Between Skin And Survival, A System Fails

For 11 days now, nine-year-old Renu (name changed) has been lying in the burns ICU at a premier government hospital in the national capital.

Forty per cent of her skin is gone — melted in a domestic accident that turned an ordinary evening into an unending corridor of hospital hours.

Doctors say she needs an urgent skin graft. Every hour without one increases the risk of infection, sepsis and irreversible loss.

Renu was lucky as her hope arrived. A donor was located — not in Delhi, but in Amritsar, more than 450 km away. A family grieving their own loss steps forward, believing that a child's life may be rebuilt through theirs.

But by the time the team reached Amritsar, precious hours were lost. For, a skin graft must be harvested within six hours after death.

The retrieval team returned empty-handed. Renu waits again.

Plastic surgeons say the incident reflects a deeper structural challenge — unlike organ donation, skin donation does not fall under any national funding mechanism, there is no centralised coordination network, and public awareness remains scarce.

The issues were discussed threadbare during a national brainstorming session on skin banking and skin donation organised by the Department of Plastic, Reconstructive and Burns Surgery at AIIMS Delhi, along with Organ retrieval Banking Organisation (ORBO) a few days ago.

The objective was to review current practices and develop strategies to strengthen skin banking services nationwide.

“India records nearly 7 million burn injuries every year — a burden among the highest in the world. Of these, around 150,000 people lose their lives despite medical intervention, and nearly 250,000 others survive with lifelong deformity, scarring, disability or functional impairment."

“Yet the current supply remains far below what is required, leaving burn units across India struggling to meet demand arising out of accident, domestic mishap, acid attack, industrial burns or electrical injuries," said Prof. Maneesh Singhal, Head of the Department of Plastic, Reconstructive, and Burns Surgery at AlIMS, New Delhi during the session.

“Skin donation is possible in every death. There is no issue of HLA matching. Also, the catchment area is huge as unlike the brain dead cases, skin can be grafted within the window period (six hours) from even those who are dead. Yet we lose most potential grafts simply because there is no national system that connects skin banks, burn wards and retrieval teams,” Dr. Shivangi Saha, Assistant Professor, Plastic, Reconstructive and Burns Surgery later told The Health Outlook. The skin can be preserved for five years.

She had moderated the session along with Dr. Nandini Tanwar and Dr. Manju R.

The meeting brought together burns and plastic surgeons, Organ Retrieval Banking Organization (ORBO), a nodal facility for cadaver organ and tissue donation related activities at AIIMS, Delhi, National Organ and Tissue Transplant Organization (NOTTO), hospital administrators, faculty from Anatomy and Forensic Medicine, NGOs, nurses and technicians, with participation from 22 skin banks across India.

The experts also noted that while organ donation has a national registry, hotline, ambulance priority and state funding, skin donation still depends on scattered personal initiative. Most skin banks in the country were set up only after 2022, but none has crossed even 100 donations.

Prof. Aarti Vij from ORBO emphasized key challenges that need to be addressed, including raising awareness about skin donation, training retrieval teams, ensuring proper infrastructure for skin banks, integrating skin donation with existing organ donation networks, and investing in technology and research.

Dr. Anil Kumar, Director, NOTTO, presented the national registry for skin donation and transplantation, designed as a central portal for skin donation and banking, and clarified policy issues such as Licensing criteria for skin banks and collection centres.

Dr. Sunil Keswani, Director, National Burns Centre, Mumbai, shared SOPs and lessons from over 17 years of skin banking experience, focusing on quality assurance.

At the meeting, experts from 22 skin banks laid out a set of structural reforms required to strengthen skin donation and retrieval services in India.

Foremost was the demand for a national skin donation and retrieval network, modelled on organ coordination systems, to ensure that available grafts can be mobilised swiftly across states.

They also called for government-backed financial support — both to scale infrastructure and to fund trained personnel, preservation systems and cold-chain storage. Alongside this, experts pressed for dedicated rapid-response skin retrieval teams in every zone, equipped to carry out harvesting within the crucial six-hour window.

Another major recommendation was for large-scale public awareness campaigns to normalise post-mortem skin donation, similar to eye and organ donation drives. In India, burn injuries rank just below motor vehicle accidents as a cause of trauma-related deaths, posing a large economic, social and public health burden.

According to the doctors, an average-built person’s body can yield up to 3000 sq cm of skin. Any individual above 18 years of age can donate their skin within six hours of death, provided they do not suffer from conditions such as HIV, Hepatitis B & C, STDs, generalised infection and septicemia, skin infection, malignancy, or evidence of skin cancer.