TISSUE DONATION
Dr. Esteve Trias
Transplant Services Foundation
Hospital Clínic Tissue Bank
Barcelona, Spain
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
INTRODUCTION
TISSUE TRANSPLANT IMPORTANCE
Processing and
preservation methods
More time
Number of donors
Need
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Quality of life
DONORS
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
NEEDS
INTRODUCTION
TYPES OF TISSUE DONORS
Brain Death
Living
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
NHBD
Domino
TISSUE DONORS
HOSPITAL CLÍNIC
-772 beds
-48 IUC beds
-3 reanimation beds
Reference population
900.000 inhabitants
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE DONORS
HOSPITAL CLÍNIC
Where?
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE DONORS
HOSPITAL CLÍNIC
Where?
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
IUC
Brain Death
Hospital
Emergency departm
Cadaveric
Cardiology
Domino
Orthopedics
Obstetric department
Living
TISSUE DONORS
HOSPITAL CLÍNIC
’99-’09
X Potentiallity
1710 Deaths
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE DONORS
HOSPITAL CLÍNIC
’99-’09
X Potentiallity
1710 Deaths
Brain Death
3-5% H Deaths
45-75
Cadaveric
25-35% H Deaths
466-631 (586)
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE DONORS
Emergency Unit 28.5%
Oncology
21.2%
Internal Medicine 8.5%
CV/Cardiology
7.3%
Total
64%
Others
36%
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Emergency Unit
Internal Medicine
Others
Oncology
Cardiology / Surgery
TISSUE DONORS
HOSPITAL CLÍNIC
Living
Potentiallity
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE DONORS
HOSPITAL CLÍNIC
Living
Potentiallity
Domino
Heart Transplant
0-25 year
Amniotic Membrane
Program Caesarea
200 year
Femoral Heads
Hip replacement
100 year
Cord Blood
Number of Deliveries
1500 year
Bone Marrow / PBSC
Active Hematologic Unit
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE DONORS
413 TISSUE DONORS H CLÍNIC 2012
12%
13%
4%
71%
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Brain Death
NHBD
Living
Cadaver
TISSUE DONORS
HOSPITAL CLÍNIC
2000
1800
1600
1400
1200
1000
800
Deaths
Potentiallity
600
400
200
0
1999
2001
2003
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
2005
2007
2009
TISSUE DONORS
Hospital Deaths
1866
>80 years old
631
33,81%
Sepsis
326
17.47%
HIV / Serologíes +
183
9,81%
Haematologic Neopl.
138
7.39%
Exclusion Criteria
1278
68,5%
Potential Donors
586
31,5%
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE DONORS
HOSPITAL CLÍNIC
2000
1800
1600
1400
1200
1000
800
Deaths
Potentiallity
Detection
600
400
200
0
1999
2001
2003
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
2005
2007
2009
TISSUE DONORS
HOSPITAL CLÍNIC
2000
1800
1600
1400
Deaths
1200
1000
800
Potentiallity
Detection
Donors
600
400
200
0
1999
2001
2003
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
2005
2007
2009
DONOR SELECTION
Medical and Social History
Physical Exam
Blood Samples
Serologies
Warm Ischaemia Time
Autopsy
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DONOR SELECTION
MEDICAL AND SOCIAL HISTORY
Hospital Donor– Clinic History
Extrahospitalary Donor ?
Who ask?
Who answer?
Questionnaire enough?
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
DONOR SELECTION
ABSOLUTE CONTRAINDICATIONS
Unknown cause of death
Cancer (Except corneas)
leukemia, linfoma...
Sepsis: virus, bacteria and fungi
Collagenosis
Neurologic disease or unknown sistemic disease
Trauma, infections o chronic tissue pathology
Risk factors for HIV or BHV or CHV
MEDICAL AND SOCIAL HISTORY
Growth Hormone treatment
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
DONOR SELECTION
PHYSICAL EXAM
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
DONOR SELECTION
PHYSICAL EXAMINATION
Jaundice
Genital lesions
Non medical injection sites
Enlarged lymph nodes
Tattoo / piercing
White spots in the mouth
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DONOR SELECTION
PHYSICAL EXAMINATION
Enlarged liver
Insertion trauma / perianal lesions
Rash / scab / skin lesion (non-genital)
Blue / purple (gray/black) spots / lesions
Trauma / Infection to potential retrieval sites
Abnormal ocular findings (icterus, scarring)
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DONOR SELECTION
PHYSICAL EXAMINATION
TxC
DONOR
IDENTIFICATION
John Smith
30/11/1963
MH:1000456372
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
RECOVERY
TEAM
DONOR SELECTION
BLOOD SAMPLES
SEROLOGIES
BLOOD GROUP
HEMOGRAM
BIOCHEMISTRY
GONODOTROPHINE HORMONE
BLOOD CULTURES
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
DONOR SELECTION
BLOOD SAMPLES
Time from death to blood sample.
Avoid hemolisis < 6 - 24 h
False Positives
Hemodilution
Transfusion 48h previous to sample
False Negatives
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
Date/hour blood extraction
DONOR
Weight......Kg
Plasma volume=Donor weight....../0.025=
ml
Blood volume =Donor weight....../0.015=
ml
A. Transfussed blood previous 48h:
Red cells concentrate/48h
Total bloodl
Reconstructed Blood
ml
ml
ml
Total A=
B. Total Volume colloids previous 48h:
Dextrane
Plasma
Plattelets
Albumine.....
ml
ml
ml
ml
Total B=
ml
ml
ml
ml
Total C=
C. Cristalloids Volume infussed previous 1h:
Saline serum
Dextrose
Ringer
Others.......
Donor viability
1.- B+C>Plasmatic Volume
yes
no
2.- A+B+C>Blood Volume
yes
no
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DONOR SELECTION
SEROLOGIES
Ab HIV 1-2
Ag HIV 1
Ag HBVs
Ab HBVc
Ab HCV
Ab CMV
Lues: VDRL, RPR
Ab HTLV I/II
PCR HIV
PCR HCV
PCR HBV
Chagas ?
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
DONOR SELECTION
WARM ISCHAEMIA TIME
Not refrigerated
Refrigerated at 4ºC < 6 h
12 -15 h Post Cardiac
Arrest
24 h Post Cardiac Arrest
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
DONOR SELECTION
AUTOPSY
If unknown Cause of Death
Mandatory
Always recommended
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
WARM ISCHAEMIA TIME
AUTOPSY
Date
13-XI-2005
Male 44 years old affected Aortic valve disease, stenosis,
Admitted for valvular surgery
PA: Colostomy 1998
Smoker 25 cig/day
Hypercollesterol / Hypertension
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Date
13-XI-2005
Male 44 years old affected Aortic valve disease, stenosis,
Admitted for valvular surgery
PA: Colostomy 1998
Smoker 25 cig/day
Hypercollesterol / Hypertension
14-XI-2005
Extracorporeal circulation – Heart valve surgery – Mechanical prosthesis
Intensive Unit Care - Anticoagulation treatment
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Date
13-XI-2005
Male 44 years old affected Aortic valve disease, stenosis,
Admitted for valvular surgery
PA: Colostomy 1998
Smoker 25 cig/day
Hypercollesterol / Hypertension
14-XI-2005
Extracorporeal circulation – Heart valve surgery – Mechanical prosthesis
Intensive Unit Care - Anticoagulation treatment
19-XI-2005
Good evolution - Moved to Cardiology ward
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Date
13-XI-2005
Male 44 years old affected Aortic valve disease, stenosis,
Admitted for valvular surgery
PA: Colostomy 1998
Smoker 25 cig/day
Hypercollesterol / Hypertension
14-XI-2005
Extracorporeal circulation – Heart valve surgery – Mechanical prosthesis
Intensive Unit Care - Anticoagulation treatment
19-XI-2005
21-XI-2005
Good evolution - Moved to Cardiology ward
Sudden Neurological damage– Cranial TC:(Brain haemorrhage, it’s not
possible to discard Arterial-venous Malformation vs Cranial Tumor)
Intensive Unit Care re-admission, treatment barbiturics, steroids…
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Date
13-XI-2005
Male 44 years old affected Aortic valve disease, stenosis,
Admitted for valvular surgery
PA: Colostomy 1998
Smoker 25 cig/day
Hypercollesterol / Hypertension
14-XI-2005
Extracorporeal circulation – Heart valve surgery – Mechanical prosthesis
Intensive Unit Care - Anticoagulation treatment
19-XI-2005
21-XI-2005
Good evolution - Moved to Cardiology ward
Sudden Neurological damage– Cranial TC:(Brain haemorrhage, it’s not
possible to discard Arterial-venous Malformation vs Cranial Tumor)
Intensive Unit Care re-admission, treatment barbiturics, steroids…
26-XI-2005
Irreversibility – Tracheotomy and moved to Neurologic ward
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Date
27-XI-2005
Fever 38ºC, xr: Condensation left basal lung, possible Pneumonia
Blood Cultures. Ceftriaxone and Clindamicine treatment.
Good analitical and xr evolution - normothermia
g
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Date
27-XI-2005
Fever 38ºC, xr: Condensation left basal lung, possible Pneumonia
Blood Cultures. Ceftriaxone and Clindamicine treatment.
29-XI-2005
Good analitical and xr evolution - normothermia
7:30 am
10:30 am
Auricular Flutter, instability - Cardioversion
12:30 pm
Alert for Cardiac arrest – Ventricular Fibrilation
g
Defibrilation 300J – 360J – 360J – Asystolia
Advanced Ressuscitation Maneouvres 30 minuts – unsuccesfull.
Death 13:00
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Date
27-XI-2005
Fever 38ºC, xr: Condensation left basal lung, possible Pneumonia
Blood Cultures. Ceftriaxone and Clindamicine treatment.
29-XI-2005
Good analitical and xr evolution - normothermia
7:30 am
10:30 am
Auricular Flutter, instability - Cardioversion
12:30 pm
Alert for Cardiac arrest – Ventricular Fibrilation
g
Defibrilation 300J – 360J – 360J – Asystolia
Advanced Ressuscitation Maneouvres 30 minuts – unsuccesfull.
Death 13:00
MEDICAL AND SOCIAL HISTORY
PHYSICAL EXAM
BLOOD SAMPLES
SEROLOGIES
WARM ISCHAEMIA TIME
AUTOPSY
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
OCULAR TISSUE
SELECTION CRITERIA
. Age: 2y-no upper limit
. No antecedents of:
retinoblastome
intraocular neoplasia
herpes queratopaty
ulcers or infections
cornea surgery—individual evaluation
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
AMNIOTIC MEMBRANE
SELECTION CRITERIA
. Age: Fertil woman
. No antecedents of:
uncontrolled pregnancy
hª obstétrica con alteraciones
pregnancy<34 weeks
amniorresis>12h before birth
duración parto>24h
mother fever - newborn infection
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DONOR SELECTION
DONOR QUALITY CONTROL
Serologies, blood cultures...
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DONOR SELECTION
DONOR QUALITY CONTROL
Serologies, blood cultures...
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
TISSUE QUALITY CONTROL
No tissue pathology
Tissue Culture
Preservation
DONOR SELECTION
DONOR QUALITY CONTROL
TISSUE QUALITY CONTROL
Serologies, blood cultures...
No tissue pathology
Tissue Culture
Preservation
VIABILITY
Traceability
DISTRIBUTION
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Recipients
DONOR SELECTION
NO TRANSMISSION
EXTRACTION
DISTRIBUTION
E.E.B.A
E.B.A.A.
E.A.T.B
A.A.T.B
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DONOR SELECTION
Donor
Heart Valves
Corneas
Recipients
Follow up
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Bones
DONOR SELECTION
NO TRANSMISSION
UNKNOWN BUT...
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
?
Thanks to Ted Eastlund for provide me his slides and material
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DISEASE TRANSMISSION
ARE TISSUES AND CELLS SAFE?
Cambridge dicctionary:
Safe: not dangerous or likely to cause harm
Webster dicctionary:
Safe: free from harm, injury or risk
It seems that tissues and cells are safe
……………………or not
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
1400000
12 7 9 0 9 2 12 8 12 5 9
Nº Injertos Tx
1200000
1000000
9 0 6 15 3
800000
675370
600000
7 10 0 6 4
5 2 3 19 7
400000
337338
243787
200000
2 0 8 2 19
0
1994 1995 1996 1999 2000 2001 2002 2003 2007
SourceUSA data: AATB Annual Surveys2007.
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Bone
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
POSSIBLE INFECTION
Tissue transportation
Tissue recovery
Donation /medical
and social history
• Window period
• Cross-contamination
• False negatives at the end
• Human errors
•………
Tissue
implantation
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Donor suitability
Tissue processing
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DISEASE TRANSMISSION
INFECTION DISEASE TRANSMISSION BY TISSUE ALLOGRAFTS
______Bacteria__ _______Tuberculosis_______ Epstein-Barr Virus
Fresh Cornea
Frozen Bone *
Fresh Nerve
Fresh Cartilage
Cryopreserved Heart valve
Frozen Tendon*
Frozen Bone *
Frozen Pericardium*
Fresh Skin
Cryopreserved Heart valve
* Could have been treated with gamma irradiation and prevented
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DISEASE TRANSMISSION
INFECTION DISEASE TRANSMISSION BY TISSUE ALLOGRAFTS
___HIV-1___
Frozen Bone*
Frozen Tendon*
_Hepatitis C____
Frozen Bone*
Frozen Tendon*
Cryopreserved Vein
____Hepatitis B____
Fresh Cornea
Cryopreserved Heart valve
* Could have been treated with gamma irradiation and prevented
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DISEASE TRANSMISSION
INFECTION DISEASE TRANSMISSION BY TISSUE ALLOGRAFTS
_____Rabies______ ___ _CJD____
Fresh Cornea
Organ-associated Artery
Cytomegalovirus
Fresh Skin
Yeast, Fungus_____
Freeze-dried Dura
Fresh Cornea
Fresh Cornea
Cryopreserved Heart Valve
Herpes simplex
Fresh Cornea
HTLV-I___
Frozen Bone*
* Could have been treated with gamma irradiation and prevented
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
DISEASE TRANSMISSION
Allograft characteristics affecting ability to transmit disease
• Nonviable Allograft
– Bone
– Costal cartilage
– Dura mater
– Fascia
– Ear ossicles
– Tendon
• Non-viable Acellular
– Connective tissue
• Can be disinfected,
processed, sterilized
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
• Viable Allograft
-- Heart valve and vessels (?)
– Cornea
– Articular Cartilage
– Skin
– Marrow
– Stem cells
– Blood transfusion
• Contains viable cells
• May be antibiotic treated
• Cannot be sterilized
The most worrisome tissue
allografts are those that are not
heavily disinfected or sterilized
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
HCV Transmission by Organ & Tissue
Allografts from a Seronegative Donor
(anti-HCV NEG, HCV RNA POS)
Cadaveric
Organ &
Tissue Donor
ORGAN RECIPIENTS -- OCT 2000
Lung HCV infection
Liver?
Heart --died early
Kidney HCV Infection
Kidney?
TISSUE RECIPIENTS
Corneas (Italy)---- Oct 2000
Saphenous Vein HCV infection ----2001
Tibialis Tendon HCV Infection---- 2001
Patellar Tendons HCV infection ---2002
Skin
Bone (gamma irradiation)
Annals of Internal Medicine 2005; Vol 143: pages 648-654
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
HCV FROM SERONEG DONOR:
37 Recipient follow-up
• 32 TISSUE RECIPIENTS TESTED
• 3 Previously HCV infected
• 1 recipients not found (bone, bone-tendon recipient)
• FIVE of 27 were HCV RNA POS genotype 1a
– 1 (?2) of 2 saphenous vein recipients (reported to CV
tissue bank 2001 but bank thought it was not from vein)
– 1 of 3 tibialis tendon recipients
– 3 of 3 bone-tendon-bone recipients
• 22 of 27 were NEG (2 skin recipients and 16 recipients of
irradiated bone )
MMWR 2003;52:273, Ann Intern Medicine 2005; 143:648-654
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Papillary Adenocarcinoma of the Iris
Transmitted by Corneal Transplantation
Arch Ophthalmol. 2002;120:1379-1383
• Nov 1990. 22 yr old Male : received corneal graft for keratoconus
• Apr 1992. No signs or symptoms. 20/20 vision
• June 1992 (19 mo later) Saw MD because of a 2-week history of
– slight right eye irritation
– discoloration of his iris.
• Aug 1992 mass approximately 4.0 x 2.5 mm, arising from the iris.
– Initially thought to be foreign body granulomatous reaction
• One week later: rapid growth: Excisional Biopsy
– poorly differentiated adenocarcinoma
– Radiation therapy to eye (10 000 rad (100 Gy) of 125iodine plaque
radiotherapy to a depth of 3 mm at the limbus)
• 2002 (10 yr later). No recurrence Vision 20/30
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Recipient’s right eye at time of excisional biopsy
June 1992
McGeorge, A. J. et al. Arch Ophthalmol 2002;120:1379-1383.
A, Preoperative appearance in June
1992. The mass is at 6- to 8-o'clock
positions on the iris and into the
anterior chamber angle
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
B, Postoperative appearance in
September 1992
See iris defect.
Copyright restrictions may apply.
New emergent infections diseases
Lymphocytic Choriomeningitis Virus Infection in Organ Transplant
Recipients. Massachusetts, Rhode Island, 2005
MMWR vol 54 /May 26, 2005
West Nile Virus Infections in Organ Transplant recipients-New York and
Pennsylvania, August-September, 2005
MMWR vol 54 /October 14, 2005
Be careful with tuberculosis: an increase of infected cases
Transplantation transmitted tuberculosis. MMWR vol 57/ April 4, 2008
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Sources of Infections Transmitted by Tissue
Allografts from Deceased Donors
• Newly Infected donor
– Sero negative window
• HCV: frozen bone, frozen tendons & saphenous vein*,
• HIV : frozen bone & tendon
– Wrongly diagnosed but systemic acute illness in symptomatic donor
• Grp A Streptococcus Toxic shock syndrome: frozen tendon*
• Rabies: fresh cornea, fresh artery*
• CJD: dura, fresh cornea
* Occurring or reported in 2002, 2003, 2005
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Sources of Infections Transmitted by Tissue
Allografts from Deceased Donors
• Postmortem endogenous contamination of donor tissue at
time of tissue recovery (non infected donor)
– Yeast: frozen heart valves (1998)
– Bacteria: fresh cartilage*, frozen tendon*
– Bacteria, yeast : cornea*
* Reported in 2002, 2003, 2006
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Sources of Infections Transmitted by Tissue
Allografts from Deceased Donors
• Unusual bacteria acquired from tissue bank processing
environment
– Contaminated HBSS washing reagent: Frozen
pericardium
– Environment: Frozen tendon*
……………………………………………
* Reported in 2006
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
POSSIBLE INFECTION
Tissue transportation
Tissue recovery
Donation /medical
and social history
• Window period
• Cross-contamination
• False negatives at the end
• Human errors
•………
Tissue
implantation
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013
Donor suitability
Tissue processing
The risk of infectious disease transmission
from tissue allograft transplants is low and
mainly with fresh or minimally processed
allografts
Workshop on Quality Systems in Ocular Tissue Banking
Zagreb, Croatia January 2013