Roberson Jeffrey L, Pham Julie, Shen Jolie, Stewart Kelly, Hoyte-Williams Paa Ekow, Mehta Kajal, Rai Shankar, Pedraza Jorge Morales, Allorto Nikki, Pham Tam N, Stewart Barclay T
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia.
School of Medicine, University of Washington, Seattle.
J Burn Care Res. 2020 Nov 30;41(6):1271-1278. doi: 10.1093/jbcr/iraa093.
Wound excision and temporary coverage with a biologic dressing can improve survival for patients with large burns. Healthcare systems in low- and middle-income countries (LMICs) rarely have access to allografts, which may contribute to the limited survival of patients with large burns in these settings. Therefore, we aimed to describe the lessons learned from the implementation and maintenance of tissue banks in LMICs to guide system planning and organization. PubMed, MEDLINE, CINAHL, and World Health Organization Catalog were systematically searched with database-specific language to represent a priori terms (eg, skin, allograft, and tissue bank) and all LMICs as defined by the World Bank. Data regarding tissue banking programs were extracted and described in a narrative synthesis. The search returned 3346 records, and 33 reports from 17 countries were analyzed. Commonly reported barriers to ideal or planned implementation included high capital costs and operational costs per graft, insufficient training opportunities, opt-in donation schemes, and sociocultural stigma around donation and transplantation. Many lessons were learned from the implementation and management of tissue banks around the world. The availability of skin allografts can be improved through strategic investments in governance and regulatory structures, international cooperation initiatives, training programs, standardized protocols, and inclusive public awareness campaigns. Furthermore, capacity-building efforts that involve key stakeholders may increase rates of pledges, donations, and transplantations. Some issues were ubiquitously reported and could be addressed by current and future tissue banking programs to ensure allograft availability for patients living in countries of all income levels.
伤口切除并用生物敷料进行临时覆盖可提高大面积烧伤患者的生存率。低收入和中等收入国家（LMICs）的医疗系统很少能够获得同种异体移植物，这可能导致这些地区大面积烧伤患者的生存率有限。因此，我们旨在描述在低收入和中等收入国家实施和维持组织库过程中吸取的经验教训，以指导系统规划和组织。使用特定数据库语言对PubMed、MEDLINE、CINAHL和世界卫生组织目录进行系统检索，以呈现先验术语（如皮肤、同种异体移植物和组织库）以及世界银行定义的所有低收入和中等收入国家。提取有关组织库项目的数据，并在叙述性综述中进行描述。检索返回3346条记录，分析了来自17个国家的33份报告。常见的理想或计划实施障碍包括每个移植物的高资本成本和运营成本、培训机会不足、选择加入的捐赠计划以及围绕捐赠和移植的社会文化耻辱感。从世界各地组织库的实施和管理中学到了许多经验教训。通过对治理和监管结构、国际合作倡议、培训项目、标准化方案以及包容性公众宣传活动进行战略投资，可以提高皮肤同种异体移植物的可及性。此外，涉及关键利益相关者的能力建设努力可能会提高承诺、捐赠和移植的比例。一些问题被普遍报道，当前和未来的组织库项目可以解决这些问题，以确保所有收入水平国家的患者都能获得同种异体移植物。
