Awareness about skin donation needed in India: Expert

Sunil Keswani, plastic and reconstructive surgeon, says lack of awareness means only a fraction of burn survivors receive skin transplants each year, though they are critically needed

The Mumbai-based National Burns Centre (NBC), a leading institution dedicated to the treatment, rehabilitation, and prevention of burn injuries, has raised serious concerns over the acute shortage of skin donations in India.

Spearheading the NBC’s campaign to encourage more skin donor pledges, its director and noted plastic surgeon Sunil Keswani said that lack of awareness remains the biggest hurdle.

Keswani is a distinguished plastic and reconstructive surgeon with extensive expertise in burn care and rehabilitation. He completed his MBBS from the Armed Forces Medical College, followed by an MS from Tata Memorial Hospital and an MCh in Plastic Surgery from Seth G S Medical College and KEM Hospital. A pioneer in burn care in India, he established the National Burns Centre at Airoli in Navi Mumbai — the country’s first dedicated state-of-the-art facility for comprehensive burn treatment.

He has also played a key role in advancing skin donation and transplantation, setting up a skin bank at the NBC and contributing to the establishment of 12 more across India.

“It is likely that only one in 10 people are aware of skin donation or the process involved. This lack of awareness means only a fraction of burn survivors receive skin transplants each year, though they are critically needed,” Keswani told DH.

Excerpts from the interview:

Explain skin donation for a layperson. From where is skin extracted, and how long can it be preserved?

Skin donation is a simple and noble act carried out after death, where the outermost layer of skin is gently removed to treat burn patients. Skin is typically taken from non-visible areas such as the back, thighs and legs, ensuring there is no disfigurement. Only a very thin layer (about one-eighth of the skin thickness) is harvested. The procedure takes about 30–45 minutes and is conducted with dignity and respect. Skin must be donated within six hours of death. Once processed, it can be preserved in skin banks for up to five years. The donated skin is used as a temporary biological dressing for about three weeks. It helps reduce severe pain, prevents infection and fluid loss, and improves survival chances until the patient’s own skin regenerates.

What is the scenario of skin donation in India compared to abroad?

In developed countries, skin banking is well established and awareness levels are high. In India, however, there is still a wide gap between demand and supply. Despite millions of burn injuries being reported each year, donation rates remain low due to myths and lack of awareness. Even leading centres face a severe shortage, making skin a scarce, life-saving resource.

How many skin banks are there in India, and where are they located?

India has 34 skin banks, of which eight are in Maharashtra. The NBC has played a role in setting up 22 of these facilities.

What is the process of skin donation?

After death, the family must give consent and inform a skin bank through a 24×7 helpline. A trained team reaches the location, screens the donor for suitability and harvests the skin using a dermatome. The body is then respectfully dressed and returned to the family. The process is safe, dignified and does not delay last rites.

How is donated skin accessed for patients in need?

Burn patients are treated in specialised centres. When burns exceed 40–50% of the body surface, the patient’s own skin is insufficient. In such cases, preserved donor skin (allograft) is issued from skin banks and used as a temporary cover to prevent infection, reduce fluid loss, alleviate pain and improve survival chances.

Are there laws governing skin donation in India?

Skin donation is regulated under the Transplantation of Human Organs and Tissues Act (THOTA), and overseen by bodies such as the National Organ and Tissue Transplant Organisation (NOTTO), Regional Organ and Tissue Transplant Organisations (ROTTO), and the State Organ and Tissue Transplant Organisations (SOTTO). Consent from next of kin is mandatory, commercial trade is illegal, and strict ethical and medical screening protocols are followed.

How does the Airoli centre function?

The NBC established a state-of-the-art skin bank in 2009 in collaboration with international partners. Its functions include round-the-clock skin retrieval, processing using glycerol, preservation at controlled temperatures and distribution across the country.

What is the level of awareness about skin donation? Are there campaigns like those for organ donation?

Awareness about skin donation remains significantly lower than that on organ donation. Myths — particularly that donation disfigures the body — persist. While large-scale national campaigns are limited, hospitals and NGOs are increasingly working to raise awareness through walkathons, car rallies, talks at condolence meetings, colleges and old-age homes.