Doctors warn donor skin shortage risks lives
Doctors warn donor skin shortage risks lives
09 April 2012
published by www.theage.com.au
Australia — DOCTORS are struggling to treat serious burns victims due to a shortage of donor skin and warn that lives could be at risk in the event of a major disaster such as Black Saturday.
While deceased organ donors have more than doubled in recent years in Victoria, donors of tissue including skin, bone and cardiac valves have declined.
Most critical is the shortage of donor skin, which can be life-saving for patients with extensive and infected burns.
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Director of The Alfred hospital’s adult burns unit, Heather Cleland, said donor skin was used as a temporary cover for wounds in patients whose own skin could not yet be grafted because it was too damaged.
”It makes it possible for the patient to get better instead of being constantly subjected to an influx of bacteria through these open wounds,” she said.
”We probably get six to 10 patients a year who would significantly be in need of it. The problem is that once you’ve got a patient who needs it, they need a lot of it.”
Donor skin was imported from the US to treat victims of Victoria’s Black Saturday bushfires in 2009 after local supplies were quickly exhausted.
Victoria was then home to Australia’s only skin-banking facility, where skin can be stored for up to five years, but is now backed by a Queensland bank. Supply remains precarious, including from overseas. US banks have previously refused to supply skin to Australia during bushfires in California.
Director of the Victorian Institute of Forensic Medicine Professor Stephen Cordner – who oversees the tissue bank – said: ”If a major burns disaster on the scale of Black Saturday or the Bali bombings occurred tomorrow, there would be no available skin in Victoria to adequately treat burns victims.
”Even if we had an event where two or three people had serious burns, we wouldn’t be able to cope.”
Father-of-three Tim Attwater said donor skin helped to save his life after a 2006 accident in which a tin of paint thinner exploded in his shed in the heat from a potbelly stove.
He sustained burns to 90 per cent of his body and was flown to the Alfred Hospital where he spent seven weeks in an induced coma before undergoing extensive rehabilitation. Mr Attwater encouraged people to consider donating skin to help other burns victims.
Dr Cleland said she only requested donor skin for the most serious cases, but found herself regularly on the phone to interstate surgeons discussing where limited supplies should go. ”They will have a patient, and I’m saying, ‘I’ve got two patients with 70 per cent burns and one of them is not doing very well’ – so we’re trying to make decisions between ourselves about where is this going to be most helpful,” she said.
Dr Cleland said that without donor skin, ”you need to keep mechanically excising these wounds to make sure the bacteria doesn’t increase these patients will need all sorts of antibiotics, and probably intensive care, because that septic load will put terrible pressure on their kidneys.”
Only a very thin shaving of surface skin is obtained from deceased donors in Victoria, who have mostly died in circumstances that have been referred to the coroner.
The tissue must be retrieved from donors within 24 hours of their death, but pressure on coroners to perform other duties within this time can create delays. There were 31 deceased skin donors in Victoria last year, down from 87 donors in 2007.
Dr Cleland and Professor Cordner say more is needed to extend the pool of potential donors, and raise community awareness about tissue donation. Improving access to donor tissue was one of the recommendations of a state parliamentary committee last month following an inquiry into organ donation.
