The CTS Tissue Donation Process

1. The CTS Tissue Donation Process Community Tissue Services – Boise, ID

2. CTS Overview • CTS is a not-for-profit 501 (c)(3) company established in 1964 to provide blood products to the Dayton community • Dayton Regional Tissue Bank established as a Division of CBC in 1986 in response to the needs of local surgeons for allograft tissue • Name changed to Community Tissue Services in 1995 to reflect growth into communities across the nation (and internationally) • Community-focused, emphasis on quality service and tissue products • Currently CTS is the fifth largest tissue bank in the United States

3. Eye/Tissue Branch Organizations • Community Tissue Services – covers the state of Oregon, Southern Washington, and SW Idaho. • Idaho Lions Eye Bank – covers all of southern Idaho. • Intermountain Donor Service – covers SE Idaho. • Northwest Eye and Tissue – covers Northern Idaho

4. Referral Process • Refer all deaths to the 1-800 donor hotline. • Procurement agency will triage donor suitability with hospital staff. • Staff will be told what tissues can be donated. • Only designated trained requestor may approach the family for donation. • Consent outcome is reported to agency for recovery coordination.

5. Recovery Coordination Timelines • Tissue recovery coordination begins immediately after receiving the triage information. We need consent and med/soc prior to recovery. • No refrigeration occurred start within 15 hours from death. • Refrigeration occurred start within 24 hours from death. • Due to shorter recovery timelines, eye and organ donation would have already occurred.

6. CTS Staff Involved in Recovery • Tissue recovery team consists of a coordinator/circulator and two recovery technicians. • Technicians are notified by Coordinator to come in for the recovery. Must be able to arrive within 1 hour of the call.

7. What Tissues can be donated? • Skin • Posterior back, anterior and posterior legs • Bone • Humerous, Femur, Tibia, Fibula, Patella, Calcaneous • Tendon/Ligament • Anterior & posterior tibilalis, gracilis, semitendinosus, patellar, achilles, peroneus • Vascular/Cardiac • Saphenous vein, Femoral vein/artery, Heart for valves, Pericardium, Costal Cartilage

8. How long does a recovery take? • Depends on the number of tissues that will be recovered • Each graft has particular age limits assigned if a donor falls within all graft age limits then all grafts are recovered • The average recovery time is 4-8 hours, not including team/donor transportation.

9. Skin Retrieval • Consideration of length/width requirements • Lubrication • Skin traction • Depth of graft: 0.012 to 0.018 in. • Adjustment of dermatome setting • Pressure and speed • Blade change

10. Bone and Soft Tissue Recovery • Initial incisions are made and the skin and fat are dissected away from the underlying muscle. • Each graft is recovered separately according to strict sequencing to eliminate the chance of cross contamination. • The techs are required to change their gloves and surgical blade between each graft. • Each graft is swabbed with two culture swabs and two different medias are inoculated and incubated to promote growth. • The grafts are individually bagged, wrapped and labeled. • All grafts recovered are then placed in another bag, wrapped, and placed in a shipping container and sent to Dayton for quarantine.

11. What Happens to Tissue Next? • Tissue is frozen and remains in quarantine until all donor screening criteria is complete. • Once transplant safety has been determined (thorough QA, QC, and Medical Director review)the tissue is sent to processing and made into surgery-ready grafts.

12. Processing Information • Aseptic technique • Cut and shaped into grafts • Debrided to remove muscle and connective tissue • Treated with agents to reduce bacterial and viral bioburden • Antibiotics • Hydrogen Peroxide • Alcohol • Sterile water • Allowash™ • Cut and shaped into grafts • Packaged for final storage

14. Storage Methods • Room temperature • Ambient temperature or cooler • Common storage for lyophilized and air dried grafts • Wet Ice • Zero degrees Celsius • Temporary storage for transport • Refrigeration • 1 to 10 degrees Celsius • Storage for fresh tissues • Frozen • Short term storage up to six months (-20 to -40 degrees C) • Long term storage up to five years (-40 degrees C or colder for bone)

15. Distribution of Tissue • Distribution staff receive requests for specific tissue grafts from hospitals & surgical centers • Provided to qualified clinicians • From tissue bank to dispensing service which is responsible for: • Receipt • Maintenance • Delivery to Clinician • Distributed with package insert for handling instructions and information • 30,809 tissue grafts from CTS-P recovered donors placed by Distribution in 2009!

16. Examples of Processed Tissue Grafts – Bone transplants Crushed Cancellous – Used for space filling Cancellous Blocks – Used for spinal fusion Cancellous Cubes-Usedfor reconstructive surgeries

17. Examples of Processed Tissue Grafts – Bone transplants Cortical Struts – Used for spinal fusion or to replace cancerous bone Fibula Segments and Rings - Used for cervical disk fusion

18. Examples of Processed Tissue Grafts Femur Grafts – Used for hip surgery • Connective Tissue • Commonly used in orthopedic surgeries (ex: athletic related injuries) Patella Ligament- Used for ligament repairs (ex: ACL replacement)

19. Skin Grafts • Thickness of a sunburn peel • Biological bandage • Reduces infection • Helps to maintain temperature & fluid balance • Used to treat severe burn victims • Just one burn victim can utilize skin grafts from 10 to 15 donors Example of a skin graft donor site halfway through the initial healing stage Skin graft being meshed (processing)

20. Questions? Amanda DeRoche CTBS(AATB)