An Urgent Need For Skin Donors
Sitting through a video session on a medical procedure with graphic visuals was not how this 25-year-old had imagined her assignment to pan out on a weekday morning.
Squeamish and terribly confused, she was all set to bail out. But she remembers being coaxed by her peers to stay back and watch the entire video.
A few weeks have gone by, and now Anusha M, who is studying to be a counselor, is proud to have stuck to her resolve. She feels that she is now part of a noble cause.
Anusha, along with her course mates of Banjara Academy, were part of an educational programme at Karnataka's first Skin Bank, which has been set up at the Victoria Hospital in Bengaluru.
These students were taken through the various processes of skin donation and the importance of pledging the body’s largest organ.
“I was not even aware that one’s skin could be donated. And when they asked me if I wanted to pledge my skin, I refused to sign the form. I assumed that skin from my entire body would be peeled off, and how horrifying it would be for my family. But they (Skin Bank staff) said that I was mistaken and asked us to watch the video clipping.
At first, I was very squeamish. I could not watch it. But my batch mates forced me to watch the entire thing, and I am glad I did. I learnt that skin is only harvested from the inner thighs and legs. We were told how the harvested skin is later stretched and used later on burns victims. I walked away pledging my skin later that day,” recalls Anusha.
Anusha's decision however was not received well by her friends and relatives. While her friends and cousins frowned upon the idea of skin donation, her fiance was upset with her for having done something “drastic”.
“I went back and talked about it in my inner circle. But ironically nobody was interested to hear what I had to say. My friends neither understood the concept, nor were they interested in learning more about it. I do not think they will ever be up for skin donation.
As for my fiance, he was very upset that I had pledged my skin. I told him that I have the card in my wallet and that in case something happens to me in future, he will have to donate my skin. He said that he would not do anything of that sort. But when I explained it to him, he kind of understood what it entailed, and agreed to honour my request,” she added.
Anusha happens to be one among the 1280 people who have pledged their skin ever since the Skin Bank was set up at the hospital in the year 2016. The Skin Bank was started with the help of Rotary and Ashirvad Pipes.
The numbers get sparser when it comes to those who have actually donated their skin.
In the last three years, donations have been received from only 108 deceased persons, which has benefitted 93 burns victims from across the country so far.
In 2016, the Bank received 16 donations, and the number went up to 40 in the year 2017. While as many as 33 people donated their skin in the year 2018, the number however dramatically came down in the year 2019, with only 17 persons donating their skin.
Dr Smitha S Segu, Plastic Surgeon at the Hospital, says that there is very little awareness about skin donation and that a lot more needs to be done in the direction of educating people.
“The awareness programmes and campaigns we are doing is not sufficient. Also, it took so many years for people to understand that you can donate eyes and other organs. To date many people do not even know that skin can be donated too. It will take a little more time for people to get used to the concept,” she said.
When asked if there was resistance among people to donate their skin as opposed to their other organs, Dr Segu said that people were actually misinformed.
“The main concern is whether there will be bleeding or deformity of the body after the skin is harvested. Also, people want to know if it will hinder the processes of the last rites. When there is a death, people are in their own grief. But for us, the six hour period is crucial to harvest the skin. Most people are not aware of this. We need to do a lot more in this regard,” she added.
With Victoria Hospital alone receiving 3 to 5 burns patients every day, the demand for cadaver skin is very high. There are close to 20 other hospitals in the state with burns units, and they too are constantly in need of donated skin.
“There is a lot of demand as we have seen excellent results using donated skin. But there have been instances where we have faced a severe shortage of the organ. Hospitals have asked us for 3,000 sq cm of skin for 40% burns, and we have not been in a position to give them that much at that time,” added Dr Segu.
Dr KT Ramesh, Head of the Department of Plastic Surgery, Victoria Hospital says that there are many misconceptions about skin donation.
“When we first started the Skin Bank many people came asking us to change the colour of their skin. They wanted fairer skin to be put on their face. We had to repeatedly tell people that the Skin Bank had not been set up for cosmetic reasons and that there was no way we could change the colour of one's skin. What we are doing is an emergency and life saving procedure,” he said.
Also, the general perception is that skin is harvested from the entire body of a donor and that there will be deformity.
“Skin is harvested usually from the thighs, leg or back region of the donor. There will be no deformation or disfigurement to the body of the donor. Moreover, using the donor skin is a temporary process. We are basically buying time for improvement of the general condition of the patient in addition to overcoming the critical situation. Once the wounds start to heal after four to six weeks, and the patient’s general condition improves, we harvest skin from their body wherever there are no wounds, and graft it in the affected areas,” added Dr Ramesh.
A majority of the burns patients that come to Victoria Hospital are from lower social income groups, who cannot afford treatment in private hospitals. Treatment here is free of cost.
Though only persons above 18 years of age can donate their skin, the harvested skin incidentally comes of greater use to the pediatric age group as there are more instances of children coming into the hospital with burn injuries.
Dr Ramesh too agrees that the stakeholders need to create more awareness about skin donation.
“We definitely need to create more awareness. However people are slowly beginning to realise that skin too can be donated like the other organs in our body. Our team and doctors are reaching more and more people. We are going to schools, old age homes, meeting healthcare personnel, media, conducting awareness programmes, NGOs, walkathons. The demand for skin should come down. We want each and every one to donate skin. Once the awareness increases, we can set up collecting centres of skin and process it in our Skin Bank,” he added.
Dr Segu, who was among those instrumental in the setting up of the Skin Bank has also been successful in convincing her family members to pledge or donate their skin. Among the eight to ten deceased relatives who have donated skin, was 89 year old Sundramma.
Sundramma passed away on 25 July 2016. Before donating her entire body, her children decided to donate her skin too, along with her eyes.
Shruthi Vinay, who is the grand daughter in law of Sundramma said that the latter was the one who had insisted that her body be donated after her demise.
“She would always pester us to get her a form so that she could donate not only her eyes, but also her entire body. She used to constantly talk about organ donation. My husband was actually quite fed up with her for repeatedly telling us that she wants to donate her body. We do not believe in donating the body after death. When she fell ill, and still persisted, we had a conversation with our entire family, including her sons, and took a collective decision to donate her body,” says Shruthi.
Having heard about skin donation from Dr Segu, who also happened to be Sundramma’s doctor, the family also decided to donate her skin. “As granny had decided to donate her body, we agreed that her skin too should be donated. My mother in law was a little apprehensive initially about donating her skin. But there was no resistance from the other family members,” she added.
Shruthi said that Sundramma was an avid reader and had kept herself abreast on all topics. “She was a voracious reader. She would read the newspaper back to back. When we asked her why she wanted to donate her body, she said that she did not want to be a burden on her children, and also that she wanted to contribute to medical science. She wanted to set an example and inspire the younger generation about organ donation,” she added.
The skin is the body’s first line of defense, as it acts as a water proof material, preventing infection from entering the body. When the skin is damaged, the entire body’s defense mechanism breaks down. If untreated, bacterial infection, dehydration, loss of protein and electrolytes takes place. Eventually, the victim dies.
According to the doctors, skin donation is vital as it reduces infection significantly and the pain. It is not only a cost effective temporary dressing, it reduces the cost of treatment also. It lessens the hospital stay and increases the survival rate of the patient.
There are three types of grafts – Autograft, Homograft or Allograft and Xenograft.
Autograft is the technique where the skin is harvested from a different part of the patient itself.
Under the Allograft method, the skin harvested from another person (deceased) is used on the patient.
The Xenograft technique, which is presently not used in India, is a method of treatment where the skin of an animal species, like the cow, pig or frog, is grafted on the patient as a life saving measure.
The harvested skin from the donor is brought back to the Skin Bank for processing. Here, the donor’s blood is tested for serology markers.
Over 1000 people in Bengaluru die due to burns every year. Burns and road traffic accidents are found to be the common cause of skin loss, followed by machinery injuries.
Infection is the primary cause of morbidity and mortality in burns patients. Early intervention and prompt excision of dead skin and covering it with autograft will reduce the mortality in 40% of burns wounds. In mixed burns of 50% or above, it is invariably not possible. In these situations, allografts help in covering the burnt area.
Skin is not used when it shows up positive for HIV, HCV and HBsAg infections; dermatitis or other infections of the skin; collagen disease and other autoimmune diseases affecting the integrity of the skin; malignancy like sarcoma, carcinoma, lymphoma and leukemia; active jaundice; STDs; sepsis or bacteraemia.
The harvested skin is preserved in 50% glycerol and antibiotics, following which it is preserved in 85% glycerol and incubated at 4 to 8 degrees Celsius for two to three weeks.
Later it will be trimmed, measured and meshed and sent for a microbiology test to determine if there is any bacterial and fungal growth. If the skin is infection free, then is ready for distribution all over the state and the country.
The Skin Bank is now scouting for a famous personality to endorse the skin donation. "We need somebody to push it hard. We also need more government support. Rotary is planning to launch a massive awareness in the meantime," said Dr Segu.
She also requested more NGOs and IT companies to be part of the awareness campaign.