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Musculoskeletal tissue banking in Singapore: 15 years of experience (1988-2003)

Journal of Orthopaedic Surgery, Dec 2004 by Nather, A

ABSTRACT

Purpose. To report 15 years' experience of musculoskeletal tissue banking by the National University Hospital Tissue Bank.

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Methods. This study describes the development of Singapore's national bone bank since its establishment in 1988. The bone bank's protocol follows guidelines recommended by the American Association of Tissue Banks and the European Association of Tissue Banks using strict donor selection criteria. Informed consent is obtained from all potential donors for tissue procurement and laboratory tests. Detailed medical history, thorough clinical examination, and chart review is performed for consenting donors. Suitable donors are subjected to tests for hepatitis B, hepatitis C, syphilis, and culture/sensitivity test of tissue for aerobic and anaerobic organisms. For living donors, repeat testing for AIDS and hepatitis C is performed at least 180 days after procurement. Tissue procurement is performed under sterile conditions. Small tissues are procured using the 'sterile double jar technique' and long bones using the 'sterile triple wrap technique', both developed by the author. Deep-frozen bones are gamma irradiated at 25 kilograys. Morsellised bones are lyophilised and gamma irradiated. Meticulous preparation for grafts is performed during transplantation. Antibiotic prophylaxis is used for 2 weeks.

Results. The bank maintains a good quality control. In January 2003, it was accredited ISO 9001 status. Up to June 2003, it has procured 440 bones from 440 living donors and 1055 allografts from 63 deceased donors. 854 musculoskeletal transplantations have been performed using tissues processed by the bank. Complication rate encountered was only 2.2%.

Conclusion. The tissue bank provides high-quality allografts for safe tissue transplantations.

Key words: living donors; muscle, skeletal; tissue banks; tissue donors; transplantation, homologous

INTRODUCTION

During the last decade, musculoskeletal tissue transplantation has become well established internationally,1-3 and tissue banking has gained increasing importance in the Asia Pacific region.4-5 The awareness of tissue banking and the demand for bone and soft-tissue allografts in the region have increased significantly. This had led to the development of new tissue banks in Malaysia, Indonesia, and most recently, India and South Korea.

Development of the National University Hospital Tissue Bank

The National University Hospital (NUH) Tissue Bank was established in October 1988 as a research bone bank then called the National University of Singapore (NUS) Bone Bank. This was funded by an NUS research grant, RP 880334 'Use of Allografts for Bridging Large Bone Defects', with the author as the principal investigator. The bank was initially equipped with 2 electrical freezers for storage of tissues at -80°C.

There has been tremendous growth in the clinical function of the bank as the national demand for bone and soft-tissue allografts has increased rapidly. In January 1994, the bank received an additional grant of S$239 965 from the Totalisator Board to upgrade itself as a national bone bank to supply bone and soft-tissue allografts to all hospitals in Singapore.5 It then acquired 4 electrical freezers (-80°C) and 2 lyophiliser units (each with a band saw, shaker bath, lyophiliser, laminar flow cabinet, and vacuum sealer). It started processing lyophilised, gamma-irradiated bone grafts in 1994. Gamma irradiation was first introduced into Singapore in September 1992.5 The deep-frozen long bones were packed in dry ice (-20°C) in polylite containers and flown to the Malaysian Institute of Nuclear Technology in Bangi, Selangor. There, the bones were subject to gamma irradiation at a dosage of about 25 kilograys, then returned to the bank within 12 hours for restorage in the freezer at -80°C. For smaller deep-frozen bones procured from living donors, gamma irradiation was performed in a gamma chamber at the Department of Nuclear Medicine in Singapore General Hospital.5

In September 1995, the bank was inaugurated as a hospital bone bank and re-named the NUH Tissue Bank.5 The author became its director under the NUH Administration Board. In 1998, the bank started functioning as a cost centre of the hospital, which was non-profitable, self-sustained and operated independently. The bank continued its focus on maintaining good standards and quality control, together with the whole hospital, it was accredited ISO9001: 2002, ISO14001, and OHSAS18001 in January 2003.

METHODS

Legal status

The development of tissue banking in Singapore started from the Medical (Therapy, Education and Research) Act of 1972,4,6 in which it stipulates "any person of sound mind and 18 years of age or above may give all or any part of his body for education... transplantation.... The gift takes effect upon death." This 'opting-in' law requires informed consent from the donor, his/her relative, or a next-of-kin. The tissue bank is prohibited from selling tissues procured and processed; however, it is allowed to charge processing costs i.e. costs of procurement, processing, and distribution of tissues.

Health Care Industry

Musculoskeletal tissue banking in Singapore: 15 years of experience (1988-2003)

Journal of Orthopaedic Surgery, Dec 2004 by Nather, A

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