, which has the documented history of earliest transplantation by Sushruta, almost 2500 years ago, has few recognized bone banks among them two of the oldest are located one each in Mumbai and Delhi. 1. TATA Memorial Hospital and 2. AIIMS,New Delhi.

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 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 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 andstored directly, or under non-sterile conditions if secondary sterilization is planned. Bone may be removed up to 24 hours after death provided the cadaverhas been kept cold in the mortuary. Grafts are cleaned of soft tissue, measured,individually wrapped and labelled.
  4. ScreeningThe 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.
  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 temperatureindefmitely.
  6. SterilizationContaminated grafts or grafts notprocured under sterile conditions require secondary sterilization. Irradiation isthe commonest method employed.
  7. Re-implantation The graft is allowed to thaw and is soaked in antibiotic solution. Prophylactic antibiotics should be given to the recipient. At reimplantationthe 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, there is more need of Bone donations and Bone Banks to cater the growing needs of Bone grafting. Its time Govt should consider setting up more Bone Banks. One of India's first cadaveric bone banks started in 1999 in AIIMS remains a non-starter. Officials say the bank has received just 24 cadaver donations in last 18 years. More so, there has been no donation in the last two years. The donated bones can be used for replacing a lost segment of bone due to cancer, infection or injury.

Even after being set up in 1999, the first bone donation was not until 2001.People think that taking out bones will mutilate and disfigure the body and the limbs will dangle. After the bones are taken out , the body is reconstructed and shape of limbs is restored with the help of wooden sticks, cotton and wool. The team takes about 10 minutes to take out the bones and 30 minutes in stiching. The body is reconstructed and the shape and structure of the limbs are restored.

Bone banks, essentially, provide surgeons with real human bone material which can be used for treating such patients. Since the constitution of the replacement is the same as a real bone in the body, the patient’s system accepts it better and it helps the affected area in recovering faster .It is estimated that over 40% of patients with critical bone surgeries require a replacement that can be made only from an actual human bone.

A bone bank is a medical facility where human bones are stored for use in surgeries. Like a blood bank, the bones here too are provided by a donor since real human bones are required.A small proportion of the bones come from real patients and are chunks that might be discarded during surgeries.

However, majority, bone banks depend on cadavers that are donated by people for use after they die. Instead of being buried or cremated, the bodies of cadaver donors are given to hospitals where their organs are harvested for helping transplant patients and their bones are stored in a bone bank. These bones are stored at a temperature of minus 80 degrees to ensure that they last without any deterioration.

However, the sad part is that India is currently going through a massive bone shortage. In 2013, India’s premier hospital AIIMS said that they have had only 12 or so cadaver donations in over a decade. A similar shortage is also seen at the Tata Memorial Hospital in Mumbai which is the country’s premier cancer research institution.

The reasons for that are numerous and are mainly based on false notions. Doctors say that patients are reluctant to donate bodies to a bone bank mainly because they feel that the cadaver will get disfigured after the bones are taken out.

It is such unfounded superstitions that are keeping people from helping other human beings. A bone donor does an extremely noble act by ensuring that their body can be used to save the life of another human being.

Moreover, these donations also contribute towards a potential tissue bank where body parts such as cornea, sclera, and heart valves can be harvested from donor cadavers to be used in critical life-saving surgeries. Along with the bone bank, the skin bank helps massively in treatment of burn victims. Moreover, the utility of the skin bank is invaluable as it can even be used for treating personnel of the armed forces who sustain injuries in the line of duty.

Absolutely everybody can donate their body since the restrictions are too few. The only criteria is that the person should not be suffering from diseases like hepatitis or HIV which could infect the bones of their body. Moreover, bone banks conduct extensive tests for these diseases and screen every cadaver before it is deemed fit for donation. Therefore, there is really no restriction per se on who can donate.

In fact, we all can pledge to donate your body and help save someone’s life. We hope that this article would inspire to think of the change that one can bring into this world even after we leave this universe. There is absolutely nothing more noble than helping save another human being and to give them a new lease of life.

Therefore, it is appealed to all to think about pledging our body and organs and donating them for a noble cause. Someone somewhere in our country depends on this selfless gesture in order to have a better life.

The contents/information of this article has been taken from the text available on different websites.