IF SOMEONE asked you the difference between organ and tissue donation would you be able to answer them? The concept is similar, but there is one major difference. When an organ donor dies, the odds of their death occurring under circumstances which would allow their organs to be used are extremely low.
Only about 1% of those who die will be declared brainstem dead in a hospital and will be on life support, meaning that the organs can be retrieved for transplant to another person – that is, if family members consent.
But it is worth knowing that even if you are not able to donate your organs, you can still donate tissue, such as skin, bone, corneas, heart valves and ligaments. Such donations are equally valuable and life-altering to a patient in need of a transplant.
This is something your family must be made aware of, since hospital staff often balk at the idea of imposing on grieving families to ask for consent, and it would be a great pity if your family only thought to ask about donating once the tissues were no longer viable for use.
The time frames are tight. Corneas last only 12 hours and skin, 24 hours, whilst bone remains viable for about three days.
In the best case scenario, your family should already have discussed donation in a practical manner beforehand, preferably in a congenial environment. They should certainly not be debating the merits of the idea at the end, during what are surely some of the most stressful circumstances imaginable.
Factor in the time that may be necessary to have a specialised team flown in from another part of the country to retrieve these tissues, and you’ll begin to understand why there is no time for chitchat. Sadly, for families that have not had these discussions, there is often regret afterwards, when they realise they should have thought of donating, or that they waited too long to decide.
Organs are viable for a maximum of four hours, so obviously, far more people are able to donate tissue than organs, but even so, there are not huge numbers of tissue donors, as one might expect.
The Centre for Tissue Engineering at the Tshwane University of Technology processes and supplies human tissue for implant, transplant and therapeutic purposes. It also conducts research and development aimed at improving treatment options for patients.
In 2014, The Burn Care Trust, BoneSA, the Centre for Tissue Engineering (University of Tshwane), the South African Burn Society, and Satiba (South African Tissue Association), which came on board in 2015, worked together in a strategic effort to raise awareness of burns and the need for skin within the tissue banking industry. Out of this came the launch of the National Skin Bank, this stores skin for use in burn patients.
In 2021, there are now two organisations who are catering for tissue donations and processing in South Africa, Vitanoa (previously Bone SA)which caters for the coastal areas and The Centre for Tissue Engineering which caters for the inland areas.
The skin is processed for storage via a method which employs glycerol and other chemicals to preserve the tissue. The cost-effectiveness of this method ensures that even those who do not have medical aid can access this resource. Yet even with a National Skin Bank, South Africa is still way under-resourced, with only 0.2% of the population registered as organ and tissue donors.
What is a burn injury?
According to global statistics, burn wounds are mostly unintentional and take place in the home, this most frequent incidence, is followed by work-related burns, usually in the food industry and factory production.
A burn results when skin comes into contact with a flame, hot fluids or other material, electricity, radiation or chemical and is destroyed.
Skin is critical in the management of temperature and fluid, as well as protecting the body from infections. Loss of skin affects the body’s functioning in ways that do not resolve until the skin has healed or been replaced. The pain and trauma experienced by severely burned patients is excruciating. The pain associated with burns is one of the most intense and prolonged types of suffering.
Burn injury treatment
Allograft (cadaver or donor) skin may be used for both superficial and deep burn wounds as a temporary measure (ultimately, the skin will be rejected.) With major burns, the use of allograft skin reduces the heat and fluid loss as well as number of infections and pain associated with the burn wound, improving the patient’s progress in the acute period.
Donor skin has also been identified as improving the wound bed for autografting. Use of donor skin as a sort of dressing can result in survival and improved recovery of patients with major burns.
Burn wounds must be dressed to prevent dehydration and infection, but with the use of synthetic applications these dressings must be re-applied every 2 to 3 days. Each time a new dressing is applied, the patient is subjected to further trauma and pain, and a number of newly-formed cells are lost in the process, so both the treatment time and the patient’s discomfort are extended.
With the application of donor skin to the burn wounds, the patient’s body recognises the skin as human tissue and can be tricked into believing that it is their own. Donor skin may be left on the wound for about 14 days, during which time the patient’s body is able to heal, with the donor skin providing protection against infection and dehydration.
When the donor skin has dried out after these two weeks, it detaches from the wound, without causing further damage or pain and re-application or further treatment options can be considered.
This approach has been medically recognised as the most effective way to minimise scarring and promote healing. Children particularly need skin grafts as a burn or scald can cover most of their body, and these skin grafts may be lifesaving. Patients with severe burns may need repeated skin grafts from numerous donors until their burns heal sufficiently.
Fresh donor skin must be procured and used for burn patients within days. A specially-trained team conducts the procedure in either the hospital, the local mortuary or at the funeral home. Through the entire donation process the donor’s body is treated with utmost care and respect.
The donor’s skin is cleaned with an antiseptic solution and harvested using a specialised blade. A very thin layer is taken from the legs, arms, and back. Most of the skin layers are left behind. None is taken from the face or chest. The donation of (organs and) tissue does not alter the physical appearance of the donor’s body, It is even possible for the donor’s family to view the donor’s body and they can even have an open casket funeral.
The skin will be cleaned and stored prior to use for the burn patient. Fresh donor skin must be used within 36 hours but can be stored for up to 14 days if a special storage medium is used.
Since the inception of the skin banking activities of the Tshwane University of Technology’s Centre for Tissue Engineering (CTE) in 2016, many lives have been saved through the use of donor skin.
ï To avoid burns in the first place, parents should keep appliance cords and kettles out of reach. Matches and lighters should also be kept away from inquisitive children and the dangers should be explained to them.
ï Keeping a fire extinguisher in the home could avert disaster.
ï Common causes of domestic fires include heaters that are left unattended and overloaded plug points. Heaters should also not be placed too close to curtains and couches.
ï Candles are also a common cause of fires. If using candles, place them in a container with water.
What to do in case of a burn:
ï Do not pop or remove blisters.
ï Do not put ice on the burn.
ï Do not use home remedies like butter or milk, soy sauce, toothpaste, coffee, mustard on the burn as this could cause infection and further damage.
What you should do:
ï Rinse the burn under clean, cool, running water.
ï Seek medical attention or advice.