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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      has    greatly     supported     the
                                                   Colombo Tissue Bank for a better functioning.
Deputy Vice Chancellor, Professor Chong
                                                  Now, the Bank provides about 250 pieces of
Chi Tat inaugurating the IAEA/ NUS Regional
                                                  irradiated amnion a month. The local needs are
Training Centre on 3 November 1997
                                                  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
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
                                                       Multi -Media Curriculum on Tissue Banking
grafting including musculo-skeletal tissues
                                                       produced by NUH Tissue Bank with grant
(bone, tendon, cartilage, ligament), soft tissues
                                                       rom NSTB
such as amnion and skin and others including
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 Ke y

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                source, can sterile unnecessary germs and
 Bank Operators during first Diploma Course           bacteria in the tissue without having any
 held   in November 1997.                             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

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.

 Convocation Ceremony of 1st Batch, 16 October        Many developing countries are not in a
 1998                                                 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     sterilization
techniques of tissue grafts for use in
transplant     surgery    (in    orthopedic
reconstruction, treatment for cancer,
trauma    and    high    velocity    impact
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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