Donors of homologous tissue are divided into three main categories:
• Heartbeating brain-dead donors (HB), when death has been ascertained on the basis of neurological criteria, even if the patient’s heart is still beating;
• non-heart-beating (NHB) multi-tissue donors, in the event of ‘cardiac death’, i.e. when the patient’s heart has stopped beating;
• living donors whose tissues are retrieved during surgery.
Tissue donation is the result of close collaboration between the Regional Hospital Coordination system (RHC), the facilities where harvesting takes place and the Treviso Tissue Bank Foundation (TTBF).
Retrieval takes place in the operating theatre of the same hospital where the patient is being looked after, and is performed according to strict protocols.
The following documents are required:
1. Declaration of consent to donation
2. Patient medical and social report
3. Tissue harvest report
4. Death certificate in the event of multi-tissue donation
5. Legal authorisation to carry out multi-tissue harvesting, if necessary.
Multi-tissue harvesting is carried out by a specialist team of doctors and technical experts who are available round-the-clock.
On receiving information of donor suitability and the specifics of the tissues to be retrieved, the team goes to the hospital and, in compliance with regulations, performs the procedure in an operating theatre in order to reduce the risk of bacterial contamination and ensure that the harvested tissues are maintained in excellent condition.
• Before the harvesting procedure, the doctor identifies the donor, checks that the patient presents no features that would make him/her unsuitable for tissue donation, and ascertains that consent to donation has been given.
• The harvesting team is completely independent of the hospital facility where it happens to be operating, both with regard to the equipment and any support personnel that may be required.
• Multi-tissue harvesting is a delicate and complex surgical operation and is performed using procedures and strict protocols refined with experience.
• Surgical reconstruction of the body is a very important feature.
This delicate task is performed meticulously by the team, which treats the donor’s body with the utmost care and respect. In a procedure lasting a total of 3 to 4 hours, very often the time taken for reconstruction is longer than the actual organ retrieval. Wooden prostheses and fixation systems such as plaques and metal screws are used along with gauze, cotton and previously modelled plaster casts to ensure that the donor’s anatomical structure is as faithfully reproduced as possible.
In the case of living donors, tissues are retrieved during a surgical operation.
Tissues harvested from living donors may be:
• Femural heads during hip replacement surgery;
• Vascular segments during saphenectomy;
• Placental tissue during elective caesarean section.
The donor is fully informed of the nature and purpose of the harvesting procedure, the consequences and possible risks, the examinations to be carried out, the protection of his personal and medical data, as well as the therapeutic use to which the tissue will be put. When the tissues are harvested blood samples are also taken from the patient and tested for any aerobic or anaerobic bacteria and funguses to guarantee the complete safety of the tissue removed.
Surgeons and TTBF operators scrupulously follow the protocols regarding donor selection and the information and documentation required to accompany the packaging procedures. Once prepared in the operating theatre by the specialist team, the harvested tissues are placed in sterile containers, labelled with indications of the donor’s details, type of tissue harvested, date and hour of retrieval.
When tissue harvesting is performed on a living donor during a scheduled operation, collection from the particular hospital and delivery to the TTBF headquarters are carried out by specialist forwarding agents. TTBF and hospital logistics staff coordinate transportation, guaranteeing that the container is in perfect condition and remains at temperatures of between +20C/+100C.
The Treviso Tissue Bank Foundation TTBF also preserves fragments of cranial bone harvested from patients treated in the Neurosurgery Divisions of the network for trauma, tumours, aneurysms and congenital malformations.
These donations of bone chips will allow neurosurgeons to perform autologous re-implantation in the same individual of his ‘own’ (autologous) bone fragments at a later stage of the healing process, thereby avoiding costly artificial prostheses.
When these autologous fragments are removed, a test-tube of blood is also taken to which will be added approximately 6 ml of an anti-clotting agent (EDTA), labelled with the donor’s name, surname, date of birth and national health code, preserved at +20C/+80C. The blood will be analysed for:
• Antibodies against Hepatitis B surface antigens (HBsAg);
• Antibodies against Hepatitis C virus (HCV);
• Antibodies against HIV I/II virus;
• Anti-Treponema antibodies (LUE).
If these tests have already been carried out in the hospital ward, there is no need to repeat them. The test results are simply sent to the TTBF. In the event of positive findings, the tissues are stored separately to avoid any possible contamination.
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