Erhebung zur Entwicklung und aktuellen Situation allogener Knochenbanken in Deutschland
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Philipps-Universität Marburg
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Abstract
Introduction:
The use of allogenic femurheadtransplantants provides an established method for
surgical treatment of defections on the skeletal system. As alternative to the autologous
bone-replacement the allogenic bone has the advantage of being available in almost any
amount. At the same time it possesses similar biological characters as the autologous
bone transplant. However, the disadvantage lies in the risk of transmitting various
germs. In order to offer biologically highly valuable and non-infectious allogenic bone
transplants there are allogenic bone- and tissue banks at numerous clinical facilities. The
working procedures in these banks are regulated by the National Medical Chamber
(Bundesärztekammer, BÄK).
The purpose of this survey was to evaluate the amount of such institutions at German
surgical hospitals and to precisely investigate the different working procedures
concerning processing, storing and usage of allogenic bone transplants.
Material and methods:
The enquiry by mail using a multi-page questionnaire was done nationwide in the year
2000 at the request of the Department of Bone Transplantation of the DGOC. The
acquired data were evaluated and compared to the results of former similar surveys.
Through this the development tendency of German surgical bone banks in the last 15
years could be reproduced and the impact of the guidelines of the BÄK on running a
bone bank in the daily practice could be investigated.
Results:
Selection of the donor – The first step in the risk-reduction is carried out through using
detailed anamnesis, careful clinical examinations and laboratory tests. The comparison
of studies concerning the diagnosis of HIV and hepatitis leads to a clear positive
development in the selection of the donor. In 1999 the HIV and hepatitis serology was
routinely carried out in all bone banks whilst in 1987 many institutions did not carry out
these tests. By using a comparison table it is shown that the publishing of the guidelines
on running an allogenic bone bank and their amendment has led to an improvement in
the selection of the donor.
Examination of the transplant – At the time the transplant is obtained, a number of
bacteriological smear tests are carried out in the bone bank as further steps. Whilst in
1987 only about 79 % such examinations were carried out, the number was raised to
about 91 % in 1999. Also in this aspect a clear improvement in observance of the
current regulations can be seen.
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Treatment of the transplant – The secondary sterilisation/disinfection plays an
important role in the security concept of the bone banks. At the moment the most
commonly used method for germ-deterging is the thermodesinfection at a temperature
of 80°C. This temperature related and validated method leads to inactivation of viral
and bacterial germs, at the same time preserving the biological potential of the
transplant. This development is also attributed to the guidelines for allogenic bone
banks and to the interpretation of the infection problem which have led to an increase in
the use of sterilisation methods.
Conservation and storage of the transplant – According to actual scientific
knowledge transplants can be stored at a temperature of -80°C up to a period of 5 years,
without losing their biological values. Here also, there has been a clear positive
development in the use of correct storage temperature.
Discussion:
The results of the survey show, in comparison to past evaluations, a steady
improvement in the working procedures of German bone banks. Nevertheless, security
relevant conditions are only partly fulfilled. Due to the careless handling of allogenic
transplants there is a serious risk for the transplant receiving patients. Hence the
following demands are made of future conduct of allogenic bone banks:
- By intensifying further educational programmes by the
orthopaedic/surgical societies in the form of teachings, seminars and
congresses, the operators of tissue banks should be more sensitized to
the risks of bone banking
- Setting up inspectors of higher status who regularly check that the BÄK
guidelines are followed and the new law on tissue utilization is
observed.
- With the rising need for allogenic bone transplants, regional bone banks
should be set up so that the small non bone banking institutions are
provided for.
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Dates
Created: 2008Issued: 2009-10-09Updated: 2011-08-10
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Bone bank
DFG-subjects
Knochenbank
DDC-Numbers
610
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Kutschera, Alexander (139119272): Erhebung zur Entwicklung und aktuellen Situation allogener Knochenbanken in Deutschland. : Philipps-Universität Marburg 2009-10-09. DOI: https://doi.org/10.17192/z2009.0561.
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This item has been published with the following license: In Copyright