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he Role of the Transplant Coordinator on Tissue Donation in Turkey

. Yucetin, N. Kececioglu, A.M. Ozenci, Y. Soguncu, K. Islamoglu, and F.F. Ersoy

ABSTRACT

While solid organs represent the dramatic and lifesaving aspect of donation after death,the transplantation of tissues from donors after death is a much larger-scale activity thatbenefits enormous numbers of patients, usually in a life-enhancing rather than a lifesavingmanner. Some types of tissue transplantation, such as heart valve and cornea transplan-tation, have been established for many decades and are reasonably well understood byhealth professionals and the public. Many other types of tissue donation, such as bone,skin, tendons, etc, are much less well known but nonetheless result in beneficial treatmentfor large numbers of patients. Skin is used to prevent fluid loss and infection following amajor burn; bone is used to improve the clinical success of a range of orthopedicoperations, such as joint replacements, spinal fusions, and reconstructions followingtrauma or tumor. In the United States more than 20,000 donors provided cadaveric tissuein 1999, compared to 6,000 in 1994. We ask all families of brain-dead donors for consentfor tissue donation. Between January 1, 1999, and January 3, 2003, we had 58 actualcadaveric donors, procuring three skins, 15 tendons, six bones, 13 heart valves, and 40corneas. We performed three skin, 40 tendon, and three bone transplants as well as storingother tissues. One donor can give health to 50 different recipients. In general, theargument runs for a transplant coordinator “if you can do it, then you must.” We can savelives and present a better quality of life with solid organ and tissue donation.

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HILE SOLID ORGANS represent the dramatic andlifesaving aspect of donation after death, a much

arger-scale activity is transplantation of tissues that benefitsnormous numbers of patients, usually in a life-enhancingather than a lifesaving manner.

Some types of tissue transplantation, such as heart valvend cornea, have been established for many decades andre reasonably well understood by health professionals andhe public. Other types of tissue donation, such as bone,kin, tendons, etc, are much less well known but nonethe-ess result in beneficial treatments for large numbers ofatients. Skin is used to prevent fluid loss and infectionollowing a major burn. Bone is used to improve the clinicaluccess of a range of orthopedic operations, such as jointeplacements, spinal fusions, and reconstructions followingrauma or tumor. In the United States more than 20,000onors provided cadaveric tissue in 1999 compared to 6,000

n 1994.1

Unlike organ donation, tissue donors are often asystolicnd have died up to 24 hours before tissue retrieval. Thushe potential pool of tissue donors is far greater than that of

olid organ donors. The second major difference between A

041-1345/04/$–see front matteroi:10.1016/j.transproceed.2003.11.069

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rgan and tissue transplantation is that tissues can bereserved and therefore stored for later use. The length oftorage time varies depending on the tissue and the methodf preservation.There is not a tissue transplant coordinator in Turkey. At

ur institution transplant coordinators ask all potentialonor families for consent for tissue donation. Betweenanuary 1, 1999, and May 15, 2003, we had 60 cadavericonors from whom we procured four skins, 17 tendons, sixones, 13 heart valves, and 42 corneas. We performed threekin, 40 tendon and three bone transplantations and storedhe others for later use (Table 1).2

ACL reconstruction rather than the primary repair is theethod of choice in ACL insufficiency, since the impor-

From the Akdeniz University Medical School Transplant Cen-er (L.Y., N.K., F.F.E.), Antalya, Turkey, and Departments ofrthopaedics and Traumatology (A.M.O.), and Plastic and Re-onstructive Surgery (K.I.), Akdeniz University Medical School,ntalya, Turkey.Address reprint requests to Levent Yucetin, MD, Akdenizniversity Medical School, Translant Center, Arapsuyu, 07070,

ntalya, Turkey. E-mail: lyucetin@akdeniz.edu.tr

© 2004 by Elsevier Inc. All rights reserved.360 Park Avenue South, New York, NY 10010-1710

Transplantation Proceedings, 36, 22�23 (2004)

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THE ROLE OF TRANSPLANT COORDINATOR 23

ance of the knee stability to the function of the knee haseen thoroughly understood. Although the use of autoge-eic tendon tissue is believed to have some advantages overllogeneic grafts, graft availability, donor site morbidity,nd longer operative time are the major concerns when anutogeneic graft is used for ACL reconstruction. The use ofllogeneic tendon grafts has gained wider acceptance withhe advent of modern tissue banks, high-tech sterilization,reservation methods and precise donor screening. Advan-ages of allogeneic tissues include shorter operative time,maller insicions, decreased surgical morbidity, and theraft availability independent of previous knee operations.isadvantages of allogeneic grafts include the risk of dis-

ase transmission and expense if purchased. We add ap-roximately 200,000 USD to the economy for 40 trans-lanted allograft tendons.3

Donor skin is initially used for the treatment of largereas of skin loss due to burns, degloving, and necrotizingacilities. In many cases, the use of donor skin means theifference between life and death, since it prevents infectionnd reduces heat loss, fluid loss, and scarring. Skin is alsoow being used in the treatment of smaller, chronicounds, such as pressure sores and leg ulcers. In caseshere skin is not suitable for therapeutic use, it may be used

Table 1. Tissue Procurement Activities in Turkey Between1999 and 2003

Turkey Akdeniz U.

kin 4 4eart valve 66 13one 6 6endon 17 � 4:68 17 � 4:68

or research, provided overt consent is given. Donor skin 2

an be deep-frozen or stored in glycerine. We have pro-ured only four skin donors in the last 3 years, because it isifficult to explain skin donation to the family. Unfortu-ately, these are the only skin donations in Turkey. Skinetrieval can take place up to 48 hours after death. You canave 1000$ every day throughout the treatment period.

Human homograft heart valves are now being calledllografts. Human homografts are retrieved from deceasedeople age 0 to 65 years who have given their consent foreart valve donation. Heart valve retrieval can take placep to 48 hours after death. Homograft recipients normallyave no thromboembolic or anticoagulant-related compli-ations. Patients have not suffered any infective endocardi-is related to the homograft. Patients do not normally needong-term drug therapy. Sterilization and implantationualities are the key points of heart valve transplantation.he other most important problem is the shortage ofonors. We are procuring heart valves only from brain-deadonors if we do not use the heart for transplantation.wentyfive and 29 hearts were procured in Turkey for heartalve transplantation in 2001 and 2002, respectively.

As far as tissue donation is concerned, one donor canive health to 50 different recipients. In general, the argu-ent runs for transplant coordinator “if you can do it, then

ou must.” We can save lives and present a better quality ofife with solid organ and tissue donation.

EFERENCES

1. Fehily, D. Warkick, R. Lotty, B: Tissue donation and banking.ransplant Coordination Manual, p 2512. Saglık Bakanlıgı UKM dataları (Turkish Health Ministeryatas)3. Ozenci, AM, Gur S: ACL reconstruction with tendon allo-

rafts: review of the current knowledge. Eur J Sport Travma R

3:152, 2001