542 Lessons Learned from Implementation and Management of Skin Allograft Banking Programs in Low- and Middle-income Countries: A Systematic Review

Abstract

Abstract Introduction Wound excision and temporary coverage with a biologic dressing can improve survival for patients with large burns. Allograft skin possesses many of the ideal properties of biologic dressings and can play a major role in the management of large burns when autologous tissue is not available or the patient’s condition does not allow safe autografting. Healthcare systems in low- and middle-income countries (LMICs) rarely have access to allografts, which may contribute to limited survival in large burns. Therefore, we aimed to describe the lessons learned from the implementation and maintenance of tissue banks in LMICs to guide system planning. Methods PubMed, MEDLINE, CINAHL, and World Health Organization (WHO) Catalog were systematically searched with database-specific headings and language to represent a priori terms (e.g., skin, allograft, tissue bank) and all LMICs as defined by The World Bank. Data regarding tissue banking programs (e.g., date of creation, location, lead agency, functions, products), governance, capital investments, safety, maintenance and operations, costs per donation, ethics and sociocultural issues were extracted and described in a narrative synthesis. Results The search returned 3,346 records. After eliminating duplicates and non-relevant records, 33 reports were analyzed. The synthesis represented tissue banks from 17 countries. Commonly reported barriers to ideal or planned implementation included high capital costs and operational costs per graft, opt-in donation schemes, and sociocultural stigma around donation and grafting. Reports repeatedly recommended: i) developing a legal framework for oversight, accreditation and ethical practice; ii) engaging diverse stakeholders (e.g., government and non-governmental agencies, community and religious stakeholders, health officials) to improve donation and transplantation rates, iii) creating regional training hubs, and iv) facilitating international cooperation across tissue banking programs to improve transplantation efficiency. Conclusions Many lessons were learned from the development and management of tissue banks around the world. The availability of skin allografts can be improved through strategic investments in international governance and regulatory structures, regional cooperation and training initiatives, standardized protocols, and inclusive public awareness campaigns. Capacity-building efforts that involve key stakeholders may increase rates of transplantations. Applicability of Research to Practice Ubiquitous challenges in implementing and maintaining tissue banks represent important lessons in program planning to improve allograft availability for patients in countries of all national income levels.