Educational Administration: Theory and Practice

2024, 30(6), 914-924

ISSN: 2148-2403
https://kuey.net/ Research Article

Skin For Life: Skin Donation And Skin Banking

Ameeta Verma1*
1*
Research Scholar, CT University, Ludhiana, Punjab.Prof. (Dr.) Simranjeet Kaur Gill 2, Principal, School of Law, CT University, Ludhiana, Punjab.

Citation:Ameeta Verma, (2024)Skin For Life: Skin Donation And Skin Banking,Educational Administration: Theory and Practice, 30(6),
914-924, Doi: 10.53555/kuey.v30i6.5398

ARTICLE INFO ABSTRACT

Donate Skin Save Lives. The body’s main defence mechanism is its largest organ, the
SKIN, which is destroyed in burn cases and leaves the body vulnerable to infectious
invaders. Patients are at risk for infection, fluid loss and eventually death if the burnt
region is not immediately covered with appropriate skin substitutes. Use of Cadaveric
Skin (skin donated after death) improves the chance of survival by 50% as it shields burn
victims against infections and helps in faster recovery with less pain and fewer scars.
India, the second most populous country in the world has an estimated annual burn
incidence of 6-7 million, which is the second largest group of injuries after road
accidents and most of them are from the lower or middle income group. Therefore, it is
essential to develop a cost-effective method of treating the affected population. In such
situation, cadaveric skin harvested from the deceased person is the efficacious and most
suitable option, in contrast to synthetic skin substitutes. Despite being a temporary
covering such skin is crucial since it promotes the reproduction & growth of the patient’s
own skin. Many patients who could not have been saved without cadaveric donor skin
can be saved now. Hence, the Skin Bank is a beneficial fortune for providing cadaveric
allograft skin. Voluntary Skin Donation and Skin Bank are the cornerstone of safe skin
transplantation. But due to lack of awareness of this facility and shortage of enough
banks in our country, we are losing patients everyday. According to the report of
National Crime Records Bureau (NCRB), 2020, thirty-five Indians died in fire accidents
daily between 2016 and 2020. Skin transplantation is not limited to the cases of burn
accidents, but with the country's changing health needs and evolved facilities, this has
expanded to cover the patients being treated with critical skin issues, acid attack victims
and similar interventions. But several reports have attested to a shortage of donor skin
across the burn healthcare facilities in India. Therefore, the purpose of this study is
twofold, firstly to assess the knowledge of Skin Donation and Skin Banking among the
general population and secondly, to enhance the need of skin donation and skin bank to
ensure its accessibility and availability at the point of demand. “After all every life
counts.”
➢ Methods: A validated self administered questionnaire based study was utilized to
acquire assessment of the adult general, population knowledge, awareness and
attitude toward skin donation, to help solve skin shortages due to lack of skin banks
in India especially in northern region. The participants of 57 were selected randomly
in selected urban cities of Northern India Data was collected by using semi-
structured knowledge questionnaire, which consists of 15 questions of knowledge
regarding Banking and Skin Donation.
➢ Results: A total of 57 individuals completed the questionnaire over the period of two
months from June till July, 2022. The study shows that, out of 57 people, 79% had
inadequate level of knowledge, 21% had moderate level knowledge, and none of
them had adequate level of knowledge and Awareness regarding skin banking.
➢ Conclusion: The analysis of the study indicates that there is a lack of sufficient
knowledge and awareness regarding the life saving concept of skin Donation and
Skin Banking. Thus, the study emphasizes the need of active support and
participation of the health-care professionals, educational Institutions and the alert
citizens in raising the public awareness regarding the Skin Donation and Skin
Banking, which can help in saving lives of several young and productive members of
our society.

Copyright © 2024 by Author/s and Licensed by Kuey. This is an open access article distributed under the Creative Commons Attribution
License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
915 Ameeta Verma / Kuey, 30(6), 5398

Key Words: Awareness, Burn, Skin Donation, Skin Banking, Cadaveric Skin.

INTRODUCTION

“We Make a Living By What We Get,

But We Make a Life By What We Give”
--- Sir Winston Churchill
BURNS are a serious health problem that are a significantly affect various sectors of the population and range in age
and severity. A sizable portion of the patient's skin may suffer serious damage as a result of burn injury. Thus, the
treatment of deep and extensive burns requires expertise. The optional method of treatment for severe skin burns is to
perform an autologous split thickness skin graft (STSG) donated from a body part with intact skin.1 However despite
total tissue compliance which should be considered the main advantage of STSG, such graft have a number of
disadvantages and limitations (e.g. creation of a new wound-donor site, infection risk, pain, scaring etc).2Burns also
represents an extremely stressful experience for both the burn patients and their families.3 In this aspecthuman allergenic
skin transplants play a critical part in the care of burn patients and skin banks may be one of the essential institutions in
that care. The cadaveric donor skins used as a temporary dressing for severe burns patients who do not have enough
healthy skin on their body that the surgeon can use as graft onto their wounds.4 The donated skin helps relieve the
patient’s pain and discomfort, prevents risk of infection and minimizes fluid loss and the hospitalization time.5Thus, the
skin bank and skin donation has high benefit to the mankind by providing cadaveric human skin which can make the
treatment easy,safe and economical for the burn patients. However in a developing nation like India there are serious
gender based

social inequities,about 7 million people suffer from burn injury every year and of which 1.4 lakh people die.6 According
to the Union Ministry of Health (Govt. of India) around 4 out of 5 burnt cases are of women & children. 7 70% of the
burn victims are in most productive age group of 15-40 years and most of the patients belong

Burns Scenario in India

to the poor socio-economic group.8 Accidental burns occur due to cooking in open fire, cooking on floor, kerosene stove
and not taking necessary precautions at home and work spot. Non-accidental burns occur as a result of bride burning,
personal disputes, child abuse and acid attacks. Due to severe burn/chemical injuries, they require multiple surgeries and
prolonged rehabilitation.9 Out of 10% of these which are life threatening around half succumb to death. 10 Despite many
medical advances, burns continue to remain a challenging problem in India, due to lack of infrastructure, trained
professional, the increased cost of treatment as well as an inadequate number of skin donors which in turn results from
the current Indian tissue donation system.11 All those who can donate eye, can donate their skin too but because of lack
of awareness and such facilities, the skin donation has not picked up in our country, especially in Northern India where
unfortunately not a single skin bank has been established yet. Therefore, the organizational, legal and systematic
changes are required to improve the situation in Indian transplantology with particular emphasis on skin donation.

OBJECTIVES OF THE STUDY

• To assess the knowledge and awareness on the concept of skin donation & skin banking among the general
population.
• To emphasize the important role of human allergenic skin transplants in the treatment of burn patients.
• To enhance the need for more Skin Banks in India.
• To identify the potential reasons for the low rates of skin donation in India.

METHODOLOGY:

A non-experimental descriptive research survey was used to assess the knowledge and awareness of skin donation and
skin banking among the general population in the northern region of India. The survey was conducted during the period
from June 2022 to July 2022, in selected urban cities of Northern India at Rupnagar, Ludhiana, Patiala, Jalandhar,
Ambala, Panchkula, Nahan, Nalagarh, Bilaspur, Nangal, Shri Anandpur Sahib including the UT Chandigarh. A total of
 Ameeta Verma/ Kuey, 30(6), 5398 916

57 participants were included in the survey which were selected randomly through convenience sampling method. A
semi-structured knowledge questionnaire comprising of 15 questions, was used as research tool in this study. The
instrument was selected, based on the various review and consultation with the experts. Hence, the tool was considered
to be most suitable for getting the participants to respond. The study population was consisted of 12 advocates, 9
teachers, 3 principals, 5 nurses, 2 technicians, 4 hospital staff, 3 businessmen, 2 shopkeepers, 4 home-makers, 6 medical
students, 2 clerks, 3 drivers, 2 peons. The participants were assured that anonymity of each individual would be
maintained. After obtaining consent from the participant, the questionnaire was administered to them for 30 minutes.
The present study also included the literature search for articles related to human skin allograft use in burn care, skin
banks and glycerolized skin allografts through the text books, Indian& International Burn journals, legal journals,
statutes, reports of WHO, NCRB and NCBI (National Programme for prevention of Burn Injuries), newspapers, digests
and published statistics using Pubmed, Embase and Web of Science Data base.

INCLUSION CRITERIA: Willingness to participate

OUTCOME: The awareness on skin banking and skin donation with the general population was appraised by using of
the semi-structure knowledge questionnaire. The total sample size was 57. The majority of 45 (79%) had inadequate
level of knowledge. 12 (21%) sample was moderate and none of them had adequate knowledge level. Consequently, the
general public is regrettably largely ignorant of skin banking. The use of cadaveric skin graft for serious burns is a
newer concept in burn care management for the bay public. Therefore, the study affirms again the possible necessity of
building a new facility (Skin Bank) and recognition of life saving concept of skin donation should be taken into
consideration.

Table 1: Skin Donation Awareness Questionnaire

Name: _______________________________ Profession: _______________________________
Age : _______________________________ Email:___________________________________
1. Are you aware of Skin Banks? 9. Is entire thickness of the skin harvested?
a. Yes. b. No. a. Yes. b. No.
2. In skin banks, most commonly the skin is procured from 10. After a cadaveric skin is transplanted to a burn
patient
a Live donors. b. Cadavers. a. It remains there for a period of not more than 4
weeks.
c. Pigs. d. Goats. b. It remains there for a period of up
to one year.
3. In case of cadaveric skin donation, how many hours after c. It is permanently accepted by the patient's
body.
the death of the individual can skin be donated? d. It remains there for a period of five years.
a. Within 6 hours. b. Within 10 hours. 11. Skin is harvested from all the following parts of the
body, EXCEPT
c. Within 12 hours. d. Within 24 hours. a. Back b. Legs.
4. Is it necessary to transport the donor to the hospital after death? c. Thighs. d. Face.
a. Yes. b. No.
5. Which of the following conditions render an individual unfit 12. State if true or false- There is bleeding from the site
from where the
for skin donation? cadaveric skin graft is harvested, and there is
significant deformity
a Age less than 18 years. associated with a cadaveric skin graft
harvest.
b. Age more than 90 years a. True. b. False.
c. Diabetes.
d. Hypertension 13. If you/some one you know wants to donate skin, do you know
whom
6. The following conditions render an individual unfit for skin to approach?
donation, EXCEPT a. Yes. b. No.
a. HIV. b. Skin Malignancy. If yes, provide details
________________________
c. Septicemia. d. History of old trauma. 14. Would you like to donate skin?
7. How long can the skin be stored in the skin bank? a. Yes. b. No.
a. Upto 3 weeks. b. Upto 6 months c. Will make decision after more information.
c. Upto 1 year. d. Upto 5 years. 15. Would you like to receive informative emails on Skin donation
and
8. What kind of donor recipient matching is required for skin Burns management?
transplantation? a. Yes. b. No.
a Blood matching. b. HLA typing.
c. Age matching d. Colour matching
e. Anybody's skin can be transplanted to any one.
917 Ameeta Verma / Kuey, 30(6), 5398

Table 2: Level of Knowledge on Skin Banking

80%

60%

40%

20%

0%
79 % 21% 0%
Inadequate Moderate Adequate

Skin Donation Awareness Poster

HISTORICAL BACKGROUND
The first report of skin grafting dates back to the second century BC, when the Indian surgeon Sushruta used auto-
grafted skin for rhinoplasty.12 Skin autografting was first described by Reverdin in 1871.13 At the end of the last century
(1881), Girdner was the first to report the use of all skin to cover a burn wounds. 14 However, it wasn’t until 5 years
later that Thiersch described the histologic anatomy of skin engraftment and later popularized the clinical use of split
thickness skin grafts.15Until the beginning of the 20th century, it was not possible to bank skin because it was difficult to
maintain tissue viability. Modern skin preservation began with successful storage at +4°C and +7°C by Webster and
Matthew, respectively.16 After experiments with refrigerated cow skin, Webster managed to successfully store fresh
human skin autografts for 3 weeks. During World War II and the Vietnam War, numerous studies were conducted on
skin allografting to treat military burns and wounds.17However the first proper skin bank was the US Navy Skin Bank
set up in 1949.18 The first tissue bank in Europe, the Yorkshire Regional Tissue Bank, was established in England in
1960; the Dutch National Skin Bank in the Netherlands followed this, in October 1976. With the further evolution of
techniques to preserve skin, the Euro Skin Bank was opened in 1992. Overcoming all the hurdles, discouragements and
difficulties, the first deceased donor skin allograft bank in India became functional at LTM Medical College and
General Hospital, Sion, Mumbai on 24th April 2000 which was the only skin bank till 2009. In 2009, a collaboration of
the National Burns Centre Mumbai, Rotary International, and Euro Skin Bank developed an effective model of skin
bank and started functioning in 2013.19 Other skin banks working are at Choithram Hospital, Indore; Ganga Hospital,
Coimbatore; Government Stanley Hospital, Chennai; Orange City Hospital, Nagpur; Right Hospitals, Chennai, Surya
Sahyadri Hospital, Pune; and Victoria Hospital, Bangalore, Cuttack, Bengaluru, Rajkot (Gujarat).20 Despite this there is
not a single skin bank in Northern India. .

SKIN DONATION

Donating a person's skin after the death is known as skin donation. Skin is the largest and only organ in our body that
can repair itself, which protects us from harsh external conditions.21 It also regulates the temperature of in our body. But
if it gets burn then the skin loss its capability to repair itself. If the burnt area is not immediately covered with some skin
substitutes then patients are prone to infection, fluid loss, dehydration and ultimately death. 22 In India 100% mortality is
observed in patients having more than 60% burns because patient's own skin is not enough to cover the burnt areas. In
such scenario, human allograft is the best option. 23 These allografts can be taken from the living donors but it is very
 Ameeta Verma/ Kuey, 30(6), 5398 918

painful to take out the skin and leaves some scars behind.24 Hence, Cadaveric skin is the best alternative which can
cover the burns wounds although temporarily but will be instrumental in saving the life of such patients .Around 80% of
such patients can be saved, if we have enough skin in skin bank.25 Anyone can donate skin since there is no cross-
matching required. Hence, donated skin is the way to help promoting wound healing. 26
“When you donate eyes, you give sight when you donate skin, you give life”

WHY SKIN DONATION IS SO IMPORTANT

• Skin is usually donated to burns, diabetic, trauma and acid attack patients.
• Donating your skin after death saves lives of at least two burn patients.
• The applied skin serves as a biological bandage for the patient.
• It resurfaces the exposed body and prevents the entry of bacteria.
• Controls the loss of protein, heat and fluid from the body.
• Give patients enough time to develop own skin.
• Anyone can donate skin as there is no cross matching of blood is required.
• Lesser hospital stay.
• Cost of treatment goes down
• Reduced pain
• Increase survival rate.

HOW AND WHEN CAN ONE DONATE SKIN?

Anyone can donate skin after the death irrespective of sex & blood group, the minimum age of the donor should be 18
years but there is no upper age limit, even a 100-year old person can donate the skin and it will be used for the
treatment.27 Skin can be donated within 6 hours from the time of death. But, skin of persons suffering from AIDS,
Hepatitis B&C, Sexually Transmitted Diseases, Skin Cancer, Active skin disease and septicemia are considered unfit for
donation. At the time of skin harvesting, blood sample from the body of the deceased is also taken and necessary test for
HIV, Viral markers & Hepatitis is carried out at the Skin Bank.

SKIN PROCUREMENT
Skin harvesting procedure is very simple but standard protocol for graft-harvesting methods has to be followed. It is
performed by Skin Donation Team consisting of one doctor, two nurses and one attendant. A special instrument called
DERMATOME harvests skin, it is a battery operated instrument made exclusively for skin harvesting only. 28 Skin
Bank Team will come to the donor’s home, hospital or morgue, wherever the donor is kept.There is no need to shift the
donor to the operating room, hospital or ambulance. The whole procedure takes only about 30-45 minutes.29 Skin is
harvested from both the legs, both the thighs and the back. There are only 3 layers of skin and only the 1/8th layer i.e. the
uppermost layer of the skin is harvested.30 In this procedure, there is no bleeding from the site where the skin is
harvested from and there is no disfigurement to the body also. After the procedure, the team bandage the parts from
where the skin is removed in a proper way. 31 It is not even visible to persons who come to pay their homage. The grafts
919 Ameeta Verma / Kuey, 30(6), 5398

are transported to the skin bank in Phosphate buffered saline in glass containers placed in ice box along-with blood
sample. About 10cc of blood of the deceased is collected at the same time for serological testing. 32

Graft taken form patient’s healthy Skin is Meshed to cover a large Once the skin is harvested, the area
skin by Dermatome wound. is covered properly with bandages

LEGAL REQUIREMENTS
A doctor will take consent of the next of skin of the donor and also a witness is required to sign the consent form before
the start of the skin harvesting procedure. 33The whole procedure will be explained to the family by the Doctor. There is
no need to pay anything to the Skin Donation Team. Selling & buying organs is illegal.34 The death certificate has to be
produced and its photocopy will be evaluated by the team Doctor before starting the procedure. 35

THE SKIN BANK

The Skin Bank is a valuable resource in providing cadaveric allograft skin as a cover for partial thickness & full
thickness burn injuries.36 It is a place where skin collected from eligible deceased donor is processed and distributed as
per International Protocols. After recovery from a donar, skin is tested for infection, processed & frozen until needed.
Skin Bank is a service, it is not a product. It can only work with the cooperation & coordination of the people, for the
people. The skin bank team consists of counselor, contact person, response team including surgeon, assistant, helper,
supervising consultant, microbiologist or biochemist record keeper.37 Permission for establishing a skin bank with
procurement of deceased donor skin allograft has to be obtained from appropriate authority of the government. 38 Though
skin is an organ, split thickness skin graft (STSG) is considered as a tissue. Successful functioning of skin bank demands
constant vigilance, quality control & a team of dedicated members. Phases of skin banking establishment-
• Setting up the necessary Infrastructures and equipments.
• Recruiting manpower
• Creating awareness about skin donation
• Quality Management system for consistent quality.
• Retrieval Processing
• Medical documentation
• Storage.
“Unless we donate skin there is no value of skin bank, so please donate skin”

STORAGE OF HARVESTED SKIN

Initially the harvested skin is stored in 50% Glycerol for two hours at 4-6 degrees C for 2 hours. Then it is checked for
any infection and the put in 85% Glycerol for 3 hours at 33 degrees C in a shaking incubator.39 Then the skin is kept in a
freezer at 8 degrees C for 4-6 weeks until the serological reports are available. After 4-6 weeks the graft is transferred to
a bio-safety cabinet and made into smaller uniform strips. 40 The skin is then preserved in 85 per cent glycerol in a
temperature of 4 degrees and it is ready for use. The treated cadaveric skin has a shelf-life of four to five years.41The
stored graft is checked every 3 months for bacterial or fungal infections. The stored graft is used for treating patients
with damaged skin due to burns or injuries. 42
 Ameeta Verma/ Kuey, 30(6), 5398 920

Glycerol Allograft

THE REGULATORY AUTHORITY

Though skin is an organ, split thickness skin graft (STSG) is considered as a tissue. In India donation and transplantation
of human organs and tissues is governed by the TRANSPLANTATION OF HUMAN ORGANS & TISSUES ACT
(THOTA) 1994 and amended in 2011, in which tissues have been included along with the organs. This Act provides a
system of removal, storage & transplantation of human organs & tissues for therapeutic purposes & for the prevention of
commercial dealing in human organs, to guarantee the safety of indigenous allografts. In pursuance to the amendment
Act 2011, Transplantation Of Human Organs & Tissue Rules 2014 have been notified in March, 2014. National Organ
& Tissue Transplant Organization (NOTTO)is established under the Directorate General, Health Services as per the
mandate of the Act and as stipulated by World Health Organization guidelines, which function as apex centre for all
India activities of coordination & networking for procurement, distribution, registry & transplantation of organs &
tissues in the country. Regional Organ & Tissue Transplant Organization (ROTTO) are identified institutions which are
champions in the field to take care of a group of state. State Organ & Tissue Transplant Organization (SOTTO) is an
institutional mechanism to support the states. Registration of tissue banks, compliance with the national standards & the
appointment of transplant coordinators in hospitals registered under the act are now mandatory. Being a member of Asia
Pacific Burn Association (APBA) had adopted a new set of harmonized guidelines for skin banking in Therapeutic
Application in 2019, which offer a comprehensive manual, addressing, governance & contracts; staff responsibilities;
quality management; facilities; equipments & supply management; donor consent, testing and recommendations of good
practices pertaining to skin recovery, processing, storage & distribution. 43

SKIN DONATION AND SKIN BANKING: GREAT NEED OF THE HOUR ESPECIALLY IN NORTHERN
INDIA.
India witnesses an average of around 7 million burn trauma cases each year. Burn related mortality is very high due to
lack of allografts leading to high infection rates and most patients require skin grafting. But only 2% of the requirement
is fulfilled here.44 According to the reports45 from 2011 to 30th Sep. 2019, skin donation after death has been received
from 900 donors. The donation was procured from 478 men & 422 women. The procurement was within six hours of
death of majority of donors. Till date the skin allografts have been used for 869 patients all with burn extent of more
than 40% total body surface area. Despite this, India has only 16 skin banks and out of which there are only two
government backed Skin Banks – one is Sion Hospital, Maharashtra & other at Bangalore Medical hospital. Awareness
also plays an important part in ensuring that people donate skin but we are lacking on that part as well. Why is there still
no active involvement by the state to address the acute lack of publically supported mechanism for skin preservation and
usage, when immediate surgeries have the capability to save lives? 46 Why the victims do not receive high-quality
treatment without having to travel more 1,000 mils or shilling out the entirety of their savings? The prohibitive cost of
treatment and rehabilitation and most victims being poor explain the gross shortage of specialized skin banks along with
the burn units in government sector and reluctance on the part of the private players to share the burden. As per the
National Crime Records Bureau (NCRB), eastern regions have the highest incidents of acid violence accounting for
nearly 37%, southern region with 15%,Northern region with 35% and western region with 13%. Regardless of this, there
was not a single Skin Bank in Northern India until 2023 and the knowledge regarding the concept of Skin Donation is
very poor among the general population there. The recent rise in the incidents of terror activities and manmade disasters
contributing to quantum jump in Burn injury cases, also calls for the national preparedness to cope up with the challenge
of this public health problem. Thus, there is “An Urgent Need To Establish Skin Banks” in each and every part of our
country which can save the lives of thousands of people and offer them a much better quality of life-
• Half of the burn patients who are dying now can be saved if more skin banks are established in the country to collect
more skin for covering extensive burn wound after early excision.
• The skin allografts in the skin bank act as the most effective dressing and a barrier to infection & the rate of infection
is reduced significantly.
921 Ameeta Verma / Kuey, 30(6), 5398

• Early removal of dead skin and homografting will lead to quicker healing with less scar.

THE POTENTIAL REASONS FOR THE LOW RATES OF SKIN DONATION

Donating Organs is a kind deed that demonstrates our concern for our fellow humans who really need these organs. In
an ideal situation, giving an organ is purely a selfless act, with no ulterior intentions on the part of the donor. India
culture takes pride in ethical principles like altruism and selflessness. 47 This is depicted by a well known mythological
story of the sage ‘Dadhichi, who donated his bones for making weapons in order to help the Gods to defeat the demons
and reclaim the heaven. 48 In another mythological tale, King Shibi donated his own flesh to a hawk in order to save the
life of a dove. 49 King Shibi also offered both his eyes for the restoration of a blind man’s sight. There are countless such
instances support the idea that India culture and values favour organ donation. But the actual organ donation rates of
0.16 per million population in India are immeasurably low as compared to America and Spain. 50India has high incidence
rate of burn injuries about 7 million each year& most of the burned victims require skin grafting but only 2% of the
requirement is fulfilled. Therefore, in such grim situation ,it is essential to identify the reasons for the promotion and
positive growth of skin donations and skin banking-

• Lack of awareness among the general population: Lack of knowledge and awareness appears to be the most
important factor for the low skin donation rates in India. The organ donors come from the society. The knowledge
,socio-cultural views and awareness among various population groups in the society shape the attitudes of people
toward the concepts of skin donation & skin banking. People in India know about various organ donations like eyes,
blood, kidney, liver, heart but they are not aware that they can donate their skin too. For the lay people it is an alien
concept.
• Religious beliefs and superstitions. Different religious beliefs and myths are the reason for the acute shortage of
human allografts in our country. There are various misconceptions related to disfigurement and religious faiths that
need to be addressed.

• The geographical distribution of these skin banks & services availability are uneven and heterogeneous51-
Despite the scenario of high rate of burn injuries and mass fire disasters and mortality, India witnesses only 16 skin
banks in the entire country. Unfortunately, there is not a single skin Bank has been established yet in the northern
region.

• There is no active involvement of the government to address the acute shortage of skin donations- In most
countries in the world skin donation is linked with organ donation program and hence comprehensive counselling is
undertaken. Unfortunately, such program does not exist in our country till today. The efforts on the part of the
government in the awareness and promotion of skin donation is relatively lacking.

• Lack of infrastructure and trained professionals- Despite many medical advances the minimal rate of skin donation
continue to remain an intricate issue in Indian burn healthcare program, due to lack of infrastructure and trained
professionals.

• The time period between death and the final rites: Donor families who have lost a close relative are often anxious
about the delay in conducting last rites of the patient. The family sometimes is very concern about the delay.

• The non acceptance of brain death as death52- Estimates show that 4 lakh people die every year while waiting for an
organ transplant. Organs can be harvested from a patient who has been declared brain dead but doctors find that
relatives often confuse brain death which is irreversible with the state of coma, which can be reversed. Another bigger
problem is the inability of the hospitals in identifying, certifying and maintaining a brain-dead patient.

• The need for transplant coordinators is critical: The transplant coordinator needs to address concerns and counsel a
potential donor family.

• Lack of faith & trust of people in the Indian healthcare system. This is a serious issue and needs to be addressed
because the faith & trust of people are very important for the success of any healthcare program or initiatives.53

• Dismal on the part of the family of the registered when actual time for skin donation comes: There is a huge
difference between what people feel or say about skin donation and the actual behaviour when such a situation
arrives. In the most incidents there is dismal on the part of the family of the registered donor when the time for actual
skin donation arrives.

CONCLUSION

Organ Donation is the biggest contribution to the humanity. It not only save lives but also touches and changes the other
lives associated with the one who receives the organ. The greatest post- death gift is actually organ donation, which
 Ameeta Verma/ Kuey, 30(6), 5398 922

allows one to continue to improve people lives long after their earthly existence have ended. There are several types of
organ and tissue donation. Donation of eyes and blood has become a widespread practice, but people are still not aware
of skin donation. Highlighting and talking about such causes openly and even on public platforms will help spread the
word. Popularizing of skin banking in our country can be done through the following devised strategies-
• Through regular awareness programs at the medical institutions/colleges, educational institutions, at clubs, housing
societies, cultural or religious gatherings, BSF functions, corporate offices, the courts, banks and the public places &
social service organizations.
• Brochures, posters flipcharts, power point presentations, education films, articles in print media, television interviews,
radio talks, information Kiosk during trade fair, Walkathon, newspaper advertisements, sending SMS to mobiles on
regular basis will create awareness among the public.
• Development of burn survivor community and their interaction with the public will be more effective.
• Multi-disciplinary partnership and participation of voluntary organization need to be coordinated. Every hospital
should have in-house skin banking facility. Several collection centres can be affiliated to each skin bank facility..
• Skin Donation must be linked with the organ donation program so that comprehensive counselling can be done.
• Burn care professionals should come together to formulate guidelines and to provide assistance in the establishment of
new skin banks. It is vital to ensure the quality in functioning of skin bank. So, the establishment of Tissue Bank
Association of India will be logical step in the right direction.
• The fundamental strategy to ensure timely access to safe and sufficient supply of human skin allografts is to develop a
national coordinated skin transplantation service based on voluntary non-remunerated skin donations.
• Teaching of patients and their relatives on a regular basis about deceased organ donation and urging them to
disseminate this knowledge further.
• Motivation of general public for organ donation by using interviews of actual organ recipients leading a normal life
following transplantation and acknowledging the ‘gift of life’ from an unknown donor. This may also be helpful for
the donor family to cope with the grief.
• Healthcare institutions and Zonal Organ Donation banks in our country should use these methods to spread awareness
regarding skin donation.
• Involvement of popular television and film celebrities for spreading awareness. Introducing storylines bout skin
donation into the popular television programs and films are other important strategies that may help improve the
donation rates.
• There must be active participation of the government to promote skin donation in India.

Hopefully through these strategies the rate of skin donations can be increased & will also helpful in the establishment of
more skin banks in the entire country. This will improve the survival probability of the patients with large burns. Thus,
we all need to join hands to ensure that we can save as many lives as possible and help their meaningful return to the
family and society. India is able to set off on a path to a developed and comprehensive strengthened health system that is
based on local needs with a holistic approach by ensuring attention to each and every component of the healthcare
system.
“Be remembered forever for the noble path you’ve paved,
Be remembered forever for the lives you’ve saved”.

End Notes
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Suishchev AV. The use of cadaveric skin in the treatment of wounds. Transplantology. 2018; 10(4): 327-335.
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2. Strong DM, Nather A(eds.) Advances in Tissue Banking, Vol.2. Singapore: World Scientific, 1998, 1-19. Google
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admitted in burn unit of a rural tertiary teaching hospital Pravara Med Rev 2010;2:11-7
4. Chau A et al. The impact of skin banking and the use of its cadaveric skin allografts for severe burn victims in
Singapore. The National Center for Biotechnology Information advances science. Vol 30(7)> Page No. 696-700,
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5. ibid
6. WHO Global Health estimates: Leading causes of death, 2020 available at
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7. https://www.researchgate.net/publication/338615407-National -programme-for prevention-of-burn-injuries.
8. S.M. Keswani, etal,, skin Banking at a regional burns centre-the way forward, Burns, https.//
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9. available at https.//www.organindia.org/ORGAN-DONATION/saving-your-skin/
10. skin donation-National Burns Centre. https.//www.burns-india.com/skin-donation.
11. https://www.dailypioneer.com/com/2022/india/india-for-behind-in-organ-donation-lack-of -awareness-legal-
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12. Hauben, DJ, Baruchin A,MahlerA. On the history of the free skin graft. Ann Plast Surg. 1982; (3): 242-245.
923 Ameeta Verma / Kuey, 30(6), 5398

13. Tognetti L, PianigianiE, Ierardi F, Mariotti G, Perotti R, Di Lonardo A, rubegni P, Fimiani M Current insights into
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15. Supra Note 13.
16. Mathews ON. Storage of skin for autogenous graft, Laneet. 1945;2:775+758
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20. Fd
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