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RCA Success Story Tissue Banking Tissue Banking by Using Nuclear Techniques Tissue Bank for a Quality of Life Nearly 150 people died when fire swept a club in Quezon City in the Philippines, as the city readied itself for the Easter celebrations in March 1996. Yet the lives of many severely burned people were saved by using radiation sterilized tissue (amnion) dressings through the provision by the Philippine Nuclear Research Institute (PNRI) because the Philippines belonged to an RCA project that supported the operation of a tissue bank for a quality service to the patients. In Sri Lanka, the recently installed Colombo Tissue Bank has already began to provide radiation sterilized amnions to public and private hospitals in the nation thus contributing greatly to a quality health service. The IAEA through its technical cooperation programme Deputy Vice Chancellor, Professor Chong Chi Tat inaugurating the IAEA/NUS Regional Training Centre on 3 November 1997 has greatly supported the Colombo Tissue Bank for a better functioning. Now, the Bank provides about 250 pieces of irradiated amnion a month. The local needs are some 200 pieces a month. The rest is being sent abroad to meet urgent needs elsewhere. Similarly, the Bank processes and stores skin and bone tissues as well as brain and spinal cord membranes, intramuscular tissue, heart valves, arterial and cardiovascular graft materials. Apart from an installation and equipment support, the IAEA through the RCA programme provided the expertise to establish a total quality assurance system to maintain the manufacturing practices at the highest international standards, as well as training qualified staff to ensure that the activity is sustainable even after the RCA project ends. The RCA regional training courses on the various aspects of a tissue bank have played a pivotal role for this purpose. What is the Tissue Bank? Health care services to patients suffering from tissue damage and/or tissue loss rely on the availability of safe tissue allo-grafts for a transplantation. A tissue bank is a facility for procuring and storing human and/or animal tissue allo-grafts for use in orthopedic or plastic surgery. Tissue banks, like eye banks or blood banks, can supply a wide range of tissues for grafting including musculo-skeletal tissues (bone, tendon, cartilage, ligament), soft tissues such as amnion and skin and others including Multi-Media Curriculum on Tissue Banking produced by NUH Tissue Bank with grant rom NSTB cornea, heart-valve and nerve tissues. Many disabilities can therefore be cured by the grafting of human tissues with the result that afflicted individuals can resume normal and productive lives. For millions of severely burned, injured and disabled people around the world, tissue grafting or transplantation opens up an opportunity for a new quality of life. The process relies on the use of sterilized bone, skin, and other tissues to heal serious injuries and wounds. Radiation Sterilizations is the Key Whereas artificial devices are designed to simply replace damaged tissue, grafts of a real tissue actually induce a growth of a natural replacement material by the host body. Various steps are involved in the use of tissues for grafting: collection or harvesting of the tissue, processing and sterilization. Sterilization is extremely important. Tissues for grafting must be sterilized. Steam and chemical methods have been used in the past but the method favored for most tissues today is the radiation sterilization. The radiation sterilization, mostly using gamma rays from a Cobalt-60 Practical Hands-on Session for Tissue Bank Operators during first Diploma Course held in November 1997. source, can sterile unnecessary germs and bacteria in the tissue without having any physical and chemical influence. How the IAEA/RCA Supported the Tissue Bank Programme? For years, the IAEA has worked with key international organizations to help bring tissue bank technology to where it is most needed. Its radiation and tissue bank programme bring experts together, and is an effective avenue for channeling help to national health authorities in establishing tissue banks, training associated staff, and developing standards and regulatory guides. Health care services to patients suffering from tissue damage and/or tissue loss rely on the availability of safe tissue allo-grafts for transplantations. The IAEA/RCA has provided considerable support in this field to countries in the Asia and the Pacific region through national technical cooperation projects and through the RCA project. The IAEA programme began in Asia and the Pacific region with a single tissue bank in Myanmar in 1983. The IAEA has subsequently supported the development of another 17 tissue banks in the region. These have catalyzed the growth of tissue banking in the region and there are now nearly 70 tissue banks in the region associated with the programme. Developing countries have to import sterilized tissue allograft at great cost for use in transplant surgery (in orthopedic reconstruction, treatment of cancer, trauma and high velocity impact damage), the treatment of burns, leprosy and intractable skin wounds and pressure sore ulcers. It is out of the question for all, except for the very rich countries to purchase a femur to save a limb at USD 10,000 or 30 grams of bone chips at USD 3,000 to fill a hole in a bone cavity caused by a tumor. With the improvement of the health sector in the developing countries in the last 30-40 years, more and more patients have been treated by using sterilized tissues imported from developed countries at a very high price, increasing significantly the cost of this treatment in the developing world. st Convocation Ceremony of 1 1998 Batch, 16 October Many developing countries are not in a position to cover this increased cost for the treatment of patients and have requested the IAEA for assistance to produce their own tissues, based on the IAEA experience in radiation sterilization technology, which was successfully developed to sterilize disposable medical supplies. This experience was considered by many developing countries as an important method to be used for the sterilization of their own tissues at a lower cost. Contribution by the RCA The RCA with financial and technical support from the IAEA has assisted in the establishment of tissue banks in the Member States and it has helped to apply the radiation surgery high (in sterilization orthopedic impact techniques of tissue grafts for use in transplant trauma reconstruction, treatment for cancer, and velocity damage), the treatment of burns, leprosy and intractable skin wounds and pressure sore ulcers. So far, 14 RCA Member States have participated in this initiative; Australia, Bangladesh, China, India, Indonesia, Japan, Republic of Korea, Malaysia, Pakistan, the Philippines, Singapore, Sri Lanka, Thailand and Viet Nam. Most of these countries are using radiation sterilization as a method of choice. Experts from Australia, Japan, European countries and Japan have assisted in the radiation sterilization of tissue grafts programme. RCA Regional Training Center in Singapore The biggest achievement of the RCA’s tissue banking project was the establishment of an IAEA Regional Training Center in Singapore in 1997 in cooperation with the National University Hospital (NUH). The Center trains the tissue bank operators in the RCA Region by providing adequate curriculum relevant to radiation sterilization and the operation of a tissue bank. It is a diploma course via a distance learning programme. In 2002, the IAEA/NUH Tissue Bank Training Center was reinstituted as the International Training Center for Global Internet Delivery of Training of Tissue Bank Operators by using the curriculum established by the IAEA and the National University of Singapore (NUS). The International Training Center covers 4 regions under the IAEA framework; Asia-Pacific, Latin America, Africa and Europe. The Bone Bank of the National University Hospital (NUH) of Singapore which has been functioning since 1988 was the first batch of the Regional Training Center for Tissue Bank. Benefits from Tissue Banking Presently, nearly all RCA Member States in Asia and the Pacific region can produce their own tissue grafts using radiation sterilization technique. This in turn enabled to save USD 450 million by replacing imported tissue, making allografts available in these countries for the first time and contribute to health care. The IAEA/RCA programme on tissue banking was initiated over a decade ago, and today extends to more than 30 countries. As experience has been gained through the IAEA/RCA programme, the growth and output of the tissue banks have been exponential. Through the programme, an amplified training for personnel responsible for procurement, processing and clinical application has been carried out. Up to the year 2001, the programme had helped to produce more than 220, 000 tissue grafts with a value of USD 51 million. Through the programme, countries have realized huge savings in tissue importation costs, and surgeons in developing countries learn new grafting methods, radiation sterilization techniques and thus patients get a better health care and lives are saved.
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