Some Facts on Using Cadaver Skin for Burns

Congratulations on your recent article, “Rising Costs Are Taxing Burn Centers” (Times, June 7). Kenneth Garcia certainly deserves praise for accurate, balanced reporting, with one important exception. He wrote: “Although cadaver skin has been readily available for years, surgeons preferred not to use it because it is rejected as foreign tissue by the body’s immune system.” This statement is inaccurate and misinformed on two counts.

First, cadaver skin (the technical term is human allograft skin) has been available in this area for many years because of the work of the Southern California Tissue Bank, a nonprofit public benefit institution. It is not readily available, however. Demand nearly always exceeds supply. The determination, dedication and skill of the Tissue Bank’s staff, together with the commitment and cooperation of donor families, the area’s coroner/medical examiner offices, hospitals and other tissue/organ procurement agencies have made transplantable human skin available to the medical community. Always this is done with devotion, sometimes with sacrifice. In one year alone the Tissue Bank provided tissue services worth one-fourth of its annual revenue free of charge to Los Angeles County-USC Medical Center. Now the Tissue Bank faces a severe financial crisis, due in part to a slow, Byzantine reimbursement system at County-USC, the very hospital which once received our unconditional charity.

Secondly, surgeons prefer transplantable human skin as a wound dressing, especially during the first several weeks of treatment. All patients mentioned in Mr. Garcia’s article received tissue from Southern California Tissue Bank, from three to 26 square feet per patient. For all patients mentioned, this represents the transplantable human skin from 24 donors, an average of six donors per patient. What a contribution to the living by donors and their families! It is true that a recipient’s immune system usually rejects the skin after several days or a few weeks. In effect the transplantable tissue acts as an elaborate bandage. But this buys valuable time for surgeons later to cover the patient with a permanent wound dressing, either a skin graft from an unburned body area or the patient’s own skin cells grown by tissue culture.

Remember, in burn care there are direct and indirect patient services. The availability of donated human skin is an important indirect patient service that saves lives. To quote Mr. Ray Rahn in the article, “ . . . In burns, you’re dealing with an extremely skilled and compassionate group of people. And it would be a real tragedy to lose any part of that.”

ALLEN McDANIELS, MD

Medical director

Southern California Tissue Bank

Torrance