Established in 2010, SingHealth Duke-NUS Transplant Centre (SDTC) comprises 12 transplant programmes: heart, lung, kidney, liver, cornea, pancreas, kidney, ovarian tissue, blood stem cell (adult and paediatric), umbilical cord blood and SingHealth Transplant Tissue Centre (STTC) for skin and cardiovascular homograft. It is also one of the largest and most experienced transplant practices in the region, providing comprehensive and quality care to patients and donors.

The Singapore General Hospital (SGH) Burn Centre, which STTC serves, treats about 200 patients yearly for burn injuries. About 10 per cent of them sustained major burns, with skin taking the brunt of injuries. In such severe burn cases, human skin donated by deceased donors can be used to quickly cover large area of burn injuries of these critically ill patients with little of their own healthy skin left. But unlike heart, liver, kidney and cornea, skin donation is not so commonly known.

“Skin transplant can be life-saving. Unlike other organ transplants, it is not a permanent procedure as donor skin is not left on the patient for life,” said Dr Cheryl Hui Li Yu (below), Consultant, Department of Plastic, Reconstructive and Aesthetic Surgery, SGH. “It is used as a temporary dressing to stabilise the patient and tide them through the critical period before doctors can use the patient’s own skin on their wounds.”

There are alternatives to human donor skin to treat burns such as synthetic dressings made from polyurethane and biological dressings from non-human sources, including sheep, fish and pigs. However, there are many advantages when donor skin is used. Like-forlike, donor skin is from human origin and the tissues are more pliable and less fragile. “We prefer to use human cadaveric skin as it tends to be thicker and provides a better barrier to minimise moisture and skin losses that many burns patients experience. This results in less risk of infection,” said Dr Hui.

Skin is recovered from deceased donors within 15 hours of death. The SGH Skin Bank recovers, stores and provides donated human skin for severe burns patients. The recovered skin can be stored for up to five and a half years.

“While the skin donation process may sound very invasive, it is not so,” said Ms Ho Wen Ning (above), Transplant Coordinator, SGH Skin Bank. “We recover the superficial layer of the skin, around 0.4mm, which is around the thickness of a name card. Only concealed areas of the body — back and lower limbs — will be taken, so an opencasket funeral for the deceased donor will still be possible.”

Unlike the kidney, liver, heart and cornea, skin donation is not covered under the Human Organ Transplant Act (HOTA) opt-out donation scheme. Skin, instead, comes under an opt-in scheme that requires a person to make a pledge under the Medical (Therapy, Education and Research) Act, or MTERA. Next-of-kin can also consent to donate their loved one’s skin upon his/her passing.

Fiery accident

During Deepavali in 2022, Ms Maygalai (below) was helping her daughter put on shoes when her skirt caught fire from an oil lamp nearby. This led to her suffering almost 90 per cent burns across her entire body — only her head, face, scalp and parts of her neck were spared.

“The rest of her body was deeply burnt. Her blood circulation was compromised because the burns were deep and constricting blood flow to her legs. We had to perform an emergency escharotomy to release all the burnt tissues,” said Dr Hui.

As Ms Maygalai was critically ill when she arrived at the hospital, she was immediately sent to the Burns Intensive Care Unit. A few days later, her condition stabilised and simple dressings were used on her burns to reduce the operating time. Donor skin was introduced to allow her wounds to be dressed more efficiently and promote healing while reducing the risks of infection.

“Donor skin has contributed much to the healing process as it has given my body time to recover and move to the next stage of skin grafting using my own skin from other unburnt parts of my body such as my scalp,” said Ms Maygalai. “I’m really grateful to have gotten back the use of my hands. I am able to get back to work as well as take care of my child. To those who have donated, I’d really like to express my heartfelt thanks.”

Although her skin treatment has been completed, Ms Maygalai continues to go for physiotherapy. “I’m still walking with a cane. Improving my mobility is my main focus right now,” she shared, adding: “I, too, was previously unaware that there’s such a thing as skin donation. I would strongly urge everyone to consider it as it can make a difference and save someone’s life.”

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