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step further and sterilize the tissue."
That secondary sterilization process may include washing, sub-
chemical treatment and radiation treatment in order to reduce
risk of bacterial and viral contamination. "Secondary processing
has a significant impact on bone and soft tissue," says Dr. Gitelis.
"Most of the processes involve radiation, which ensures bacterial,
but not viral, sterility."
The downside of using radiation for secondary processing is
that it can have a detrimental impact on the mechanical and bio-
logical performances of the graft, according to Dr. Gitelis. "Some
surgeons want added security," he says, "while others prefer
implants that are as strong as possible and choose not to take
grafts that are secondarily sterilized."
You have some assurance that AATB-accredited banks meet a
certain criteria level in screening tissue donors, but your due dili-
gence is still needed. For example, Dr. Wilkins warns against
using tissue obtained from foreign donors. Some banks import
grafts from Eastern Europe, and although the paperwork says
they've been tested for HIV and hepatitis, that might not always
be the case. "There have been instances where those records
have been falsified," says Dr. Wilkins. "I'd never take a donor from
outside the U.S., because you can't be sure that the testing is
accurate or even legit."
3. Focus on safety
Negotiating the best price for tissue grafts is no different than hag-
gling over the pricing of metallic implants or medical devices, espe-
cially for base products such as bone proteins that most banks pro-
duce. For higher-end grafts — specialized implants for fresh joint
replacements and stem cell grafts used during spine surgery for non-
A L L O G R A F T S
