Sir,
I read with keen interest the article entitled “Decalcified allograft in repair of lytic lesions of bone” by Dr. Anil Kumar Gupta et al.1 The article has been well written and addresses the need for allografts and bone banking in developing countries such as India, very well. I would, however, like to point out that the statements made in the discussion are based on references which are very old 1889 to 2010, only one reference being of 2014.1 The data collected are also of the period from 1994 to 2006 and the followup, however, is a mean of 7.5 years. Although in the earlier years, bone banking in India was indeed lagging behind the rest of the world, currently there are a few state of the art tissue banks in India, with ability to service the entire country. The statements made in the discussion and also the methods of preparing and preserving allograft are not in synchronization with the present scenario.2,3 Tissue banking is a labor intensive facility and the need for trained personnel possessing a high level of integrity is essential. The guidelines given by the AATB and the European ATB have to be followed and no neglect of specified protocol is tolerable. Strict record keeping is essential, and the inability to follow the guidelines can lead to disastrous consequences.4 Nonavailability or the lack of monetary resources cannot be quoted as need to drop standards to match developing countries. Registration of tissue banks with appropriate authorities is mandatory and can definitely help check proliferation of unethical banks and unmet standards when it comes to harvest, preparation, and issue of tissue from these.5 With regard to immunogenicity, the author's opinion is presented, and no definite references are quoted. Bone banking should not go the blood banking way where a sudden proliferation and profit motive led to mushrooming of blood banks with disastrous consequences and subsequent implementation of stringent norms. Allografts from our tissue bank are available at one tenth or lesser the cost of that from overseas tissue banks, with no compromise on quality. Anybody can access details at our website www.msralc.org.
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Conflicts of interest
There are no conflicts of interest.
References
- 1.Gupta AK, Kumar K, Kumar P. Decalcified allograft in repair of lytic lesions of bone: A study to evolve bone bank in developing countries. Indian J Orthop. 2016;50:427–33. doi: 10.4103/0019-5413.185609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Drosos GI, Touzopoulos P, Ververidis A, Tilkeridis K, Kazakos K. Use of demineralized bone matrix in the extremities. World J Orthop. 2015;6:269–77. doi: 10.5312/wjo.v6.i2.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Soicher MA, Christiansen BA, Stover SM, Leach JK, Fyhrie DP. Remineralization of demineralized bone matrix (DBM) via alternating solution immersion (ASI) J MechBehav Biomed Mater. 2013;26:109–18. doi: 10.1016/j.jmbbm.2013.05.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Fölsch C, Mittelmeier W, Bilderbeek U, Timmesfeld N, von Garrel T, Peter Matter H. Effect of storage temperature on allograft bone. Transfus Med Hemother. 2012;39:36–40. doi: 10.1159/000335647. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Bostrom MP, Seigerman DA. The clinical use of allografts, demineralized bone matrices, synthetic bone graft substitutes and osteoinductive growth factors: A survey study. HSS J. 2005;1:9–18. doi: 10.1007/s11420-005-0111-5. [DOI] [PMC free article] [PubMed] [Google Scholar]