On 14th November I attended the National Health Service Blood and Transplant (NHSBT) tissue services education day at their offices in London, although the tissue bank itself is based in Liverpool and is the largest of its kind in Europe. In attendance were Anatomical Pathology Technologists, funeral directors and Specialist nurses for organ donation.
The day started with the NHSBT staff describing how we apparently see them as an inconvenience, (in their words not mine), they turn up out of hours, spend hours faffing, make themselves at home in our premises, say they are just about to start even after an hour and leave all their rubbish behind….. nobody disagreed with them!
In fact the task this team undertake on a daily basis is of huge importance, to both the bereaved families and the donor recipients.
Describing the process of tissue donation
The process for tissue donation starts with one of two distinct ways. The first and most widespread being the one we are most au fait with. The nurses or doctors treating the patient explain organ and tissue donation to the patient’s family or next of kin, and ask whether they would be willing to consent to donation during the most difficult time of bereavement and grief. If the family agree the patient’s details are referred to the NHSBT team. In Liverpool the three closest hospitals to the NHSBT centre actually refer all patients. The highly trained staff assess whether each patient would be appropriate for tissue donation and approach the families themselves.
Asking about tissue donation...."did not increase the upset of relatives"
Although this seems such a difficult question to ask, relatives have actually commented, being asked about organ and tissue donation did not increase their upset. In fact many saw it as a positive factor, ensuring their loved ones are still able to help others after death.
Of course there is a huge amount of paperwork to follow. NHSBT staff talk to the next of kin ensuring they follow a protocol set up to meet not only the HTA standards, but also many other standards in respect of taking appropriate consent and use of donated tissues. These conversations are recorded and kept for thirty years.
Perceptions Pt II
We all know what happens next , they come in take over our mortuaries and demand blood samples!
What they actually do is retrieve specific tissues in as sterile environment as possible, in accordance with need and family wishes. They do try to fit around the normal workings of the mortuary, although the time limit for retrieval is forty eight hours after death if the patient has been transferred to the mortuary within six hours of death. (This is reduced to twelve hours if more than six hours lapsed before being taken to the mortuary).
One of the most common tissue donations is corneal donation, for which we as APT’s are professionally trained and carry out this procedure on behalf of the NHSBT. Where the NHSBT’s technician’s skills come unto their own are the more specialist techniques, for instance skin, bone and heart valve donation.
Donor Skin, Heart Valves & Bone
Donor skin is mainly used for burns victims. It is used as a natural barrier against infection and to allow the deeper dermis to regenerate and grow. Donated skin has a shelf life of five years once it has been processed. Stocks are increased during times of greater risk of need e.g during the Olympics, as history has shown during major incidents public tend to be at greater risk of burn injuries.
Heart valves can be kept for up to ten years and are requested according to size, whether it be a tiny baby or an adult who are in need of a donor.
Bone has the greatest versatility. From being shaped to the need of the donor recipient to being ground down for many surgical uses. As the body doesn’t reject this donation, and even incorporates it as its own by generating new bone growth it is widely used by surgeons.
There are many more little known tissues available for donation including tendons for tendon and ligament repairs. Meniscus (taken as the entire knee) and trachea, which are decellularized for transplant to reduce the risk of rejection.
Tissue Donations from the living
Tissue donations are of course taken from live patients too, including amniotic membranes taken during c-sections for hernia repairs, breast reconstructions and many other uses.
Tissues then go through the process of cleaning, testing, shaping and storing ready for use.
Tissue is retrieved under 3rd party agreements with the NHSBT’s HTA license when taken for donation. If the tissue is for research it is taken under the premises HTA license for which NHSBT will issue audit paperwork to the HTA Designated Individual and also to the mortuary.
There are many new initiatives taking place to make tissue donation easier and quicker for the relatives and the mortuary staff.
Dedicated tissue retrieval mortuary
Within a forty mile radius of the NHSBT hub in Liverpool, deceased patients are transported to a dedicated tissue retrieval mortuary within the centre itself. Saving NHSBT staff the many hours travelling, ensuring retrieval takes place in as sterile environment as possible and allowing space for new and existing staff to train and learn new techniques from surgeons without disrupting the day to day workings of the hospital and public mortuaries. Patients are returned to the originating mortuaries within 24 hours so as not to interfere with funeral arrangements or viewings etc. This area is now being increased. NHSBT are also planning on training APT’s to retrieve heart valve donations in the more difficult to reach areas, for instance the Channel Islands.
Spreading the word of donation
When we hear three people die per day due to a lack of donated organs, it makes me and I hope you more determined to spread the word about organ and tissue donation. Especially to the student doctors and nurses we are entrusted to guide and teach regarding end of life care. As these are the staff members who will be in direct contact with the patients and relatives at the most crucial time.
Unfortunately consent is only taken from English speaking relatives or next of kin due to the risk of translation difficulties or misinterpretation. I did ask the question surely in such a multi-cultural society such as our own, this is leading to many opportunities lost for NHSBT, patients awaiting donation and also for the families who do wish to donate. This problem is being looked into for the future.
The staff at NHSBT are very informative and approachable if you do have any queries do not hesitate in contacting them.
Gemma Best MAAPT