Creation of Nepal’s First Skin Bank: Challenges and Outcomes

Lawrence Cai, BS; Chao Long, AB; Bishal Karki, MS; Kiran Nakarmi, MCh; Adnan Iqbal, MBA; Michele Casertano, MBA; Sara Anderson, MA; James Patell, PhD; James Chang, MD; Shankar Man Rai, MS

doi:10.1097/GOX.0000000000001510

Plastic and Reconstructive Surgery, Global Open (Nov 2017)

Creation of Nepal’s First Skin Bank: Challenges and Outcomes

Lawrence Cai, BS,
Chao Long, AB,
Bishal Karki, MS,
Kiran Nakarmi, MCh,
Adnan Iqbal, MBA,
Michele Casertano, MBA,
Sara Anderson, MA,
James Patell, PhD,
James Chang, MD,
Shankar Man Rai, MS

Affiliations

Lawrence Cai, BS: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Chao Long, AB: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Bishal Karki, MS: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Kiran Nakarmi, MCh: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Adnan Iqbal, MBA: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Michele Casertano, MBA: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Sara Anderson, MA: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
James Patell, PhD: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
James Chang, MD: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Shankar Man Rai, MS: From the *Stanford School of Medicine, Stanford, Calif.; †Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal; ‡Stanford Graduate School of Business, Stanford, Calif.; §ReSurge International, Sunnyvale, Calif.; ∥Design for Extreme Affordability, Stanford Graduate School of Business, Stanford, Calif.; **Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.

DOI: https://doi.org/10.1097/GOX.0000000000001510
Journal volume & issue: Vol. 5, no. 11
p. e1510

Abstract

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Background:. In Nepal, burn trauma causes more than 55,000 injuries each year. Burn-related mortality is high in Nepal, in part due to lack of allograft, leading to high infection rates. To address this challenge, our collaboration between Kirtipur Hospital, America Nepal Medical Foundation, Stanford University, and ReSurge International established Nepal’s first skin bank. Methods:. We identified 3 major tasks to create a sustainable skin banking program: 1) identify and acquire the equipment and personnel needed to collect, process, store, and graft cadaveric skin for burn injuries; 2) develop safe donation protocols and documentation tools that remain feasible for low-resource settings; and 3) develop a long-term awareness program to educate the Nepali people on skin donation, a previously foreign concept. Results:. Kirtipur Hospital acquired the necessary equipment and materials for the skin bank through a combination of local and international fundraising efforts. Existing U.S. skin banking protocols were adapted for the Nepali setting and piloted on potential patients, donors, and physicians. For the first time in the hospital’s history, patients with > 40% total body surface area burns were successfully treated with extensive allografts. Conclusions:. It is feasible to create a skin bank in a country with no tradition of allograft skin use. Long-term sustainability now depends on spreading awareness and education in the Kathmandu Valley to overcome religious and cultural barriers that have hindered donor recruitment. Our low-cost and high-impact skin bank provides a model to expand this system to other hospitals both within Nepal and beyond.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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