Living donor bone bank: Costa Rican experience / Banco de huesos a partir de donantes vivos: experiencia costarricense

Resumen Objetivo: El uso de injertos óseos es una práctica común en cirugías ortopédicas. Sin embargo, el problema diario en traumatología es el acceso limitado a injertos óseos adecuados. Estos injertos permiten proporcionar estabilidad mecánica en el área del defecto óseo, así como reparar y regenerarvlos defectos a través de sus propiedades osteoinductivas, osteogénicas y osteoconductivas. El objetivo principal de este trabajo fue proporcionar información a la población sobre las experiencias y la importancia de establecer un Banco de Huesos en Costa Rica. Metodología: Se recopiló toda la información relevante para proporcionar un breve resumen del establecimiento de un banco de huesos en Costa Rica. En primer lugar, se tomó en cuenta consideraciones legales, seguido por la definición de los criterios de exclusión de donantes de acuerdo a los estándares internacionales. Los potenciales donantes se definieron como los pacientes sometidos a reemplazo de cadera y de rodilla. Con el fin de elegir los donantes adecuados, a todos los 78 Acta méd costarric Vol 61 (2), abril-junio 2019 potenciales donantes se les realizaron pruebas de sangre para detectar enfermedades transmisibles. Los tejidos óseos se obtuvieron en sala de operaciones para, posteriormente, ser procesados bajo condiciones estrictas estandarizadas. Una vez que se procesaron los tejidos, los aloinjertos se almacenaron a -80 °C hasta que se llevó a cabo el procedimiento de trasplante. Resultados: entre los años 2016 y 2019, el Banco de Huesos tuvo un total de 69 donantes y 258 receptores de aloinjertos óseos, todos ellos pacientes del Hospital Trauma. Conclusión: El establecimiento del banco de huesos en Costa Rica ha sido un gran desafío para el Instituto Nacional de Seguros (INS). El objetivo es hacer que el mismo esté disponible para la comunidad médica en general, a fin de fortalecer la red de donación y trasplantes de tejidos en Costa Rica.

Abstract Aim: The use of bone grafts is a common practice in orthopedic surgeries. However, the daily problema in traumatology is the limited access to adequate bone grafts. These grafts provide mechanical stability in the affected area of the bone, as well as repair and regeneration of weaknesses through osteoinductive, osteogenic and osteoconductive properties. The main objective of this report is to provide information about the experiences and the importance of establishing a Bone Bank in Costa Rica. Method: All relevant information was gathered to provide a brief overview of the establishment of a Bone Bank in Costa Rica. First, legal issues were taken into consideration; followed by the definition of the donor exclusion criteria according to international standards. Potential donors were defined as all patients undergoing hip or knee replacement surgeries. In order to select the right donors, blood samples from all potential donors were tested for transmittable diseases. Bone tissues were obtained in the operating room to be processed later, under strict standardized conditions. Once the tissues were processed, allografts were stored at -80°C until the transplantat procedures were carried out. Results: Between 2016 and 2019, the bone bank had a total of 69 donors and 258 bone allograft recipients, all of them were patients at the Trauma Hospital. Conclusion: The establishment of the bone bank in Costa Rica has been a challenge for the National Insurance Institute (INS). The goal is to make the Bone Bank available to the medical community in general, in order to strengthen the tissue donation and transplant network in Costa Rica.

ESTABLISHMENT OF THE BONE TISSUE BANK AT MOSTAR UNIVERSITY CLINICAL HOSPITAL.

Bone tissue banks are necessary for collection, production, testing, packaging, storage and delivery of bone transplants. Bone tissue bank is a link between the donor and the recipient by which the donation becomes a medium of health improvement for both the donor and the recipient. At the Department of Orthopedics, Mostar University Clinical Hospital, about 200 total hip replacements are performed per year. Most patients undergoing total hip replacement surgery (90%) have been diagnosed with osteoarthritis, and they are suitable donors, having in mind their age and comorbidities. In the same Department, around 50 procedures that require bone transplants are performed per year. A team of highly competent surgeons are working on an intensive process of adaptation oriented to quality improvement and intensification of the activity, both with the goal of meeting the standards of excellence in orthopedic surgery. The presence of a bone tissue bank has a favorable impact on the quality of health care owing to bone transplant availability, as well as on the scientific role of a highly specialized institution that examines the properties of bone tissue.

Creation of the bone bank of the Rabat and Casablanca region in Morocco.

For a long time the use of bone grafting has demonstrated its interest in orthopedic surgery and traumatology. The autografts which are still very frequently used present various problems. On the one hand, it is necessary to find a correct mechanical quality and a sufficient quantity of bone. On the other hand, the graft removal lengthens the operative time and generally painful in postoperative. These disadvantages of autografts have led to the development of bone allografts. Indeed, the low immunogenic power of the bone, the good integration of the graft and the ease of bone preservation techniques make it possible to overcome the various problems posed by bone autografts. The increasing use of bone allografts has resulted in the need for a structure allowing the management of graft stocks. The purpose of this work is to demonstrate the mode of operation of a bone bank, whose conservation activity is limited to the femoral heads treated by cryopreservation and without secondary sterilization process. The bank collaborates with all orthopedic surgeons in the Rabat and Casablanca city at first and then with all orthopedic surgeons in Morocco. It provides allografts in quality and safety.

Three-dimensional virtual bone bank system for selecting massive bone allograft in orthopaedic oncology.

PURPOSE: Although structural bone allografts have been used for years to treat large defects caused by tumour or trauma, selecting the most appropriate allograft is still challenging. The objectives of this study were to: (1) describe the establishment of a visual bone bank system and workflow of allograft selection, and (2) show mid-term follow-up results of patients after allograft implantation. METHODS: Allografts were scanned and stored in Digital Imaging and Communications in Medicine (DICOM) files. Then, image segmentation was conducted and 3D model reconstructed to establish a visual bone bank system. Based on the volume registration method, allografts were selected after a careful matching process. From November 2010 to June 2013, with the help of the Computer-assisted Orthopaedic Surgery (CAOS) navigation system, the allografts were implanted in 14 patients to fill defects after tumour resection. RESULTS: By combining the virtual bone bank and CAOS, selection time was reduced and matching accuracy was increased. After 27.5 months of follow-up, the mean Musculoskeletal Tumor Society (MSTS) 93 functional score was 25.7 ± 1.1 points. Except for two patients with pulmonary metastases, 12 patents were alive without evidence of disease at the time this report was written. CONCLUSIONS: The virtual bone bank system was helpful for allograft selection, tumour excision and bone reconstruction, thereby improving the safety and effectiveness of limb-salvage surgery.

Design and management of an orthopaedic bone bank in The Netherlands.

The design and management of an orthopaedic bone bank is a complex process in which medical organisation and legislation intertwine. Neither in the Netherlands, nor in any other European country, there are official guidelines for the organisation and management of an orthopaedic bone bank. In the Netherlands, the recently modified 'law of security and quality for using human materials' (WVKL) dictates requirements for technical and organisational aspects for the use of human tissue and cells. The bone bank procedures include a thorough questionnaire for donor selection, extensive serological, bacteriological and histopathological examination, as well as standard procedures for registration, processing, preservation, storage and distribution of bone allografts. This article describes the organisation of an accredited bone bank and can be used as a proposition for an official guideline or can be useful as an example for other orthopaedic bone banks in Europe.

Simple novel bone bank storage: the Singapore General Hospital experience.

INTRODUCTION: Since 1981, the Singapore General Hospital (SGH) bone bank has proven to be a safe, reliable, and economical source of bone allografts. Femoral heads are used exclusively and are procured from patients undergoing hip arthroplasty. Screening for HIV, hepatitis B, and hepatitis C is carried out prior to surgery. Patients with ongoing infection and past history of malignancy are excluded. The bone graft procured is washed and autoclaved to 134°C for 3 minutes. It is then stored in saline solution containing penicillin and streptomycin at -80°C. Based on our experience, such a system can be readily duplicated in developing nations with minimal cost and equipment. This article presents our experience in the procurement and storage of femoral head allografts with clinical results to support the safety profile. METHODS: Ten femoral heads were harvested from patients who underwent hip arthroplasty. The femoral heads were autoclaved and stored at -80°C in an antibiotic solution. Bone chips were sent for culture immediately after autoclaving and at 3 and 6 months. RESULTS: All specimens passed the initial sterility testing and remained sterile up to 6 months. A retrospective study of 9 patients who had 13 allografts implanted between 2008 and 2010 showed that none of the recipients acquired an infection or transmissible disease due to the allografts. CONCLUSION: This study showed that our protocol allows for procurement of femoral head allografts with minimal contamination and that they can maintain sterility for up to 6 months. This finding is further supported by our clinical results. Hence, this protocol will be useful for bone banks in developing nations where sterility conditions are suboptimal and cost is an issue.

[Bone allografts and the functions of bone banks]. / Aloinjertos óseos y la función del banco de huesos.

The use of bone grafts is a common practice in musculoskeletal surgery to provide mechanical stability where there is a defect and it allows skeletal reconstruction. Classically auto and allografts have been used. The latter are the choice in large, complex defects. Allografts can be transplanted despite cell death, have osteoconduction and osteoinduction capacity, low antigenicity and biomechanical properties similar to the original bone. They can be obtained from living and death donors. They are stored by cryopreservation and lyophilization in entities called bone banks. This is a review about bone allografts and the organization and function of the bone banks.

Aloinjertos óseos y la función del banco de huesos / Bone allografts and the functions of bone banks

The use of bone grafts is a common practice in musculoskeletal surgery to provide mechanical stability where there is a defect and it allows skeletal reconstruction. Classically auto and allografts have been used. The latter are the choice in large, complex defects. Allografts can be transplanted despite cell death, have osteoconduction and osteoinduction capacity, low antigenicity and biomechanica lproperties similar to the original bone. They can be obtained from living and death donors. They are stored by cryopreservation and lyophilization in entities called bone banks. This is a review about bone allografts and the organization and function of the bone banks.

Multi-variety bone bank in China.

This is a descriptive report of the establishment and operation of a Chinese bone bank, though not a typical one. While being engaged in collection, processing and storage of allogeneic tissues, the bone bank to which the author belongs concurrently develops and produces new, non-human derived, graft materials. Among others is reconstituted bone xenograft (RBX) which possesses strong osteoinductive capability without evoking immune rejection. Hence, its appellation "multi-variety bone bank," which was established by Dr. Hu Yunyu in 1990, the first of its kind in China. There are several salient features discriminating this bone bank from others. At this hospital-based non-profit institution, allograft hemi-joints are freshly prepared and distributed deep-frozen, instead of being freeze-dried on an industrialized basis for convenient transportation. The former has much more superior biological and mechanical properties as compared with the latter. However, allogeneic tissues are sometimes in short supply due to limited number of donors and the risk of some potential donors carrying viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). New graft materials, including reconstituted bone xenograft (RBX), were developed that serve as a supplement to allografts. RBX has been successfully used in clinical practice for the management of old fractures, nonunions and bone defects, most notably of contaminated, infected open fractures and osteomyelitis with the use of anti-infective reconstituted bone xenograft (ARBX). Additionally the multi-variety bone bank serves as a training base for educating professional personnel and researchers (postgraduates) in theories and technologies of tissue banking. Up to now, eighteen special technical staff members and approximately sixty senior researchers have been trained at this institution.

The effect of the EU tissues and cells directive on bone banking in Denmark: a case study.

As a result of the EU Tissues and Cells Directive (2004/23/EC), therapeutic tissue banking is currently being restructured throughout Europe. The stated objectives are to enhance a safe and stable supply of bone and tissue in Europe and to facilitate internal exchange. We conducted an interview study to explore the effect of the Directive on Danish bone banks in terms of (1) organizational restructuring, (2) supply and range of exchange, (3) economic costs. We found that the Directive stimulated extensive re-organization of bone banks with a substantial adjoining workload; that it is doubtful whether it will increase supply and range of exchange; and that the transposition of the Directive is associated with considerable extra cost. Additionally, we found that elements in the documentation of safety were fabricated by surgeons to avoid what was seen as unnecessary questioning of potential donors.

[Establishing bone bank at Varazdin General Hospital]. / Organizacija kostane banke u Opcoj bolnici Varazdin.

AIM: Bone bank has to supply patients of our Department of Orthopedics and patients from Department of Traumatology with necessary bone grafts. METHODS: The paper describes in detail the establishment of Bone bank at Varazdin General Hospital. RESULTS: At Varazdin General Hospital, Department of Transfusion Medicine, in cooperation with Department of Surgery and Department of Orthopedics has been working on developing tissue banking for already 10 years. Primarily, surgical bone remnants and femoral bone heads are collected from live donors and then transplanted. Since 2004, bone tissue has also been collected by means of explantation and then transplanted. In 2004 and 2005, as many as 170 packages of bone tissue were collected at our institution, 40 of which were with spongiosa collected through explantation, and 130 bone remnants. As many as 61 bone remnants and 21 spongiosa were transplanted. Contamination rate of bone grafts was 15.8%. All contamination allografts were destroyed. Bone grafts were used for revision hip arthroplasty, corrective osteotomy and spondylodesis. In the last two years, we have developed a computer program for Bone Bank managing, and have improved our Quality Management System. CONCLUSION: Bone Bank is a service that retrieves, tests, stores and distributes bone grafts and allows a secure system for supplying surgeons and their patients with necessary bone grafts.

Bone banking in a community hospital.

Major orthopaedic operations are now also performed in community hospitals. Because allografts are sometimes used during these procedures, local bone banking could become an essential tool. We evaluated the indications and results of the allografts from the local bone bank used in our institution. The financial aspect was also examined. Of the 131 allografts stored in our bone bank, only 20 were discarded. Postoperative follow-up showed good ingrowth of the grafts except for one graft failure. There were no superficial or deep postoperative infections. All cultures taken during implantation remained negative. These data suggest that bone banking in a community hospital is a safe and practical alternative to address the ongoing demand of bone grafts in a small orthopaedic practice. Financial costs are reasonable. In our experience, bone banking also broadens the spectrum of orthopaedic operations that can be performed in an orthopaedic unit.

Clinical effectiveness of processed and unprocessed bone.

Bone allografts have been used clinically for a number of years. Understanding the biology of bone healing and the impact that bone banking has on this helps to improve the methodologies used in increasing the quality and safety of banked bone. Banked bone in its various forms has been used in a variety of surgical procedures, and although there is no doubt that it is clinically effective, most of the studies have been retrospective and non-randomized. The review attempts to summarize some of the data in this area and highlights some of the difficulties encountered in such work. Although there is no doubt that bone banking is nowadays better controlled, there are ever-increasing pressures to produce bone that is as safe as possible with the least impact on its effectiveness. This can only be achieved if the requirements of the providers and users of bone are better understood.

El Banco de Huesos del Hospital Provincial de Madrid / The Madrid Provincial Hospital bone bank

No disponible

Hospital-based allogenic bone bank--10-year experience.

Bone banking in a hospital provides resources of allogenic bone grafts. However, they may transmit infection from donor to recipient. We found few reports discussing the infection rate and monitoring processes associated with bone banks. The discard rate using the screening test was 18.5% (309/1674) in this series. The leading cause was hepatitis B antigen (HBsAg) positive donor serum (67%), followed by Venereal Disease Research Laboratory (VDRL) positive donor serum (15%), and anti-hepatitis C virus (HCV) positive donor serum (12%). The overall infection rate in the recipients was 1.3% (17/1365). Among 1353 implanted allografts, 22 cases (1.6%) had a positive swab culture result after thawing. Only four out of these 22 cases (18.2%) developed infection. However, the wound cultures of the infected recipients were different from the swab culture of thawing allografts except in one case. Among the 1331 recipients with sterile allograft bones, 13 (1%) were found to have infection. In conclusion, our bone bank operates under a strict monitoring system which results in a low infection rate. The recipient's status, the aseptic technique and environment during operation is likely to be more critical in prevention of allograft-related infection.

Enfermagem empreendedora -banco de ossos: da implantação à assistência

Buscou-se com o presente estudo, com preender o proc esso de regulamentaç ão dos Bancos de Ossos, verificando os proc edimentos adot ados para doação, c aptaç ão, armazenam ent o e recepç ão de ossos nos serviços existentes no estado de São Paulo. Por m eio do cadastro do Sist ema Único de Saúde, identificou-se 276 hospitais gerais c om 100 ou m ais leit os para os quais enviam os correspondência, contendo env elope respost a selado, solicitando informação acerc a da realizaç ão de cirurgias com enx ertia óss ea. Obt ev e-se resposta afirmativ a de dez hos pitais, que constituíram a população alv o do est udo. Entret ant o, em res post a ao envio de um outro instrum ent o de coleta de dados, em busca de subsídios para a compreens ão do sistema de f uncionam ento dos s erviços dos dez hospitais, apenas dois responderam justificando que não possuí am Banco de Oss os. Face a dificuldade de identificação dos hospit ais que poss uíam Banc o de Ossos por meio desta est ratégia, recorreu-se à literatura sobre o t ema. Elegeu-se dois hospitais ref erenciados nos estudos, m as um deles não aut orizou a visita. Optou-se por incluir um outro hospital do int erior paulista, reconhecido regionalmente por s er centro de ref erência de cirurgia ortopédica. Assim, f oram submetidos à anális e, em at endimento aos objetiv os do est udo, dois s erviços -um priv ado e outro públic o, o 1º localizado no interior e o segundo na capit al paulista, valendo-se dos recursos da m odalidade pesquisa estudo de cas os m últiplos. Utilizou-s e como estratégia para a c oleta dos dados um questionário semi-estruturado para nortear a entrevista com o enf erm eiro res pons ávelpelos serviços e a visita aos serviços inv estigados....

[Bone tissue harvesting after multiorgan procurements for preparation of preserved bone allografts]. / Pozyskiwanie tkanki kostnej po pobraniach wielonarzadowych celem przygotowywania allogennych przeszczepów kostnych.

Preserved bone allografts are widely used in orthopaedic and traumatology operations. Until now, bone tissue for the preparation of preserved allografts has been collected from cadaveric donors in forensic medicine departments. Increasing demand for preserved bone allografts and limited number of suitable donors led to a prolongation of the waiting time for this kind of allografts. In 1999 a group of orthopaedic surgeons from the Orthopaedics and Trauma Department of the Pomeranian University of Medical sciences started to retrieve bone tissue following vascularized organ procurements. The aim of this paper is to present the technical details and limitations of this enterprise. Between November 1999 and April 2001 bone tissue was received from 12 out of 20 multiorgan donors (60%).

Estructura y organización de un banco de huesos y tejidos / Structure and organization of a bone and tissue bank

En este artículo se revisan de forma pormenorizada la estructura y organización de un Banco de Huesos y Tejidos (BHT). La instauración de una red de BHT hará que los aloinjertos sean cada vez más disponibles para los pacientes que lo necesiten (AU)