31 Oct 2010
Much-needed donations have increased, thanks to joint effort by two agencies
Burn victims may urgently need skin donors to come forward, often as life-savers in severe cases.
But myths surround the idea of skin donation, to the extent that up to 70 per cent of Singapore’s stock of donor skin comes from Europe and the United States.
The good news is that skin donations here have gone up.
So far this year, 10 donors gave 13,500 sq cm of skin to 12 patients at the Singapore General Hospital (SGH) Burns Centre, the only specialised burns facility in Singapore.
This is a leap from 2007, where just one skin donation was made in a year when 17 burns patients needed grafts. In 2008, there were two skin donations when 19 needed grafts. Last year, six donors helped 15 burns patients.
The gradual increase in skin donations is a result of joint efforts between the Skin Bank and the National Cardiovascular Homograft Bank, the source for heart valves.
The two agencies work together as they often face shortages in donations. They felt that by working together they could pool resources to reach more potential donors.
Unlike “opt-out” schemes such as the Human Organ Transplant Act (Hota), the “opt-in” approach applies to certain organs such as skin and heart valves, and hence donations of such organs.
Under the Medical (Therapy, Education, and Research) Act – an opt-in scheme – people can donate organs and other body parts for research, education or transplant after death. This covers the donation of skin, heart valves and certain other body parts.
Hota’s coverage is limited to the heart, liver, kidneys and corneas.
Misconceptions, and a psychological barrier, over the donation process are the main reasons there are not more skin donors here.
People associate skin donations with disfigurement, but in fact there is none, said Mr Alvin Chua, principal scientific officer at SGH’s Skin Bank.
“Skin from 30 to 40 per cent of the body, from the back and lower limbs, are taken. Family members can indicate which areas they want to leave untouched,” he said.
Severe skin burn involving a celebrity was in the news recently.
On Oct 22, a mistimed explosion during filming in Shanghai caused Selina Jen of Taiwanese girl group S.H.E to suffer burns over 50 per cent of her body. Her hands and legs were most badly burnt, and her cheeks were blistered. The 28-year-old singer may need a skin transplant if it fails to regenerate.
Professor Colin Song, head of SGH’s Burns Centre and Department of Plastic, Reconstructive and Aesthetic Surgery, said the terms first-, second- and third-degree burns are no longer used as they are confusing. Instead, burns are simply classified as superficial or deep. A sunburn is an example of a superficial burn. A deep burn goes deeper than the epidermis, the most superficial layer of the skin.
Such burns injuries are termed superficial dermal, deep dermal, and full thickness. The dermis is the layer of skin after the epidermis. Skin transplants are for patients who have deep dermal to full thickness burn wounds.In the former, the skin has been burned halfway through the depth of normal skin. Full thickness burns means the skin has been burned all the way down to the fat tissue.
The two leading causes of death for burns victims are inhalation injuries, which occur when smoke from the fire is inhaled, and infection. The smoke, which contains many chemical toxins, gets into the lungs, causing damage, Prof Song said. Bacteria can take the opportunity to invade the body when that most effective of barriers against invasion by bacteria is damaged, he explained.
“Burned skin is a very rich medium for bacteria to thrive, which is why we’ve been practising the technique of early removal of burned skin, especially when the burn has gone deeper.
“That’s where the need for a ready stock of donor skin, which is used as a temporary barrier against infection, is important,” Prof Song said.
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Dept Of Plastic, Reconstructive & Aesthetic Surgery
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