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ORIGINAL ARTICLE
Year : 2021  |  Volume : 29  |  Issue : 1  |  Page : 36-39

Knowledge and awareness on deceased donor skin harvest among intensive care units' staffs in national hospital of Sri Lanka


1 Department of Plastic Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
2 Plastic Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka

Date of Submission08-Jul-2021
Date of Acceptance09-Oct-2021
Date of Web Publication08-Jun-2022

Correspondence Address:
Dr. Sivasuganthan Kanesu
Department of Plastic Surgery, National Hospital of Sri Lanka
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_16_21

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  Abstract 


Introduction: Skin coverage is a greatest challenge in severe burns when the donor sites are limited. Early skin cover is important to reduce morbidity and mortality in severe burns. We use to harvest skin from cadavers at intensive care units (ICUs) for temporary cover of excised burn wounds. As we do not get enough cadaveric donations from ICUs, we plan to conduct this study to identify awareness and knowledge on it.
Methods: We collected data from doctors and nurses working in surgical ICUs (general surgical, accident and emergency, and neurosurgical) by a self-administered questionnaire. Then, we analyzed the results by SPSS 19 data package.
Results: One hundred and forty participants responded to our questionnaire including 118 nurses and 22 doctors. Only 40% (n = 48) of nurses and 60% (n = 13) of doctors were aware about cadaveric skin donation. Only 31% (n = 44) knew that tissue or blood matching is not needed for it. 88% (n = 124) knew that graft is mainly taken from thighs. Some responded as skin of the patients with comorbidities cannot be used for the transplant. Twelve percent (n = 18) knew whom to contact when the patient for cadaveric skin transplant is identified. Only 17% (n = 24) thinks that it does not cause much disfigurement to the cadaver. Thirteen percent (n = 18) did not know any details about skin donation.
Conclusion: There is a knowledge deficit in ICU staffs regarding awareness and knowledge on cadaveric skin harvest. We could not compare the doctors and nurses as there were less participants in doctors. In ICUs, an awareness campaign is required. In future, this concept should be assessed in general public as well.

Keywords: Burn, skin graft, deceased donor, skin harvest


How to cite this article:
Kanesu S, Ekanayake G. Knowledge and awareness on deceased donor skin harvest among intensive care units' staffs in national hospital of Sri Lanka. Indian J Burns 2021;29:36-9

How to cite this URL:
Kanesu S, Ekanayake G. Knowledge and awareness on deceased donor skin harvest among intensive care units' staffs in national hospital of Sri Lanka. Indian J Burns [serial online] 2021 [cited 2022 Jul 5];29:36-9. Available from: https://www.ijburns.com/text.asp?2021/29/1/36/346902




  Introduction Top


Burn is damage to the skin and underlying tissues due to heat, chemicals, electricity, or radiation. These are more prevalent in developing countries, especially in low socioeconomic groups.[1] Majority of them are nonfatal burns that result in disfiguring, functional impairment, and economical burden to the family.[2] Achieving skin coverage is the greatest challenge in severe burns when the donor sites are limited. The early skin cover is important to reduce morbidity and mortality in severe burns. When donor sites are adequate, early excision and skin grafting is recommended. Options available when donor sites are adequate are nonmeshed split-thickness skin grafts (STSG) and meshed STSG. In extensive burns (>70%), there are other techniques available such as dermal replacements such as Integra or biodegradable temporizing matrix, cultured epidermal autografts, and temporary skin substitutes such as allografts or xenografts and amniotic membrane. Dermal replacements and skin substitutes are not available in Sri Lanka for extensive burn management, so we use cadaveric skin grafts to achieve temporary skin cover.

We used to harvest skin from cadavers at intensive care units (ICUs) for the last 3 years. Whenever there is a need for cadaveric skin, we call all the ICUs and ask for any potential donors. If a donor is available, we discuss with the medical team and relations about cadaveric skin harvest and explain the procedures. Then, we will get written consent from the guardians or relatives of the patient and proceed with the skin harvest. We do not get a call from ICUs whenever there is a potential donor, so we find it difficult to recruit donors. To find out the reason, we conducted a study with the ICU staff to identify the knowledge and awareness on cadaveric skin donation, which plays a major role in the availability of donors. There was a study conducted in Nigeria to assess the awareness and attitude of doctors and nurses towards skin donation and banking. Although it revealed that the awareness of the skin donation was high, awareness of the skin banking was low.[3]

There was a study done in Sri Lanka on knowledge and attitude of health staff in deceased donor organ donation and transplantation in doctors and nurses in National Hospital of Sri Lanka (NHSL) ICUs that revealed satisfactory knowledge and positive attitudes toward organ donation and transplant. However, deceased donor skin harvest was not included in this study.


  Methods Top


We conducted this study in the ICU (accident and emergency and surgical and neurosurgical ICU in NHSL). We included the doctors and nurses working in ICUs who were on duty at the time of data collection. Questionnaires were prepared based on which were published in the Indian Journal of Plastic Surgery 2014.[3] The initial questionnaire was in English and we translated it into Sinhala and Tamil. We conducted a pilot study in medical ICU and analyzed the responses and rephrased some questions and dropped some questions.

Ethical clearance was obtained from the Ethical Committee of the NHSL. Specific numbers were given to each participant without revealing the identification details, and data were collected by self-administered questionnaire. Results were recorded and analyzed by statistical package for the social sciences (SPSS) 19 data package. Data will be stored for 3 years and will not be provided for any other studies.


  Results Top


One hundred and forty participants were included in this study including 118 nurses and 22 doctors. As the nurses were the majority in this study, 67.1% (n = 94) have completed a diploma, 17.1% (n = 24) completed BSC, 11.4% (n = 16) MBBS, and 4.3% (n = 6) MD. Sixty percent (n = 84) of staff were not aware of skin donation. Only 40% (n = 48) of nurses and 60% (n = 13) of doctors were aware of cadaveric skin donation. Less than ¼ of the participants knew that skin can be harvested within 6 h after confirming death, unlike other organs. More than 50% (n = 78) did not know how long it would take to harvest skin from a cadaver. Which is more important for the body removal from the ICU. Only 1/3 (n = 43) of the participants knew that anybody's skin can be donated for this purpose and tissue or blood matching is not required [Figure 1]. 50% (n = 72) of people did not know how it is going to help the patients and 27.1% thought that it is the permanent solution for burn wounds. Sixty percent (n = 84) of staff did not know where to inform when skin donor is available. Most of them aware that AIDS, skin cancers, and septicemia patients cannot donate the skin [Figure 2].
Figure 1: Donor matching before skin harvest

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Figure 2: Diseases affects skin donation

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  Discussion Top


Skin is the largest organ in the human body which protects the body from mechanical, thermal, and radiation injuries prevent loss of water and acts as a sensory organ. Burns primarily damage the skin coverage, underlying soft tissues, and deeper tissues including bone.[4] Loss of epidermal barrier leads to fluid, heat, electrolyte, protein loss, and invasion of microorganisms, which leads to multiorgan failure and death. When the burn surface area exceeds the available skin donor area, it needs some temporary measures to cover while the patient is recovering from the burn. This could be achieved by either temporary or permanent skin substitutes.

In Sri Lanka, skin substitutes are not freely available and allografts from human cadavers are commonly used to achieve temporary cover after early wound excision. Cadaveric skin can be harvested within 6 h after death, and it only takes 30–45 min to complete the procedure. Skin is normally taken from both thighs and back with the help of a dermatome. Cadavers will be dressed with cotton and crepe bandages to prevent oozing from the body.

Before skin harvest, written consent will be taken from relatives. After skin harvest, the skin will be stored in a skin bank below −86 degree C and thawed whenever needed. It can be stored for up to 5 years. It is a temporary skin cover over an excised burn wound or a meshed native skin graft. It will be slough off within 4 weeks.

According to the Transplant Act 1987, organ donation is allowed in Sri Lanka. De Silva et al.[5] conducted a study on deceased donor organ donation in tertiary care center, Sri Lanka, and revealed that main supply is from live donors and deceased donors are limited to kidney and liver. They also stated that utilization of donors was hindered due to issues in donor management, sepsis, and lack of resources. Even though kidney and liver are the commonly transplanted organs from the deceased person, there was no well-established program and it is conducted via national coordinators at the moment. Not like the other organs, harvested skin from the deceased person can be banked for 5 years. There are well-established skin banks and skin donation programs in other countries including India. However, it is still not established in Sri Lanka. Recently, national organ donor card was launched on national donor day to recruit and improve awareness of live and deceased donors. It is a step forward for organ donation in the future.

Priyankara et al.,[4] published a study on public knowledge on brain death and organ donation in a selected Sri Lankan population, revealed that public knowledge and awareness about brain death and organ donation is still at a moderate level, but attitudes were encouraging. In this study, they did not incorporate skin donation.

Panse et al.[6] conducted an audit on knowledge and awareness on skin donation among medical students with pre and posttest questionnaires after providing information via a leaflet. This evaluation showed an improvement in knowledge after the posttest questionnaire. Similarly, we also designed an information leaflet to provide the ICUs in NHSL. We have to design a similar study to assess the improvement after the distribution of the leaflets.

Michael et al.[3] conducted a study in Nigeria to assess awareness and attitudes of doctors and nurses on skin donation and banking. It revealed that the awareness on skin donation was high among them. They suggested that the knowledge should be introduced during the professional training. In our study the awareness on skin donation was low among doctors and nurses, so we need to introduce this knowledge early in the professional life.

Herath and Godakandage,[7] done a study on knowledge and attitudes of health staff on deceased donor organ donation and transplant among ICU staff in NHSL, revealed more than 50% had adequate knowledge and 91% showed positive attitudes toward organ donation. 46.7% knew the legal aspects behind organ donation. There was no association between age, sex, level of education, working experience with knowledge, and attitudes. In this study, they did not mention which organ donations were included. Our study has shown that awareness and knowledge on cadaveric skin harvest were very poor, which could be the main reasons to face difficulty in finding donors for skin harvest. We could not compare this between doctors and nurses as the numbers of doctors are less. Further, we could not relate the knowledge deficit with educational level as the number of participants from different levels of education is not equal. We could not collect information regarding the working experience as well.


  Conclusion and Recommendation Top


We observed a lack of knowledge and awareness among ICU staff regarding cadaveric skin harvesting. Further studies should be done with more participants to find out the reasons for the knowledge deficit and lack of awareness. We prepared leaflets to improve knowledge and awareness of cadaveric skin grafts and needed to repeat the study to re-assess the knowledge improvement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO Factsheet on Burns; 2016. Available from: http://www.who.int/mediacentre/factsheets/fs365/en/. [Last accessed on 2017 Sep 29].  Back to cited text no. 1
    
2.
Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns 2011;37:1087-100.  Back to cited text no. 2
    
3.
Michael AI, Ademola SA, Olawoye OA, Iyun AO, Oluwatosin OM. Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking. Burns 2014;40:1609-14.  Back to cited text no. 3
    
4.
Priyankara D, Mohamed M, Kamalanthan K, Manoj EM. Public knowledge on brain death and organ donation in a selected Sri Lankan population. Sri Lankan J Anaesthesiol 2019;27:157-9.  Back to cited text no. 4
    
5.
De Silva EH, Godakandage MH. Deceased donor organ donation in a developing country; an early experience in a tertiary care center in Sri Lanka, Transplantation. 2017;101:S52.  Back to cited text no. 5
    
6.
Panse N, Panse S, Jhingan M, Kulkarni P, Gandhi G, Kulkarni Y. Knowledge and awareness of skin donation in medical students: Overcoming the barriers. Indian J Plast Surg 2014;47:141-3.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Herath P, Godakandage MH. Knowledge & Attitude of Health Staff on Deceased Donor Organ Donation & Transplantation in a Sri Lankan Tertiary Care Setting, Transplantation: August 2017;101:S63.  Back to cited text no. 7
    


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