AANA Lab Course 905 - 2nd Annual Fellows Course-Know your Tissue Bank_ Donor Demographics, Sterilization, & Storage Considerations- Xinning Li, M.D.

Know your Tissue Bank_ Donor Demographics, Sterilization, & Storage Considerations- Xinning Li, M.D.

Pdf Summary

This document provides an overview of musculoskeletal allograft tissue use in reconstructive orthopedic procedures, highlighting increasing utilization over the past decade. It emphasizes the importance of surgeon knowledge regarding tissue bank practices including donor consent, screening, serology testing, and tissue processing. Orthopedic surgeons have the responsibility to inform patients about the risks, benefits, and alternatives to allograft use.<br /><br />Commonly used allografts include various bone products (demineralized bone, cortical/cancellous segments, structural bones, osteochondral grafts), soft tissues (patellar ligament, Achilles tendon, fascia lata, rotator cuff), and cartilage (meniscus, osteoarticular segments, costal cartilage). The American Association of Tissue Banks (AATB) accredits over 120 U.S. tissue banks, processing more than 3 million allografts annually.<br /><br />Tissue banking history traces back to 1881, with significant milestones in preservation and standardization, including FDA regulations and guidelines such as Current Good Tissue Practice (CGTP). Donor assessment includes physical examination for infections or risky behaviors and infectious disease testing for HIV, hepatitis B and C, and syphilis via FDA-approved methods.<br /><br />Tissue processing involves removal of blood and cellular debris, bacteriologic and virucidal washes, pre- and post-processing contamination testing, possible gamma radiation sterilization, and final medical director approval. Sterilization methods include gamma irradiation and chemical washes, with sterilization assurance levels aiming to minimize infection risk while preserving tissue integrity.<br /><br />Though disease transmission is rare, reported cases of HIV, HCV, HTLV, and bacterial infections exist. Storage conditions vary by tissue type: fresh osteochondral grafts are refrigerated, tendons frozen at -20 to -39°C (six-month shelf life), and bone/cartilage frozen at -40 to -86°C (up to five years). Cryopreservation techniques help maintain cell viability.<br /><br />The document concludes emphasizing the diversity of available grafts, the low risk of disease transmission, and notes cost considerations. It encourages surgeons to utilize accredited tissue banks and be informed in graft selection and patient counseling.

Keywords

musculoskeletal allograft

reconstructive orthopedic procedures

tissue bank practices

donor consent

allograft screening

tissue processing

sterilization methods

disease transmission risk

tissue storage conditions

surgeon patient counseling