When Gloria Clausen, a middle school teacher from Mendham, N.J., was told by her doctor that she had a rare, cancerous tumor in the tibia of her left leg, she was presented with two options: have the leg amputated below the knee or have a bone transplant that would save her leg. Like many patients faced with similar situations one of her first questions was, "Where will you get the bone?"
In the town of Edison, an hour's drive from Gloria's home, bone tissue donated by people across the U.S. arrives via courier at the Musculoskeletal Transplant Foundation (MTF). Its arrival at this nonprofit foundation – the world's largest tissue bank – begins a process that transforms donated bones and ligaments into hundreds of thousands of bone grafts to treat problems ranging from life and limb-threatening bone tumors to sports injuries and periodontal disease. It is also where Gloria's new tibia would eventually come from to replace her diseased tibia and save her leg.
MTF is at the core of a growing phenomenon, tissue transplantation, which has become a routine part of patient care in virtually every hospital and in many doctor's offices across the country. "Tissue" in this context includes bone, skin, corneas, tendons and ligaments, cartilage, arteries and veins, and heart valves.
While it's an area that is little known or understood by the public, the statistics reveal its growing impact on people's lives:
These tissue transplants often save limbs from being amputated and give sight to the blind. They also allow recipients to walk without pain, lift up a young child, or perform other routine activities that most people take for granted.
At the MTF, technicians in masks and full body suits quarantine the bone and freeze it for at least fourteen weeks-the first step in an extensive effort to ensure that it is safe for transplantation. At the end of this "sterility hold," the bone is tested and sterilized at high temperatures-all in accordance with rules and guidelines established by the FDA, state governments, and the American Association of Tissue Banks.
Cleanliness and air purification standards for all work areas exceed the standards found in most pharmaceutical drug manufacturing facilities and hospital operating rooms. Meanwhile, under the direction of the MTF's Medical Director, the extensive personal and medical history taken at the time of donation are thoroughly reviewed. Such procedures help explain why, according to U.S. government statistics, of 10 million tissue transplants in the U.S. during the past 15 years, only 54 documented, non-fatal infections and fewer than a dozen fatal infections occurred-most of them more than a decade ago, before more accurate screening for infectious diseases.
Throughout each stage of processing, workers at MTF and other tissue banks treat donated tissue with respect. Some workers pause for a moment of prayer or quiet respect before they handle the tissues. They know in their hands are literally pieces of other human beings who had only days earlier been very much alive-and who are still loved, mourned and missed.
"We do everything that we can to ensure that anyone involved in this process remembers that this is a loved one of the family who gave us permission for donation," says Martha Anderson, MTF's executive vice president of Donor Services. "We make sure that everyone treats this person's body with great respect and remembers that this is a gift and that we are the stewards of that gift."
As the final step in processing, the sterile package containing each piece of bone receives an individualized computerized barcode that provides an additional layer of protection for future recipients. If a question about the exact source and history of any tissue ever arises, the data can be quickly found.
The hundreds of different types of bone grafts shipped to hospitals nationwide from the MTF demonstrate the extensive – and constantly growing – list of ways in which a range of medical specialties use donated bone. Orthopedic surgeons rely on bone to repair fractures, replace damage caused by cancerous tumors, and fix sports-related injuries of the knee and other joints; neurosurgeons use bone to do spinal fusions and correct scoliosis; and periodontists and dentists have found that paste made with donated bone can be essential to repair serious dental problems. In addition, donated bone often enables physicians to complete complex procedures without the additional pain and expense of a second surgery to take a bone graft from the patient's own body.
A similar pattern can be found in the growing utilization of other donated tissues such as skin, heart valves, and arteries—which have consistently proven preferable to artificial or animal-derived alternatives.
While it is now impossible to imagine modern medicine without donated tissue, the importance of transplantable tissue is, perhaps, best illustrated by a simple act that Gloria Clausen performs a year and a half after having her tibia replaced—when she wakes up in the morning she gets out of bed by first putting both feet on the floor.