NUH Bone Bank was established in October 1988 as a Research Tissue Bank with an NUS Research Project, RP 880334 : "Use of Allografts for Bridging Large Bone Defects". It was equipped with 2 Electrical Freezers for storage of tissues at -80°C -one freezer in NUH Operating Room complex and the other in Animal Holding Unit for animal experimentation. In the first 2 years, in addition to animal experimentation research, the bank procured femoral heads from Living Donors. With better public education and link-up with Kidney and Liver Transplantation Programmes -Multi Organ Procurement System set up by Ministry of Health, chaired by Deputy Director of Medical Services, Dr Chen Ai Ju, the bank performed its first Deceased Donor Procurement on 15 November 1991.

The Clinical Services provided by the bank grew tremendously. It started providing Lyophilised Bone Allografts in addition to Deep Frozen Bone and Soft Tissue Allografts in January 1994 with installation of one Lyophiliser Unit (Band Saw, Shaker Bath, Lyophiliser, Laminar Flow Cabinet and Auto-sealer). In January 1994, the bank received and additional grant of $239,965 from the Totaliser Board to upgrade the bank to function as National Bone Bank providing tissue grafts to all hospitals in Singapore. The bank acquired 4 Electrical Freezers and 2 Lyophiliser Units and was then housed in a room of 300 square feet in Department of Orthopaedic Surgery, Level 3, National University Hospital.

NUH Bone Bank hosted 'IAEA/RCA Regional Workshop on Dissemination of information on Procedures for Production and Radiation Sterilisation of Tissue Allografts' from 18 to 29 September 1995 at National University Hospital Training Centre. NUH Tissue Bank was inaugurated in conjuncton with the Opening Ceremony of this Workshop on 18 September 1995 by Deputy Vice-Chancellor, National University of Singapore, Professor Hang Chang Chieh. It was inaugurated as a Hospital Bone Bank with an NUH Administration Board and with Associate Professor Aziz Nather as Director of Bank.

This Workshop witnessed Dilivery of the First IAEA Draft Curriculum on Tissue Banking by 21 'Trainers' (13 National Co-ordinators and other Experts) to 35 'Trainees' (29 Tissue Bank Operators sponsored by IAEA and 6 Observers) from countries such as Bangladesh, China, India, Indonesia, Korea, Malaysia, Myanmar, Pakistan, Philippines, Singapore, Sri Lanka, Thailand, Vietnam, Australia, Cuba and New Zealand.

New large Purpose-Built Tissue Bank was completed at Level 2, National University Hospital in July 1997 -2000 square feet with separate:- Documentation Room, Wet Processing Laboratory, Dry Processing Laboratory, Reception Desk and Library. The Laboratories are specially designed to provide for Hands-on Training for Tissue Bank Operators. Equipment and facilities included : 5 Electrical Freezers (-80°C), 1 Cryo Freezer (-150°C), 2 Lyophiliser Units, 2 Stainless Steel Band Saws, 2 Shaker Baths, 2 Orbital Shakers, 2 Lyophilisers, 2 Laminar Flow Cabinets, 2 Vacuum Sealers, 2 Electronic Balances, 1 Oven and 1 Microscope.

NUH Tissue Bank is appointed by IAEA to be IAEA/NUS REGIONAL TRAINING CENTRE FOR RCAMEMBER STATESA(Asia Pacific Region) for training Tissue Bank Operators on 18 September 1996 in RCA Work Group Meeting in Vienna.

The SINGAPORE GOVERNMENT (represented by Ministry of Environment) with National Science and Technology Board as the funding agency awarded a grant of $ 225,500 to National University of Singapore (represented by National University Hospital Tissue Bank) to develop NUH Tissue Bank as a Regional Training Centre on 11 March 1996.

In addition, NUH Tissue Bank was awarded a Research Grant of $ 217,460 by National Medical Research Council NMRC/0221/1997:RP 97031N 'Biology of Healing of Composite Osteo- Chondral Allografts' with Associate Professor Aziz Nather as Principal Investigator on 4 June 1997.

An OPEN-DISTANCE LEARNING DIPLOMA COURSE of one year duration is conducted in the centre using the IAEA Developed Curriculum which is being processed using Multi-Media by the Centre. This Regional Training Course is for the first batch of participants in the Diploma Course.

  • 2 Weeks Intensive Course in Singapore
  • 3 Open Distance Learning Assignments over 1 year period.
  • Supervision of 'Trainee' (Diploma Registerant) by 'Trainer' (National Co-ordinator for Project : RAS 7/008) using Multi-Media Curriculum on Tissue Banking.
  • Diploma Examination by NUS at end of 1 year. Diploma Certification by National University of Singapore



NUS Tissue Bank has also provided expertise to Asia Pacific Region and to countries in Africa and Latin America by conducting UN Expert Missions. Associate Professor Aziz Nather, Director of NUH Tissue Bank has conducted several UN Technical Co-operation Missions:- Malaysia (31 Oct -11 Nov 1994) Malaysia (25 Feb -9 Mar 1996) Vietnam (1-3 July 1996) Zambia : Africa (19-27 Jan 1997) Myanmar (20-27 April 1997) Argentina, Brazil & Cuba: Latin America (4-17 Aug 1998) Sri Lanka (24-29 Aug 1998) Myanmar (14-25 Sep 1998).

NUH Tissue Bank has also hosted several IAEA Scientific Fellowships and Scientific Visits:-

IAEA FELLOWSHIPS

  • Dr. Goran Videoski, 20 Jan – 19 Mar 1997, Consultant Orthopaedic Surgeon, Republic of MACEDONIA
  • Dr. Karevski Ljupco, 31Mar – 30 April 1997, Consultant Orthopaedic Surgeon, Republic of MACEDONIA
  • Dr. Vasantha Mario Perera, 4 Aug – 3 Sep 1997, Consultant Orthopaedic Surgeon, Colombo ,SRI LANKA
  • Mr.Reuben Katebe, 26 Jan – 20 Mar 1998, Technologist, Lusaka Tissue Bank Lusaka, ZAMBIA

IAEA SCIENTIFIC VISITS

  • Professor Kamardi Thalut, 6 Nov –11 Nov 1995, Head, Department of Surgery, Andalas University, M. Jamil Hospital Padang, INDONESIA
  • Professor Tang Zhongyi, 6 –7 Oct 1996, Head, Dept of Burns & Plastic Surgery Suzhou, CHINA
  • Dr. Aye Ko, 26 May – 6 June 1997, Orthopaedic Surgeon, Yangon Orthopaedic Hospital, Yangon, MYANMAR
  • Dr. Eulogia Kairiyama, 16 –20 Feb 1998, Health Science Department, Comision Nacional De Energia Atomica Buones Aires, ARGENTINA
  • Dr. Zakaria Yahya Arajy, 27 April – 15 May 1998, Consultant Plastic Surgeon, Baghdad, IRAQ .

The bank follows guidelines set by the American Association of Tissue Banks and the European Association of Tissue Banks.

SCREENING

In addition to screening by detailed medical history and clinical examination, all donors are tested for:-

1. AIDS (Anti-HIV1 and Anti-HIV2)
2. HEPATITIS B (HbsAg)
3. HEPATITIS C (Anti-HCV)
4. SYPHILIS (RPR, TPHA)
5. Culture of Tissue Procured for aerobic and anaerobic organisms

LIVING DONOR PROCUREMENT
Femoral heads, TKR slices and other small bones are procured and stored using STERILE DOUBLE JAR TECHNIQUE:

DECEASED DONOR PROCUREMENT
Long bones are procured and stored using STERILE TRIPLE WRAP TECHNIQUE.

PROCESSING OF TISSUES
GAMMA IRRADIATION OF DEEP FROZEN BONES
As an additional safeguard to ensure sterility, all bones are gamma irradiated at a dosage of 25 KILOGRAYS at the MALAYSIAN INSTITUTE OF NUCLEAR TECHNOLOGY in Bangi, Selangor, Malaysia using the COBALT 60 SINAGAMA PLANT by Dr Norimah Yusof. This joint collaboration is under the auspices of the INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA) started in September 1992. The bones packed in dry ice are airflown to MINT and flown back within 12 hours for re-storage in NUH Tissue Bank.

LYOPHILISATION OF BONE ALLOGRAFTS
Where structural support is not needed, morsellised bones are best used as LYOPHILISED (FREEZE-DRIED) GAMMA IRRADIATED grafts.

To ensure good quality assurance and quality control of products, NUH Tissue Bank employs meticulous documentation and tracebility of all grafts from procurement to transplantation. The bank follows several Standard Operating Procedures, uses several forms such as donor forms, recipient forms, consent forms , processing forms, radiation forms final inspection forms and forms for authorization of tissue grafts etc. in addition to maintaining log books for various freezers, lyophilisers and for despatch. All procedures follow NUH TECHNICAL PROCEDURES MANUAL and our NUH QUALITY CONTROL MANUAL for the production of tissue grafts. The bank is being subjected to medical audit very soon.

Bone and ligament allograft transplantation is legal in Singapore. Procurement of musculoskeletal tissues does not follow "The Human ORgan Transplantation Act 1987" (HOTA) whereby kidneys could be procured unless there is prior written objection by the deceased (Muslims exempted). It follows the "MEDICAL (THERAPY, EDUCATION AND RESEARCH) ACT 1972" whereby consent is needed from the next of kin.

NUH Bone Bank provides a catalogue of all tissue graft products it produces to all nine hospitals it serves so that doctors and dentists can request for the appropriate product needed for each patient with its own individual needs. The catalogue includes our processing procedures and also instructions for preparation of allografts for use in the operating theatre.

In addition to a feature in the public education pamphlet issued by the Society of Transplantation Singapore which includes kidneys, liver, heart, bones and ligaments and cornea, NUH Tissue Bank has produced its own public education booklet for distribution to the public.