New Delhi: The National Organ and Tissue Transplant Organisation (NOTTO) is preparing guidelines on processing and storage of human bones and aims to create a database of donors, recipients and hospitals with these facilities, as demand for natural bones for reconstructive procedures rises in the country.
Processed human bones, or those that have been sterilized to reduce the risk of infection, are required to perform bone fixation surgery in patients who may be suffering from bone cancer, or had a trauma, or other medical conditions that have destroyed their bones. Currently, metal plates or rods are mostly used to fix bone fractures, raising the risk of infection and other complications.
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“Like human organs, we are now getting demands for processed human bones from orthopaedic surgeons. These are used in cases when a patient’s bone gets destroyed due to trauma or disease. The artificial bones are more vulnerable to infections or chemical reactions and do not even have great strength,” said Dr. Anil Kumar, director of National Organ and Tissue Transplant Organisation, which comes under the Union ministry of health and family welfare.
“So, we are drafting technical guidelines for bone banking, detailing how to process bones, storage, what kind of infrastructure is needed, sterilization, who are the donors and recipients and which hospitals have bone banking facilities so that the government can track and trace the network. The guidelines will suggest the know-how to the doctors about all safety measures, and training of doctors for bone banking facility,” Dr. Kumar added.
At present, only a few hospitals in India have bone banks, including the All India Institute of Medical Sciences (AIIMS) in New Delhi, the Indian Spinal Injury Centre and Apollo Hospital.
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Dr Rajesh Malhotra, a senior orthopaedic surgeon at Apollo Hospitals and former chief of Apex Trauma Centre at AIIMS, said, “We take bones from multiple organ failure donors, cadaver donors. Very few bones are procured from live donors who have got amputated or are trauma patients. The metal plates or imported implants are very expensive and cost ₹10-12 lakh. Also, not every one is able to afford that.”
Metal implants can get loose over time, break, and become infectious. Donated bones are less expensive, work as natural bones and look like part of the body. So, donated human bones are the permanent solution, Dr Malhotra emphasized.
“The problem is that there is very poor donation in India. However, now it is taking momentum. There is poor awareness among the people about bone donation. Orthopaedic surgeons require proper training to perform such operations as these are very complicated surgeries,” he said, adding there are some of the gaps prevailing in the bone banking system that need to be addressed.
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India’s organ donation law—the Transplantation of Human Organs and Tissues Act, 1994—does not thoroughly discuss bone banking management. So, people are following similar protocols as in the case of organ donations. “However, that is not the case [with bone donation]. Organ donation is a life-saving procedure, but bone donation is a life-enhancement procedure,” Dr Malhotra said.
Organ or bone donation in India is not as popular as in the US or Europe due to cultural and religious beliefs, as also due to lack of awareness and complicated legal formalities.
Indian Council of Medical Research data suggests that incidence of bone cancer in India is approximately 1-2 cases per 100,000 people annually. Moreover, Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.