Cremationists Find Growing Demand for Transplant Tissue
An uncustomary but prized 15th birthday present left Christa Chappel indebted to the Southeast Tissue Alliance. Chappel received a tissue donation after she tore her anterior cruciate ligament (ACL) on her right knee during a high school soccer game. To a soccer enthusiast, the accident was a huge setback with a no-end-in-sight recovery. Chappel’s name tallied the donor list that finds patella tendon implants. After two months of waiting, her mom Amy decided to take matters into her own hands. Amy contacted the Southeast Tissue Alliance, who contacted Chappel’s surgeon and secured a tendon that week. Just four months later, Chappel was walking without a brace. This story is one of many successes circling back to tissue banks. Tissue donations are a goldmine for helping to find cures and treatments for disease research. One bone in a leg alone can result in 20 or more grafts for spinal surgery. Vice President of Operations at Southeast Tissue Alliance, Michael Scott, speaks volumes about the fact that consumers have the choice to donate tissue-and might not be aware. In Florida, 60 percent of deaths occur outside the hospital. Subsequently, they are not reported to tissue banks. Read on to learn how funeral homes and crematories offer a great opportunity to meet the growing demand for transplantable tissue.
Q: Please describe a tissue bank.
Scott: Tissue banks exist to provide patients with tissues to either replace or repair physical defects whether from injury, birth defects or diseases. Or to help with the healing process, such as skin for burn victims. Unlike organ transplantation, tissues are not typically implanted immediately. They are recovered from deceased donors, normally within 24 hours of death, then medically screened and prepared for transplantation, then ultimately distributed to implanting physicians as needed.
Q: How long have tissue banks been in service? Are new technologies affecting how banks collect, store and dispense their materials?
Scott: The first tissue bank was founded in 1949 by the U.S. Navy. As technology and experience grew, tissue implants entered the mainstream of medicine in the early 1980s. So much so that this year we expect that more than 1.5 million tissues from more than 35,000 donors will be implanted to help enhance and even save lives. This is more than three times that of just 10 years ago. Advances include pre-shaped grafts that can be implanted with minimally invasive procedures allowing for out-patient surgery. Regarding new technologies, there are decellurization processes for some tissues that allow the body to heal faster, and most recently, grafts using adult stem-cell technology are showing significantly improved healing times. Another benefit from the growing science is that virtually all of the recovered tissues are used. This means that a single donor can help many more people than in the past. It is not unusual for a donor to be able to help as many as 100 individuals.
Q: Please describe the process of what takes place after a person donates a body to a tissue bank.
Scott: most tissue recovered by tissue banks are used for transplant, but tissue may also be used to support important research. If they have consented in advance, donors or their next of kin are asked how they want the tissue to be used. The process is called “informed consent.” During the process, they may be asked if they wish to also donate tissue for research or medical education. It is important to note that donations for research are critical to help find cures or treatments for diseases such as cancer or Alzheimer’s. Donating for research only is also an option for some when the donor may not be medically suitable for transplant.
Q: What are the ethical guidelines for harvesting and disposition?
Scott: The American Association of Tissue Banks (AATB) is the only organization in the United States that presently accredits tissue banks. The AATB published specific standards for tissue banks. Accreditation is not mandatory at this time although most important banks have undergone the accreditation process. Some states have published regulations for tissue banks and inspect them. These regulations typically address safety, ethical and reporting matters. Perhaps the most important ethical guideline for tissue banks is the process of informed consent. The Model Elements of Informed Consent detail the information that should be provided to a consenting individual. These include descriptions of the tissue to be recovered, how they will be recovered and how they will be used. Consenting individuals are also informed about: disease testing, the role of for-profit and not-for-profit agencies in the process, where the tissue may be implanted, and how donations can impact funeral arrangements. They are also informed that they should not incur any costs related to their donation. Most tissue banks also have policies that govern who may request informed consent and the avoidance of any conflict of interest.
Q: Why are tissue banks important?
Scott: Tissue banks fulfill a vital role in our health-care system by providing safe tissues for implant, research and medical education. Thanks to their efforts, millions of people have had their lives enhanced by receiving grafts that help to repair physical defects, eliminate pain, restore mobility or function and help people see again, or restore their dignity. There has always been a shortage of specific types of grafts, such as heart valves and certain tendons and corneas. These shortages can delay needed surgeries or require a surgeon to use substitutes that may not be as ideal as human tissue. Other tissue such as bone and skin remain in high demand and may have limited availability.
Q: How does using human tissue differ than using plastic or another form of tissue in research?
Scott: Human tissue is a natural solution to a physical problem. Unlike organs, processed tissues do not reject, but instead become part of the body where they are implanted. While the body recognizes the implanted tissue as foreign, instead of rejecting it, it simply goes about the process of replacing the tissue with its own over time. There is a place for synthetics and metal in certain applications, but they often cannot match the healing properties of human tissue. In the case of research tissues, there is no substitute to using human tissues. The only way to know how a human cell is going to react to a chemical is to test it on human cell. Similarly, if you are testing a new medical device for the spine, short of using a live person, the best way is to test it on another spine.
Q: What is performed on the tissue?
Scott: Safety is the tissue bank’s first concern for transplantation. The FDA requires that certain disease testing occur, and that tissue banks have detailed, validated procedures to ensure the safety of tissue. In addition to a medical evaluation of the donor and disease screening, the tissue is swabbed to determine if there are any contaminants. Each tissue bank has a process that they will use to either wash or sterilize the tissue. This usually involves the use of chemicals, antibiotics and/or a light dose of radiation that has a minimal effect on the healing qualities of the tissue. The tissue is usually formed or shaped into individual grafts. One bone in the leg could result in 20 or more grafts that might be used in spinal surgery.
Q: For the cremation industry, what should cremationists know more about in terms of tissue banks?
Scott: A growing number of funeral operators offer donation to families as a service they can provide that incurs no cost to the family yet lets them gain comfort in knowing that their loved one helped others. What a tribute to their loved one to be able to help as many as a hundred other people. Tissue banks have become more funeral-friendly. The dignity of the donor is paramount and the bodies should be carefully reconstructed by the tissue bank using prosthetics that are crematory safe. Our tissue bank works closely with funeral operators to ensure that the family’s needs are met with a minimal interruption to the preparation process.
Q: For consumers, can they donate certain tissues and cremate the rest of the body?
Scott: Consumers have choices. Tissue donation and whole body donation are two separate functions. Most tissue banks do not take the whole body as that managed either by State Anatomical Boards or private agencies that specialize in whole body donation. For most tissue banks, only certain tissues are recovered. The body is reconstructed and there are sufficient cremated remains to give to the family.
Q: Do your donations come from funeral homes?
Scott: Approximately 90 percent of our donors are referred by hospitals that by law must refer deaths to organ and tissue procurement organizations. The remaining 10 percent are referred by funeral homes that offer donation as a service to families, or are approached by families who want their loved one to be a tissue donor.
Q: How do people designate their bodies be donated to a tissue bank?
Scott: We do not encourage people to donate to a particular donation organization, but instead ask that they register with their State Anatomical Gifts Registry. Typically people do so through their Department of Motor Vehicles or State Health Agency. This way, their wishes can be fulfilled by the nearest available donation agency who will have established agreements and procedures with recovery sites.
Q: Are tissue banks growing in number and the amount of donations? Are there any trends currently happening in regards to this?
Scott: Most areas are covered by tissue banks already and there are not many new recovery agencies being formed. The field of tissue banking has seen some consolidation for purposes of efficiency. The number of donors is increasing each year thanks to public education efforts and increased legislation supporting donations. More so, the number of implantable grafts is increasing substantially thanks to medical and scientific advances.