USE OF BONE ALLOGRAFTS IN BANGLADESH
You are probably aware of the fact that Bangladesh Atomic Energy Commission (BAEC)
has a tissue bank project, where bone allografts are being processed.You, as an
orthopaedic surgeon, can be a valuable contributor to the bone banking process by
taking part in aseptic harvesting of bone and by promptly sending it to the tissue bank
for processing. You will be benefited by getting processed (freeze-dried and radiation
sterilized) bone allografts in ready-to-use packets, and you will also help other orthopaedic
surgeons in treating their patients better with a large supply of bone allografts.
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The femoral heads you remove during a hemiarthroplasty, girdlestone procedure or during a
total hip replacement are the most useful bones to be used as bone allografts. Essentially,
the femoral heads are removed from the body aseptically (as done in a clean OT), and
these should be immediately cleaned with plenty of normal saline and immediately packed
in a sterile double container without adding any preservative. Sterile double gloves may be
used in place of sterile double container. The harvested femoral heads should be immediately
placed in the icebox of a refrigerator (temp. 0 - 5°C) and should be sent to the deep freezer
at RIHD (temp. -20° to -40°C) or to the tissue bank at the Savar campus of BAEC within
24 hours. Each harvested bone graft should be accompanied by a completed donor tissue
form, with documentation that the donor has been clinically screened for hepatitis, syphilis,
active tuberculosis and AIDS, and that serological screening of HBsAg and VDRL/RPR has been
done. In addition, a completed donor consent form must accompany the harvested graft.
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It takes about 4 weeks to process a bone allograft. The Savar tissue bank produces cortical,
cortico-cancellus and cancellus bone allografts as chips, granules and decalcified bone
powder - all freeze-dried and sterilized by gamma radiation. At the moment bone allografts
are processed and supplied to you (as end users) free of cost. But, possibly the tissue bank
will decide a charge for "processing costs" for allografts it would supply - to make the
programme self-sustainable financially (and in future this will include serological testing for
Hepatitis C Antibody and HIV 1 & 2 Antigens).
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Tissue banks like blood banks and eye banks are already playing a great role in the medical
services of our country. Bone and musculoskeletal tissue banking also has a great potential
in promoting the quality of life of many orthopaedic patients. Bone allografts are used to fill
up large bony defects.They are of particular use in Trauma Surgery, Spinal Surgery,
Reconstructive Surgery for Bone Tumours and Revision Surgery after Total Hip Replacement.
At the moment, femoral heads procured from live donors are the main source of bone
allografts in our country. We at RIHD are using bone allografts with good results since 1992.
Large segments bone (massive bone allografts) and tendons and Fascia Lata strips may
also be harvested from deceased donors just as corneas are being procured as a result of
Sandhani's eye donation campaign. A lot of public motivation and mass awareness
programmes need to be done to initiate musculoskeletal tissue donation from deceased
donors. It is hoped that you would actively participate in musculoskeletal tissue banking.
For any further detail please feel free to contact me at NITOR, or use this dicussion group
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Junior Consultant in Orthopaedics, NITOR, Dhaka
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