Last Updated on April 18, 2024 by Neelam Singh
It’s not common knowledge that skin, the largest organ in a human body, can be donated. In India, where over 1 million people are moderately or severely burnt every year as per WHO, skin donation can be of immense help.
Unfortunately, awareness about skin donation and skin banks, where skin is stored, is limited, creating difficulties for those who endure deep burns. Acid attack survivor and activist Pragya Prasun Singh, who sustained 47 per cent burn injuries, reveals that her treatment was delayed because there was no skin available for grafting.
What is skin grafting?
Severely burned or injured skin cannot heal itself without any assistance. One method of accelerating the healing process for patients with severe burn injuries is to cover the lesion with allografts, or skin taken from an organ donor. Known as a cadaver skin graft, usually. Post skin-burning, it needs some skin covering for protection, pain relief, infection prevention, fast healing, and life preservation. Patients are at risk for infection, fluid loss, and even death if the skin substitute doesn’t cover the burnt region.
Singh’s own donor area, which is the thigh and lower back, was also damaged and hence she was dependent on allograft. “My wounds were not healing. If I had got skin immediately, my wounds would have healed in 45 days, but it took me months to heal,” says Singh.
Future of skin banks
In India, where burn cases are tragically prevalent, skin banks emerge as vital sanctuaries of hope. These repositories play a pivotal role in preserving human skin for grafting, offering a lifeline to those severely affected by burns.
The number of skin banks in India stands anywhere between 20-25, a number that is not adequate to meet the demand for skin by burn victims. Most of these banks are located in Tier-1 metros like Delhi, Mumbai, Chennai, Pune, Bhubaneshwar, Bengaluru, Ahmedabad and Jaipur while even fewer are located in Tier-2 cities like Indore, Belgavi, Coimbatore, and Sangli.
Recent scenario of skin banks in India
According to Dr P. K. Bilwani who retired as a plastic surgeon from Civil Hospital, Ahmedabad, the number of skin banks has gradually increased in the last few years, but they can only be of help when skin is being donated. In skin donation, skin has to be harvested within six hours of death and stored at the correct temperature in a skin bank. When a patient has more than 40% burns, skin from deceased donors can often save their lives.
“People know about eye donation, heart donation, kidney donation, and liver donation but are not aware of skin donation. Even if they know that skin donation is possible, they don’t know how or where to do it”, says Dr Bilwani, who now runs Gujarat Burns Hospital and Research Centre, Ahmedabad. During his long and illustrious career, Dr Bilwani has saved many lives. He adopted the novel approach of using a live donor.
“Due to the paucity of skin, I started asking relatives, especially mothers, to donate their skin in case their child gets burn and owns a damaged donor area. Mothers would readily and happily donate. They remove a very thin layer of skin from the donor and use it to cover the infected or wounded area. The donor doesn’t lose anything and it’s completely safe. It’s better than stored skin. I have been able to save the life of a 6-month-old baby due to the skin donation done by her mother. There was no skin bank in Ahmedabad at the time and I couldn’t have waited for cadaver skin to come from Mumbai”, shares the senior doctor.
Where skin banks play a role?
Broadly burns can be in two parts: superficial (first degree burns) and deep burns (second-, third- and fourth-degree burns). Since the superficial burns affect only the outer layer of skin, the epidermis, they don’t require surgical intervention. It is deep burns that requires a skin graft. It can be an autograft (the patient’s own skin) or an allograft/cadaver graft in cases of extensive burns. When biological dressing incorporates natural skin, the recovery is faster.
A 9-month-old baby sustained second degree burns (affected both the epidermis and, dermis, part of the lower layer of skin) and hospitalized in SIMS Hospital in Chennai. She had 30 per cent burns and sepsis had already set in. “Boiling hot rasam fell on the child and she the burns were severe. They sent her to us after she got treatment at a nearby hospital. Her wounds became infected. After she came, we resurfaced the skin with a cadaver skin graft, and the burns came down to 8 per cent. She recently celebrated her first birthday with us”, says Dr Shyamnath Krishna Pandian K, Consultant Plastic Surgeon, SIMS Hospital, Chennai, harping on the significance of skin grafts.
Dr Pandian says, sustaining a skin bank needs motivation and effort. “I have a 6-member team, but I am the only one who goes to harvest skin after we get a call for skin donation. The awareness is less, and doctors can’t advertise for skin donation as there are strict rules along with organ donation. SIMS Hospital set up a skin bank four years ago and has a regular supply of skin. “We get 50 burn patients in a year but being a private hospital, this number is small. Government hospitals usually take in the most burn patients,” he adds.
Awareness among the populace
Not every skin bank boasts a sufficient stock of skin. Last year, the Rotary Ashirvad BMRCI skin bank, in Karnataka, reported a dip in skin donations. “In Victoria Hospital there’re only 50 skin donations in the last four years,” reveals Singh who works towards raising awareness about skin donation.
Promoting awareness about skin donation is essential to ensuring an adequate supply of donated skin grafts. Education campaigns can dispel myths, raise public understanding of the importance of skin donation, and encourage individuals to come forward as donors. A larger number of skin banks and their promotion among the public can also lead to heightened awareness.
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