Tuesday 16 August 2016

Singapore in need of local skin donors

Many not aware skin can be donated upon death and that donated skin can save lives
By Seow Bei Yi, The Straits Times, 15 Aug 2016

More people in Singapore are donating their skin but there is still a shortage of local donors for those who need grafts after serious burns.

Locally donated skin comprised just 18 per cent of skin transplants last year. The deficiency, thus far, has been met by tissue banks abroad such as the Euro Skin Bank and others in the United States or Canada.

But this means Singapore may find itself short of skin at any point, when these nations have to meet their own needs following crises such as massive fires.

Now, the Singapore General Hospital (SGH), which houses the local skin bank, aims to raise the proportion of locally donated skin to more than 50 per cent in the near future.

It said it will continue working with the National Organ Transplant Unit and Health Ministry to raise awareness of the importance of skin donation but gave no further details.

One key challenge is that skin donation is not covered by the Human Organ Transplant Act, under which organs such as kidneys may be harvested unless people opt out.

Interested skin donors must opt in or have their skin donated by their next-of-kin upon death. But relatives often do not feel comfortable doing so.

Last year, 13 of 220 patients admitted to SGH for burns had injuries affecting over 40 per cent of their body, requiring donor skin.

Such a patient usually needs more than what one donor can provide, and yet, there were just three Singapore donors in 2013. This jumped to 18 two years later.

It is a slight improvement over the 71 donors from 1998 to August 2011 - in what has been described as a critically low level.

The uptick could be due to a new transplant tissue centre, said Dr Chong Si Jack, a plastics, reconstruction and aesthetic surgery consultant in SGH.

A merger between the SGH skin bank and the National Heart Centre's national cardiovascular homograft bank, it has allowed transplant coordinators to work together to secure more skin and heart valve donors last year.

Healthy skin is the ideal burn treatment. It acts as a temporary bandage to reduce dehydration and prevent infection.

It reduces mortality rate from 45 per cent to 16 per cent and cuts hospital stays by about 10 days.

When a severe burn victim is admitted, skin grafting is required typically within 72 hours upon removal of the burnt skin. This is why donor skin has to be available at all times.

Dr Chong attributes the low donation rate to lack of awareness. "Many people are not aware that skin can be donated upon death... and that donated skin is life-saving."

Sometimes, next-of-kin do not agree to donate a dead person's skin as they do not know of his or her wishes, or want to keep the body as it is, he said.

Pledges take years to yield donor skin

But, he added, an open casket funeral is possible as skin is usually taken from the back and lower limbs rather than exposed areas. The amount taken can be about the thickness of four pieces of paper, and the procedure causes minimal bleeding.

In Singapore, donor numbers are unlikely to change overnight as a pledge translates into donor skin only years later, said Ms Annabelle Ip, an SGH medical social worker.

Ms Emily Tan, also an SGH medical social worker, warned that while Singapore has a foreign supply of donor skin, this could lead to over-dependence.

"Skin is unlike other organs, where you have a transplant list... burns... can happen anytime."

• Anyone above 18 can complete an Organ Donation Pledge Form (www.liveon.sg) and submit it to the National Organ Transplant Unit.

Emotional support vital during long recovery
The Straits Times, 15 Aug 2016

A woman caught in a fiery accident last year recovered with the help of donor skin, a biosynthetic wound dressing and skin from her own body.

Ms Joena Shivani, 38, who had burns on 60 per cent of her body, was at a temple in January last year when her sari caught fire from an oil lamp. "It was immediate. The flames just shot up. I could feel a burning sensation," she said.

She tore off her flaming clothes but only her face and chest were spared. The welfare assistant had nine operations in three weeks, spent about two months in hospital and wore up to 20kg of bandages at one time. Sometimes she fell sick after people visited her. She said: "Without skin donors, it's hard to heal because of infections."

Besides learning how to walk again after her first month in hospital, she had to wear pressure garments to keep the skin from tearing. Her calorie intake was raised on doctor's orders as her skin needed nutrients to regrow, she said.

Over a year later, she is still undergoing the long recovery process burn victims face. "When people see burn survivors, they say we're okay as we're walking, we've recovered," she said. But the process extends well past the hospital stay.

Being introduced to the local Burns Support Group and seeing other survivors spurred her on. They assured her that, with proper care, her skin would look normal again in the long run.

Entrepreneur Jason Lim, 26, hopes to help patients with trauma and reach out to burn patients by sharing his story online. He too is a burn survivor. He was hospitalised for 44 days in 2014, after a road accident in Cambodia scorched about 20 per cent of his body, including his thighs, elbows and stomach.

"I didn't have trauma, but I know how it feels waking up in a hospital and having your life change," said Mr Lim, whose last memory before the accident was of cruising on a bike in Phnom Penh one night. He found himself in Singapore General Hospital a month later, with metal bars in his legs and burn marks on his body.

He said: "It's frustrating, and it's lonely. I felt no one could understand what I was going through. With support groups, you don't feel alone anymore. That itself brings so much healing psychologically."

• Watch Jason Lim's story here: http://www.jasonyolt.com/

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