In their vaults there is no money or jewels, but tissues: corneas, epidermis, veins and arteries, bones, ligaments and rare blood. A (public) network throughout the national territory is our insurance.
As the weeks pass, they are gradually being discharged from hospital Niguarda of Milan the Italian boys injured in the fire Constellationsa Crans Montanalast New Year’s Eve. Of the 12 hospitalized, 5 remain, of which one will be discharged soon, as specified by the Milanese hospital.
Very young people with burns over a large part of their body who owe their lives to the grafts with which specialized surgeons replaced damaged or completely missing skin with healthy skin, allowing theirs to regenerate. A miracle made possible by the quantity of epidermis present in special public health facilities in which human tissues of all kinds are collected, preserved and distributed when necessary: musculoskeletal, such as bones, tendons, cartilage and ligaments. Oculars, like corneas. Cardiovascular, such as heart valves, arteries and veins, and finally cutaneous, such as the skin used for major burn victims.
The tissue banks and the national transplant center network
The so-called Tissue banksauthorized by National transplant center and organized in a network spread across the entire peninsula after the entry into force of the law 91 of 1 April 1999 in the field of organ procurement and transplants, they are specialized in the selection, collection, processing, conservation and delivery to the departments of tissues from cadaveric and living donors. The safety and quality of the biological material in custody are guaranteed by meticulous controls.
Currently Italy can count on 30 tissue banksof which 5 are dedicated to leather. By 2024 they had harvested well 93 square meters of epidermiswhich was the salvation of the young victims of the fire in Switzerland. «Among the tissues, the white skin transplant is the only one considered a life-saving intervention like a heart or liver transplant, because without it it is not possible to live, you have no other alternatives», explains the doctor Carlotta Castagnoliresponsible for Skin Bank of the City of Health and Science of Turin. «According to data from our institute, since we opened the Skin Bank the mortality of serious patients in large burn departments has halved. In 1998, in patients burned on 50, 60 and even 70% of the body, it was 24%. Today the death rates have dropped to 12%.”
The fight against time and the absence of blood rejection
Unlike blood, “Bank skin” does not have to belong to the same blood group as the recipient. The patient with severe burns is immunocompromised and has a slowed tissue rejection system. «The important thing is to operate on the badly burned victim immediately, as soon as he arrives in the emergency room. Because it is a fight against time”, he concludes Chestnuts. «The surgeon eliminates the areas of burnt skin while the damaged areas are covered with healthy skin taken from the patient himself, “shredded” into a net and made larger, even nine times the original size. On top of everything, to seal, the “Banca skin” is placed. This protects the underlying layers from infections and promotes the regeneration of the subject’s skin until healing. It takes time, but it’s worth it.”
With the introduction of electronic identity cardin July 2016, adult citizens were given the opportunity to register their consent, or refusal, to donate organs and tissues at the end of life. The choice is sent to Transplant information system which identifies the citizen as a donor. At any time, you can change your consent or dissent by going to Asl of belonging. A donor with his body saves and improves dozens of lives.
The sampling protocol and storage in liquid nitrogen
The tissues are collected, with full respect for the body, by specialized medical and nursing staff who work in highly sterile environments. Unlike organs, they can be removed up to 24 hours after death. Once collected, the samples are sent to the banks where the suitability of the donor and the biological material, which must be free of infections, is checked. Then, they are treated to prepare for the transplant and finally stored at low temperatures: the bones at -80°C while the skin at -189°C in liquid nitrogen.
According to the latest annual report of National transplant centerin 2024 tissue donations reached a record figure: 15,487 withdrawals with an increase of 2.7% and over 2,110 actual donors. These donations made it possible 25,872 transplants3.7% more than the previous year, mainly corneas and musculoskeletal tissue. The fact that corneal membranes, heart valves or portions of bones are not essential for survival does not make them less valuable than skin.
Bone reconstruction and recovery of joint motility
«Do we want to talk about how much the use of donated bone tissue can improve the quality of existence?», explains the doctor Giulio Maccauroprofessor of orthopedics and musculoskeletal system diseases at Catholic of Rome and medical director in charge of the complex orthopedics and traumatology operational unit of Gemelli Polyclinic. «Let’s think about the cases of “prosthesis revision” operations in which the cavities around the orthopedic implants that replace those that have become infected or worn need to be filled. Or in oncological resections. Again, to fill bone gaps that make the limb in general more fragile due to illness or trauma””.
Not only bone tissue but also soft tissue: «Tendons and cruciate ligaments can be used on the limbs and also on the shoulders, for example in case of failure of previous surgery. Orthopedic, oncological and even dental surgery is aimed at banks to reconstruct, graft or replace damaged ligament parts. The result is a total recovery of the motility of the treated joint.” Bone tissue can be taken from living animals, such as the head of the femur, or from cadavers, such as long bones or the pelvis. Soft tissue only from cadaver. «This is why the topic of donation is important», he specifies Maccauro. “Everything in the human body can be donated and everything can be of help to other people.”
Management of rare groups and excellent facilities in Italy
Even for transplanted bone tissue, it is not necessary to match the recipient’s blood group. Bone processing processes eliminate the donor’s blood cells, reducing the risk of rejection. So, everyone can receive it. Even those patients from “rare blood”one in 1,000, whose red blood cells present antigens that do not allow them to receive it from anyone else who does not have the same antigenic structure. Fortunately, in Italy there is also a protection in this sense, namely the Bank of blood components from rare groups in the Lombardy Regionbased in the immunohematology laboratory of the transfusion center of Milan Polyclinic. Active for over 15 years, more than 2 thousand units of rare or extremely rare blood are stored there. Alongside it is the Rare blood cell bank of Ragusa hospitalin Sicily and some regional ramifications.
