**6. Activities of a musculoskeletal tissue bank**

The description of activities of a musculoskeletal tissue bank is summarized in the algorithm below ( **Illustration 01**).

Every activity related to the bank should also be based on the ethical principles inherent to the activities of any organ transplantation. They are:

 **Autonomy and self-determination:** The recipient of tissue from the musculoskeletal system should be provided with information in accessible language about the entire tissue obtainment process, the risks and the chances of success or failure of the treatment. The following stage is the patient's decision, after their evaluation of the information received, set out in an informed consent form.

Professionals with specific training provide all the required information, using language exempt from complex or technical terms, enabling the patient to achieve easy understand in order to make the final decision. For this document to be authentic, the consent must be free, that is, not caused by coercion. The professionals of a musculoskeletal tissue bank should be objective and impartial while providing guidance to recipients. Every process is recorded in the Recipient's Form.

<sup>5</sup>Administrative Ruling no. 211, of March 24, 2003

Illustration 01. Algorithm of the Musculoskeletal Tissue Donation and Transplantation Process

Cryopreserved Musculoskeletal Tissue Bank in Dentistry: State of the Art and Perspectives 45

**Justice** – The principle of equal opportunities for the use of available tissues. The

 **Symbolism of the body** – This principle is employed mainly in the reconstruction of the deceased donor's body after removal, which should be performed carefully, with the apparent anatomical parameters respected, thus ensuring that the family receives a

The main source of musculoskeletal tissues is the notification of deceased donors to the Transplant Centers, Organ Service Services, and Hospital Transplant Departments. The teams that receive the organs and tissues are only notified after a series of procedures and exams has been carried out to ascertain brain death and obtain the family's consent for the process of organ and tissue donation. Brain death is initially verified by a neurologist, using techniques of physical and imaging (doppler) exams, which are repeated after six hours in the presence of a family member of the potential donor. Once there is no doubt as to the irreversible diagnosis of brain death, the family members are asked whether they would consider donating their loved one's organs. The family interview is done by trained members belonging to an intra-hospital committee, or by an organization that looks for organs. The entire donation process should be recorded and legally signed before the teams are notified to remove each organ (heart, liver, kidney, pancreas, lung, intestine) and tissues (osteochondral and fascial-ligamentous, skin, vessels, cornea, heart valves). Each team should have clearly-defined criteria for selecting, and at the time of notification, accepting or

For donors of musculoskeletal tissue, the selection follows a rigorous control process, with serological tests for antigens and HIV antibodies, Hepatitis A, B and C, HTLV-1 and 2, Syphilis, Chagas disease, Toxoplasmosis and Cytomegalovirus, as well as state-of-the-art tests for evidenciation of D (Nucleic Acid Amplification – NAT) HIV and Hepatitis B and C, bone marrow aspirate smear of the sternum and iliac crest sample, both for

Donors with the following criteria were excluded: orthopedic pathologies, such as osteoporosis, osteonecrosis, rheumatoid arthritis, lupus erythematosus, neoplasias, age group that compromises that characteristics of the tissues, blood transfusions, tattoos or piercings within the period of the immunological window, use of illegal drugs, travel to endemic zones, generalized or localized infections, fractures, open sores on the limbs from which the musculoskeletal tissues are to be removed, or any other situation that places in

The whole procedure is carried out in totally antiseptic conditions, just as in surgery. Special gowns made from synthetic material are used, and all the surgical stages of antisepsis are

The removed tissues are immediately packaged in triple packaging, hermetically sealed, and

A very important stage of the capture process is donor reconstruction. The body should be delivered to the family free from any deformation and as close as possible to its appearance before the tissue removal. This is because the fear of deformation has been one of the main

doubt the quality of these tissues, pursuant to the Brazilian legislation.

delivered, under refrigeration (-4ºC) to the Tissue Bank.

definition of ethical parameters in distribution is imperative.

body in adequate conditions.

refusing the donor in question.

histopathological investigation.

followed.

**7. Obtaining musculoskeletal tissues** 

