Awareness on bone donation continues to be low in the city. While doctors pointed out that bone donations could improve the quality of life of patients, including those diagnosed and operated for bone cancers, they have not taken off to a large extent.
According to the Transplant Authority of Tamil Nadu’s website, there were 46 bone donations in 2019 and 48 in 2020. The western zone accounted for a significant number of donations and procedures.
In Chennai, two major hospitals have bone banks — Rajiv Gandhi Government General Hospital and Cancer Institute (WIA). Health officials as well as doctors pointed out the need for more awareness on bone donations. “We have been visiting various hospitals in the city and interacting with their doctors seeking their support to increase awareness of bone donations,” Chandra Kumar Krishnan, associate professor, Orthopaedic Oncology and in-charge of the bone bank at Cancer Institute. The bank was set up in 2019.
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12-hour duration
“Families are willing to donate after the death of a person. We need to harvest the bones within 12 hours of death but we need a sterile environment. This is a limitation. When there is a brain dead donor, an operation theatre is where teams harvest organs such as lungs, liver, kidney and heart. Awareness and time are limiting factors. We need to sensitise families and transplant coordinators,” he said.
He said that most people assumed donation of bones would result in mutilation of the limbs of the deceased. “The donor is respected at all times. Tissues are procured in a manner similar to that used during surgery. The procedure can take anywhere between 2-3 hours. Wooden dowels will be used to reconstruct the limbs. The bones of the upper limb, lower limb and the hip bones will be retrieved. Time is the limiting factor in the number of bones that will be retrieved,” he said.
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The institute had conducted awareness initiatives on the need for bone donation among nodal officers and transplant coordinators of the north zone.
The main thrust is on preserving bone, large quantities of which are required in managing bony defects following surgery for bone cancers, or bone loss during trauma, or bone fusion in spinal surgery, or even during revision joint replacement surgery, he added.
In patients with bone cancer, the first part of the surgery consists of removal of the portion of the bone containing the tumor. In reconstructing the bone gap/defect, bridging bone defects is one of the most challenging problems, he said, adding, “Broadly, they are metal prosthesis or allografts or a combination of both. Since the tumor occurs in the first two decades and the survival of the patients have improved to nearly 80% at five years, biological options of reconstruction where feasible should be considered. The best method of reconstructing a bone defect would be by using bone because bone will unite with bone tissue itself. Prosthesis use has its own demerits such as mechanical failure, infection and need for revision as and when necessary.” Bones, once processed, can be stored for up to three to five years.
Bridging gap
“At the bone bank at RGGGH, we have been preserving bones from surgeries. This is beneficial for patients as we can bridge the gap in case of defects in the bone such as when we perform total hip replacement. We can fill up for the bone loss. This way, it is more biological than metallic, the advantage being it incorporates into the native bone,” Deen Mohammed Ismail, director of the Institute of Orthopaedics and Traumatology, RGGH, said. Cadaveric donations have slowed down in the last one-and-a-half years due to the pandemic, doctors said.
Health officials said there was a need for awareness on bone donation while hospitals were lacking in initiatives. “Every family that consents for organ donation is asked for not only the major organs but also skin, bone and tissues. A continuing medical education programme was organised for transplant coordinators on bone donations, ” an official said.