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Japan facing critical shortage of donated skin for life-saving graft operations

Kyodo

A national skin bank is facing a critical shortage of donor skin for grafts for patients with severe burns.

Hospitals and other institutions involved in skin grafts are seriously concerned and are making efforts to raise public awareness in an effort to increase donations, which are harvested from donors after death.

“The problem is, there aren’t enough donations,” said Hiroaki Nakazawa, director of the Japan Skin Bank Network.

Nakazawa, a professor of plastic surgery at Nihon University, said that due to a lack of donor skin, only limited amounts of donor tissue are used during surgery. The shortfall is made up by using artificial skin.

There are no such shortages in the United States and Europe, Nakazawa said.

Skin grafting provides patients suffering severe and extensive burns with temporary cover, protecting against infection and allowing the tissue below to heal.

If a patient’s dead skin is not replaced, it can cause bacterial infection that can spread all over the body, allowing body fluids to evaporate, resulting in death due to a rapid drop in blood pressure, blood poisoning or multiple organ failure.

A few weeks after the skin graft, the donor tissue is rejected by the recipient’s immune system, at which point the grafted skin needs to be replaced by an autograft — or healthy skin taken from the patient’s own body.

In recent years, the number of skin donors has decreased substantially. Only one case of skin donation was reported in 2016, compared with an annual total of 20 to 40 donations between 2007 and 2012. Donations fell below 20 in 2013 and 2014 and dropped to five in 2015, according to the network.

The number of burn patients receiving skin grafts has also fallen due to the shortage of donors, it said. Over 70 burn patients received skin grafts in 2007, but only 19 did in 2015, and the number dropped to five in 2016.

The national organization, which collects donor skin and freezes it, was established in 2004. It had 82 member institutions as of April 2016.

The network said skin can be donated just like other organs, such as the heart, liver and eyes, but public awareness of skin donations remains low.

“Although artificial skin today is of high quality, it is still not as functional as human skin,” said Hiroto Ikeda, associate professor in emergency medicine at Teikyo University.

A survey conducted on 7,000 severe-burn patients by a Tokyo-based network of burn treatment institutions between fiscal 1983 and 2002 showed that the survival rate among those who had skin grafts was higher than those who did not.

Skin grafting had an especially significant effect on those with burns involving 40 to 69 percent of their bodies, according to the Tokyo Burn Unit Association.