According to Dr. Keswani, a surgeon who heads the program, skin donation would come in use for orthopaedic surgery, cosmetic surgery, plastic surgery, and most importantly, to help patients who suffer burn injuries. “A patient dies of burns because of an infection that occurs when the skin barrier is broken due to the burn accident”, he explains. “One can save such patients if the barrier is created once again by providing new skin. In major burns (those greater than 30%) the new skin has to be from somebody else - at least initially. This is called a ‘homograft’.” Burns, he says, are terribly painful, extremely expensive, and have a high rate of mortality.

 

Dr. Keswani’s father helped set up the National Center for Burns, the largest and only dedicated Burns Hospital in the country. It is fully equipped with the latest technology. “Burns units are not present in all but around 5 parts of the country”, says Dr. Keswani. “For instance, the whole of Calcutta doesn’t have one. Therefore, critically ill patients are forced to fly down to Mumbai –thus, the demand for homografts is extremely high at this hospital.”

 

Skin grafts can be taken from two sources – either from a living donor, or from the body of a deceased donor, within 12 hours of death. Often, because there isn’t enough skin in skin banks to use, doctors have to ask relatives or friends of the patient to donate their skin. “This process is intensely painful for the donor”, according to Dr. Agarwala. “The donor goes through surgery, then has to remain in hospital for about 10 days, and then is asked to rest at home for about 2 months.” Dr. Keswani furthers, “Why subject a living person to go through this excruciating process, when there can be so much skin extracted from dead bodies who have no more use of it?”.

 

Another method is ‘dressing’, a very expensive alternative. Moreover, the patient has to rely on heavy antibiotics if healing by this method, as per Dr. Agarwala’s knowledge. “Using skin grafts not only cuts costs, it is also the healthiest method”, he emphasizes. “A large percentage of burn patients come from economically lower classes, who can’t afford to pay the costs that are required for dressing.”

 

Anyone above the age of 18 can register to become a skin donor. The patient, however, should not have died of skin disease, HIV, cancer, hepatitis, or another transmissible ailment. The program has set up centers at hospitals in 5 different areas, to encompass more of the city. These are at the National Burns Centre at Airoli, Masina Hospital in Byculla, Sion Hospital, Holy Spirit Hospital in Andheri, and Holy Cross Hospital in Kalyan. They have set up state-of-the-art skin banks at these centers, and each will be equipped with instruments called ‘dermatomes’, which are tools to extract skin grafts with precision. “The skin banks, however, are unfortunately empty at the moment, because of the lack of donors.”

 

Skin grafts are taken only from the body’s thighs and back, and only a “wafer-thin transparent layer”, according to Dr. Keswani. There is no bleeding, and no internal organs are exposed, and the body is properly covered and returned to the family for cremation. “Our main obstacle is that families get too emotional at a relative’s death, and do not call us to allow donation”, he expresses. “We tell our donors to ask for full family support before signing up.” Moreover, the body has to be in good condition for cremation, according to Hindu faith. “We have conducted research, and have roped in a few sadhus who establish that as long as the feet and face is untouched, the body can go through its due rites”, says Dr. Agarwala.

 

The skin grafting process does not need ‘tissue typing’, which is a laboratory test required to evaluate the closeness of the tissue match between the donor and the recipient’s tissue. In other words, any person’s skin can be grafted on anyone. This is mainly because the graft is only a temporary barrier that protects the patient from fatal infection; eventually, the patient’s own skin will start to regenerate. Therefore, donated skin can always come in use; unlike blood donation, where the patient can accommodate only a certain type of blood, or kidney or eye donation, where the tissues have to be matched.

 

The doctors have set up a 24-hour helpline, where a relative can call to inform of a donor’s death. This helpline also gives out information for patients, not just about the program, but also everything to do with burns and its treatment. “Patients often worry about whether the method their doctor suggests is a good one”, says Dr. Keswani. “This helpline will assess the method and then give advice to the patients. Sometimes, we even ask the patient to e-mail a photograph so our doctors can get a sense of the case and then give their feedback.” The program is also trying to get the RTO to print on every driver’s license whether or not he is a registered organ donor, so that in the event of a fatal accident, the driver’s organs can be used to help save someone’s life.

 

·         Research and learn as much as you can about organ and skin donation.

·         Make your decision, and ask for your family’s support. In the event of your death, your next in kin will be asked for consent.

·         Call the Burns Helpline: 27643333.

·         Ask for a registration form. They will post it to you. Complete the form and post it back.

·         You can change your mind at any time, even after registering.

 

Donated skin, if not used immediately, needs to be preserved, just like other organs. Dr. Keswani and his team have launched state-of-the-art skin banks, which will serve a healthy way to preserve skin. However, before the skin is put up for storage in the skin banks, it is first tested for viral or bacterial infection. According to Dr. Keswani, skin can be preserved in two ways. It can be stored at a temperature of 4-6 degrees Celsius in a sort of ‘fridge’. This method can preserve skin up to 4 weeks. An alternative method is to store the donated skin in a solution containing 85% glycerol, which can keep it fresh for as long as 3 years. “There is no need for us to use the glycerol method as of now”, says Dr. Keswani. “The demand for skin is so high right now, it doesn’t even stay for those four weeks. Once we have enough donors, we can start to implement the glycerol method.” For now, he says, they have a modern fridge that serves the purpose.

 

Case Study (Donor)
Devashree Dhruv had just delivered a baby boy. An ordinary delivery, which yielded a healthy boy. Seven days after his birth, Devashree was heating a steam-bath for herself, as the doctor had advised her to. Unfortunately, the flames caught on to a wooden bed-leg, and the fire spread through the room. 

Rajesh Srimankar, a 52-year-old businessman, was shocked one morning when he was informed that an accidental fire had caused his daughter 88% burns. “She was in hospital for 20 days. It was a terrible time for us.”, he says. With only 12% of her skin tissue intact, Devashree would need a large amount of skin grafting to be performed, in order to save her. She was first admitted to Andheri Hospital, but later shifted to the National Center for Burns in Airoli, where she would receive specialized treatment. The surgery was complete, but Devashree passed away the next day due to a heart problem that had suddenly developed. 

“Because skin was not available at the time, her father-in-law and I stepped up to give her grafts of our skin”, says Srimankar. “She was in a critical condition, and needed the skin immediately.” When asked about the process, Srimankar says that it is inexplicably painful. “Devashree’s father-in-law and I had to stay in hospital for over 10 days, and were then asked to spend 2-3 months on bedrest, because that’s how long it takes for the skin to regenerate.”, he recalls. “Even in that period, we would have to visit the hospital virtually every alternate day, to take periodic tests.” 

Srimankar is now actively involved in promoting cadaveric skin donation. “Because I can speak from hands-on experience”, he says, “I know just how important this can be to someone’s life, and to their family. I hope people understand how much good that graft of skin can do, after they have lost use for it.” He expresses just how painful it is for live donors, but also how, for a family member or close friend, it is imperative. “Sometimes, though, even the skin you donate isn’t enough to save someone. Especially because it is only harvested from the thighs in case of live donors, and therefore needs 2 people to donate per patient.” If the skin banks had enough skin, more lives can be saved everyday, he reckons.  

“I only want that people understand the gravity of the good they can do with this donation”, Srimankar accentuates. “People are aware of eye-donation, and albeit that is a wonderful thing, I think skin donation would be a step ahead. It helps not just one sense, but saves an entire life”.

Case Study (Patient):
Seven-year-old Divya Ratardi was leaving her house to go for her classes, but unfortunately didn’t realize that there was a hot water bucket outside the door. Her foot went into the bucket, and she slipped and fell, the hot water spilling all over her. Divya suffered 50% burns on a large part of her body, everything chest down.

“Because there was no donation to draw from, Divya’s own skin had to be taken from parts that were not affected”, said her father, Shailendra Ritardi. “Skin was harvested from her thighs as well as her hands – it was a nightmare to see her in that much pain.”

Divya’s skin had to be grafted twice, therefore, skin was taken from both her hands and her thighs. According to her father, skin donation is a marvelous idea. “I know what we went through with Divya, and I wouldn’t want anyone to go through that”, he states. “Once a person is dead, there is no need for his skin. If people cooperated, we could save so many lives, and ease so many patients of the pain they are in.”

 

Things you should know: (FAQs put together by the Doctors)
 ·         Is the body disfigured when skin is removed?
No. The removal of organs is a surgical procedure, and the body is treated with the same dignity and respect as any other operation.
·         What happens to your donated skin?
 A system is in place to use skin donation fairly. Factors such as race, gender, age, income and celebrity status are not considered when determining who receives skin donation.
·         Will your decision to become skin donor affect the quality of your medical care?
No. Organ and tissue recovery happens only after every effort has been made to save your life, and death has been legally declared.
·         Are there any complications?
No inner organs are exposed, No bleeding occurs from the area of skin donation.
·         Are skin transplants successful?
Yes. Transplantation has become a very successful and accepted treatment.