Information for Graft Recipient Patients

“Because of deformity of bones at birth I required my first hip replacement at 41 years of age and my other hip when I was 49. Unfortunately both hip replacements have been revised and needed bone graft from the bone bank. Without the bone graft I would have been confined to either a bed or a wheelchair many years ago.”

 Ted Ellery – Bone Graft Recipient

“Ashleigh was first diagnosed with a significant scoliosis in April 2006. She collapsed while she was practicing for a gym competition and her back went into a serious spasm. Even though she had been a competitive gymnast since she was 6 years old, this was the first indication that there was anything wrong with her back.

From that time she seemed to be in constant pain. She wore a brace for 12 months and in that time her curvature improved, however after only 24 hours out of the brace, the lumbar curve had collapsed again.

 Ashleigh underwent a posterior spinal fusion ( T9 – L4) which was a huge success. Just over a year later she is doing really well, finishing year 12 and getting as fit and strong as she can.

 If Ashleigh had not had access to the bone bank for the bone grafts needed in her operation, her family have no doubt that her recovery would have been much slower and more difficult.”

Ashleigh & Jennifer Bester

Some surgical procedures require the use of bone or tissue grafts. In some instances your surgeon may be able to use your own bone (autograft) for your surgery; however for complex procedures a donated graft (allograft) may be required, and your surgeon will request this from the Perth Bone & Tissue Bank.

The use of allograft (tissue donated by another person) is necessary due to the limited availability of your own bone.  It can eliminate the necessity of your surgeon performing a second operation to retrieve your own bone, which reduces the time under anaesthetic, pain from the second surgical site, loss of mobility, and risk of infection at the secondary site.

What is the Bone & Tissue Bank?
The Perth Bone & Tissue Bank is a not-for-profit institution which co-ordinates the collection, screening, storage and distribution of donated human bone and tissue graft materials for surgical procedures.

All Australian Tissue Banks are regulated and licensed by the Therapeutic Goods Administration, which is the auditing body of the Commonwealth Department of Health and Ageing.

Where does the graft material come from?
You may be aware that many people choose to donate their organs and tissues. There are two types of bone donation:

• Patients having hip replacement surgery can donate the ball part of the hip joint (femoral head).
• During their lifetime, people may indicate a wish to donate organs and tissue.  These otherwise healthy people may become donors as a result of an unexpected death. With the consent of their next of kin, they can donate musculoskeletal bone and tissue (long bone and associated tissue such as tendons, ligaments & fascia) after death.

How can donated bone & tissue be used?
Donated bone is very valuable for use for patients who may require a bone graft e.g. for bone tumour surgery, spinal surgery, hip revision surgery and a variety of general orthopaedic procedures.  Bone graft can be used in many ways to aid patients who have bone defects.  Use of tissue grafts such as tendons, ligaments and fascia are also common.

It is not necessary for the donor and recipient to be tissue matched as is needed for the transplant of organs.  However, the Rhesus factor is matched where possible for female recipients of child bearing age.

Bone grafts are often used in conjunction with prosthetic implants such as metal hip implants, plates & screws.  Once implanted into the recipient, the bone graft does not grow, but can stimulate the recipient’s own bone to grow into the graft to repair areas of lost bone.

How are donors screened?
There are strict donor selection criteria and regulatory controls related to the screening and testing of donors and donated material.
A thorough review of the donor’s medical and social history is obtained.
A variety of laboratory specimens are collected from the donor for routine testing, to exclude infectious diseases.

The donor’s blood is tested in the Laboratory for a wide range of diseases including:

• Syphilis
• Hepatitis B & C
• HIV (AIDS)

Swabs and bone chips are cultured to ensure that there has been no contamination during the collection process. a bone chip is also examined by a Pathologist to exclude any diseases which could be transmitted.

Donated bone & tissue is frozen at -70^°C awaiting clearance from the Laboratory.  In some instances, tissue is processed in our clean room to produce special types of graft which meet surgical requirements and to reduce wastage of this prescious material.

Processing involves removing soft tissue from the bone under strict environmental controls, then cutting and packaging it into individual graft items. Checks for microbial contamination are conducted throughout processing, then graft is irradiated as the last processing step, before release for transplantation.

What is the risk of transmission of disease?
Bone graft procedures are very common.  The demand for human graft materials is growing, and bone & tissue donations assist many patients undergoing complex surgical procedures, thereby improving mobility and function.
There is a remarkable record of safety with tissue grafts, and strict regulatory controls monitor the donation and transplantation of tissue in Australia.

Although rigorous steps are taken to ensure screening, testing and processing are performed according to strict guidelines, there remains an exceedingly low chance of disease transmission.

Consent to receive graft material.

Your Surgeon, or a Doctor in the Hospital, will discuss the use of graft for your operation with you.

You will be required to read and sign a specific form to consent to receive graft . The Bone Bank will not provide graft for your surgery unless this consent is completed.

If you are uncomfortable with any detail in the consent form, or have any questions, you should discuss this with your Surgeon.

What happens to the graft after the transplant?
Bone and tissue grafts do not grow; they are incorporated into the recipient’s body by a process of conversion into new bone or soft tissue.

Will I have to have to take “immunosuppressant” drugs after the surgery?
Unlike patients who receive organ transplants (such as kidney or heart transplants), it will not be necessary for you to take any medications specifically related to tissue rejection.
You may however be prescribed other medications such as antibiotics following your surgery.

Is there any cost associated with receiving a graft?
There is no payment made to the donor or donor family for the donated material, nor is there any cost to them.

Australian Law prohibits the sale of human tissue. However, a “fee for service” is approved by the Commonwealth for each graft transplanted. Graft fees are fully recoverable through the private health funds, or through Medicare if the surgery is done in a Public Hospital.

Fees for the supply of graft items incorporate the many costs associated with providing the material, including laboratory costs, operational costs including maintenance and operation of our clean air processing room, consumables used in the retrieval and processing of the graft, regulatory and quality system costs, and administration costs such as staff wages and professional indemnity insurance.