Eye, Skin & Other Tissues

Eye Donation

Eye Donation

In the case of eye donation. Call the central eye bank number or that of an eye bank near where you live and they will come and take the corneas with the least amount of hassle for the family. The whole process takes 5-10 minutes. If you do take the trouble to donate eyes, you’ll be proud to know that two people who suffer from corneal blindness will be now able to see, thanks to your generous donation.

These are some important things to take care of in order to make a successful eye donation after death.

  • Call the nearest eye bank within six hours of death.
  • Switch off the fans and keep AC on if possible
  • Close the eye lids and keep a moist cloth over the eyes.
  • The head should be slightly raised with a pillow.
  • Keep on your phone the addresses & phone numbers of your nearest eye bank. See attached document for Eye Banks across India.

Skin Donation

Skin Donation – What It Means & How It Happens
Indian Society has been aware of eye donation after death for several decades. But Skin Donation is a relatively newer concept. It is a donation that anyone can make after their deaths, which can save the lives of thousands of people and offer them a much better quality of life.

Skin donation, can be made AFTER cardiac death. (Organ donation can only happen if the person has been declared brain dead).

Cardiac death is when the heart stops beating. Brain Death is when the brain dies but the deceased keeps breathing with the help of a ventilator, and the heart and other organs are kept alive artificially. This can happen only in a hospital under certain conditions. A person can donate their organs only in the case of brain death, BUT they can donate their eyes and skin even when they suffer a cardiac death.

Who needs skin?
It is estimated that more that 7 million people in India suffer from burn injuries every year. 80% of these are women and children. It is the second largest group of injuries after road accidents. Out of the 10% of these which are life threatening, around 50% succumb to their injuries. Nearly 1 to 1.5 lakh people get crippled and require multiple surgeries and prolonged rehabilitation in India every year.
A burn wound is probably the most devastating of all the wounds – physically, psychologically, socially and economically. Early burn wound closure is crucial for survival of patients with large burn wounds. An infected burn wound which leads to systemic sepsis is the single most major cause of death in burn patients – especially in India.

Why is skin donation so important?
Our skin is the largest human organ. It acts as a shield to protect us from heat and cold, as well as environmental impacts such as chemicals, the sun’s UV-radiation and bacteria.

Normally, our skin would mend itself from the daily wear and tear. But when the skin gets badly burned or damaged, it’s unable to repair itself without help. For patients with severe burn injuries, one way to promote healing is by covering the wound with Allografts – skin from an organ donor. Skin is needed to prevent infections, decrease pain and provide protection, and help faster healing and save lives.

If the burnt area is not immediately covered with some skin substitutes, then patients are prone to infection, fluid loss and ultimately death.

In case of smaller percentage of burns, skin from the un-burnt area of the patient is taken out and put on the burn wound to cover it. But when burns percentage is more than 40% to 50%, then the patient’s own skin is not available to cover the burn wound. In that scenario we need some skin substitutes. In emergencies when skin is not available, often relatives of patients offer their own skin, as a live donor.

It is said that skin is the best substitute for skin. Thus, Skin donated after death is the best and cheapest substitute compared to artificial skin substitutes.

Such skin is a temporary dressing but is vitally important as it helps in patient’s own skin to regenerate. 80% of such patients can be saved if we have enough skin in skin banks. This is why skin donation is so vital. Donating your skin after your death, instead of burning or burying your body would be a great service to millions who are suffering. Watch the film below for more information.

Skin Allograft Donors
Skin allograft donors can be of two kinds: Living & Deceased Donors

Living Donor – For procurement of Skin grafts, the living donor needs to undergo a series of investigations for preoperative evaluation followed by a surgical procedure under suitable anesthesia, hospitalization for at least 2-3 days, donor site healing time of about 10 days and postoperative wound site pain. Maximum body surface area that can be safety utilized for harvesting of skin grafts is 15-20 percent at a time.

To avoid vested interests and commercial angles – it is advisable to use only close relatives as living donors. In the present age of nuclear families availability of such a relative is obviously very rare and inconvenient too. Sadly, it is even more difficult to come across a willing donor for a young female patient. In reality, majority of our patients are young females from poor socioeconomic strata with compromised nutritional status and have large burn size. So the problem is obviously challenging.

Deceased Donor – The other alternative is to procure skin grafts from a cadaver donor (or a deceased person), and preserve them for use in future. The concept of skin donation after death is not new, and the first skin bank was established in the USA around 1950.

The skin allograft transplant differs from organ transplantation as the skin grafts are used to provide temporary long term protection and are not expected to survive in the recipient permanently as transplanted organ. This means that neither ABO blood group nor HLA matching is required for allograft skin transplantation. So any human being can be a donor for anyone else.

The paucity of live relative donors and the inconvenience associated with this procedure made it obvious that we need to obtain skin allografts from cadaver donors.

Benefits of Skin Donation/Allografts
The chief benefits of use of allografts (Donor Skin) burn wounds are:

  • Effective control of protein and fluid loss from wounds
  • Reversal of hypermetabolic state with improvement in nutritional status.
  • Augmentation of immunological response.
  • Control of wound infection and improvement in the wound bed making it ready for acceptance of precious skin autografts.
  • Immediate pain relief and general feeling of well being.
  • Excellent biological wound cover till the autograft donor sites become ready for reharvesting.
When is Skin Donation possible?
Skin can be donated within in 6 hours from the time of death, and perhaps more if the body is in cold storage. Many people do not realise that skin can be donated in the same manner as corneas, organs or tissues upon a person’s death. Donor skin can be effectively frozen and stored for long periods, up to five years. Cities in India such as Mumbai, which have a Skin Bank, can store the donor skin and make it available to all the burn victims who need it. The skin is only taken from the back, thighs and legs and does not in any way disfigure the body.

On receiving intimation in event of death, the crew from the Skin Bank (if there is one in your city) can reach the location of the body, and in a simple procedure that takes just around 45 minutes, remove the skin from the back, abdomen and the legs. There are total 8 layers of skin, but only 1/8th, i.e. the uppermost layer of the skin is only harvested. Skin Harvesting is performed by Skin donation Team consisting of one Doctor, two Nurses and one attendant. Thickness of skin removed is very small and there is no disfigurement of the body. The Skin Bank Team will come to the donor’s home, hospital or morgue wherever the donor is kept. There is no need to shift the donor to the operating room, hospital or ambulance.

Following is the procedure followed by the National Burns Center Mumbai, in case of a skin donation.

  • Upon death of a possible donor, the next of his/her authorized kin needs to inform on the BURNS HELPLINE of National Burns Centre (NBC): 022-27793333 (active 24/7).
  • Upon receiving such a call, after checking for cause of death and contraindications, the Skin retrieval team will reach the place of death in a specialized Burns Ambulance. Death Certificate and Consent of relative is taken.
  • Then, the retrieval team harvests the skin of the donor only from legs, thighs and back with a special instrument called DERMATOME. Only one eighth thickness of the skin is harvested so there is no disfiguring of body at all. It is not even visible to persons who come to pay their homage as after harvesting, the area is bandaged and the donor’s body is handed over to the next of the kin.
  • This Procedure takes only about 45 minutes.
Who can be a skin donor?
Any person above the age of 16 years will be accepted as skin donor after death if behavioral and medical history and serological testing of the deceased ruled out the following conditions.
– Hepatitis B or C, HIV I / II, Transmissible diseases.
– Skin cancer, skin infections, damaged skin.
– Systemic sepsis.

Consent for skin donation is obtained from the closest prioritized relative after explaining the procedure

Facts On Skin Donation
  • You don’t have to pay anything to the Skin Donation Team, selling & buying organs is illegal.
  • Anyone’s skin can be transplanted on any one, there is no blood matching, no color matching, no age matching required.
  • The skin is only taken from the back, thighs and legs and does not in any way disfigure the body.
  • You need to produce the Death Certificate and its photocopy which will be evaluated by the Team Doctor before starting the procedure.
  • There is no bleeding from the site where skin if harvested from and there is no disfigurement to the body also. After the procedure we bandage the parts from where skin is harvested in a proper way.
  • Currently there are skin banks in Mumbai, Chennai, Karnataka and Delhi.
Below is a short film on Skin Donation which you must watch to know how it helps people.