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Skin Deep

Tissue Banks Mobilize to Aid Disaster Victims

By Helen Shortal | Posted 9/12/2001

Since Tuesday's attacks on the Pentagon and the World Trade Center, volunteers around the U.S. have swarmed blood-donation centers, filling the once-depleted coffers of the nation's blood banks.

"We're urging people to hold off right now and donate blood later this month," says Kate Davis, a spokesperson for the Bethesda-based American Association of Blood Banks (AABB). "Fresh blood can only be stored for 42 days, so we'll need to replenish the supply in a few weeks."

But burn victims from the disasters need something more than blood transfusions. They need skin.

Grafts of skin tissue play a key role in the treatment of severe burns. "Once burn patients have been stabilized from trauma, applying skin is a very good way to control infection and reduce pain," says Ellen Heck, the director of transplant services at the University of Texas Southwestern Medical Center in Dallas. "People don't think about donating skin tissue the way they think about blood or organs, but it's quite important."

Just as someone can plan to donate body organs after death, skin can be donated for medical treatment, research and education, as long as family members of the deceased also agree to the donation. But tissue banks that can collect, store, and distribute skin are far less numerous than organ or blood banks. While AABB includes more than 2,200 member blood banks, there are fewer than 40 banks for skin tissue accredited by the American Association of Transplant Banks (AATB), headquartered in Northern Virginia.

"On Tuesday morning we sent out alerts and mobilized the resources of our banks throughout the country," says Bob Rigney, AATB's chief executive officer. "We began getting reports on skin availability, and we were in touch with the major burn centers on the East Coast to make sure they had supplies on hand. Our bank in Dallas arranged to move skin up here, and the Red Cross sent skin from California."

The Baltimore Regional Burn Center at Johns Hopkins' Bayview Medical Center is one of the facilities that is prepared to receive and treat victims of the World Trade Center and Pentagon attacks. But at present, no patients have been transported to Bayview, and just 10 survivors from the Pentagon crash are being treated at the Washington Burn Center. Twenty-five patients in critical condition are being treated at the Burn Center at Weill Cornell Medical Center in Manhattan.

"In situations of this nature, individuals usually have other severe trauma, like wounds or crushing injuries, that need to be treated first," Rigney says. "Burn patients must be stabilized and hydrated before grafts are supplied. But quite frankly and quite sadly, there are very few survivors to treat."

For laypeople, the terminology used in skin-tissue management can be a bit unsettling. For example, skin itself is measured and inventoried in square feet--which seems a lot more visceral than the proverbial pint of donated blood.

"We sent approximately 70 square feet of skin to the Washington Burn Center, to treat the victims they have there now," Heck says. "It might take 25 to 30 donations to supply that amount, and there will probably be requirements for additional skin, since each patient may need several grafts during the course of treatment for a major burn."

With U.S. aviation only slowly returning to normal, tissue banks around the country faced an unexpected challenge this week: transporting the vital and perishable inventory where it was needed.

"Skin has to be available within 24 to 48 hours after the burn, since you want to be able to graft skin before infection becomes a problem," Heck says. "We packed the skin in large insulated coolers with dry ice, and two of our transplant technicians drove the skin from Dallas to Washington in a center van. They left on Tuesday at 4:30 p.m. and arrived in Washington about 24 hours later."

While tissue donation is far less common or well-known than organ donation, many more would-be donors meet the criteria to provide skin. Beyond communicable agents such as hepatitis or HIV, few medical conditions rule out tissue donation, once cardiac arrest has occurred. Organ donation requires the very specific circumstance of clinical brain death, combined with continued respiratory and circulatory support.

"We're encouraging people to think about the decision to donate, to talk with their loved ones about tissue donation, and to fill out donor cards, because disasters and medical emergencies can happen at any time," Heck says. "I think this tragedy will heighten awareness about the need for tissue donation. But we can't do a skin drive the way we can do a blood drive--after the emergency takes place."

For more information about skin and organ donation, visit www.lifegift.org. Donor-card forms can be accessed online at www.aatb.org.

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