The State Government last year built a $10 million facility in Midland which threw a lifeline to WA’s bone and tissue bank, PlusLife, to upgrade and rehouse from its ageing facilities at Hollywood Hospital. Then last August, a $250,000 grant from Lotterywest has enabled it to kit out a dedicated research laboratory.
Prof Andrew Smith, who is on the board of PlusLife and is the chair of the research and development committee, believes that it will be the only clean room research lab for bone and associated heart tissue research in Australia.
“A clean room means that the air is microbiologically filtered so that no pathogens, bacteria or viruses can enter, which allows us to produce products for transplant that is absolutely safe,” he said.
The not-for profit PlusLife, which is the only bone bank in WA, has provided more than 18,000 grafts in its 25 years of operation though its beginnings were humble –a simple laboratory bench at QEII Medical Centre with just two staff and two freezers donated by the SCGH Women’s Auxiliary.
The current managing director Anne Cowie said the Midland facility would include two tissue processing cleanrooms, freezer storage, a tissue testing laboratory and a dedicated research laboratory.
Ways to donate bone etc
PlusLife manages bone and tissue donations in WA and also provides graft material nationally and internationally. It operates two donor programs. Living patients having hip replacement surgery can donate the ball of their hip, which is used commonly in a ground-up form for children with spinal deformities, complex joint surgery and dental and facial bne loss treatments for patients with dental and facial bone loss.
And, as with organ donation, bone, tendons and ligaments can be donated after death with consent from next-of-kin.
Andrew, who is an oral and maxillofacial surgeon, said while PlusLife had engaged in research for a number of years, the new facility would allow a more focused approach in the areas of orthopaedic, spinal, dental and facial procedures.
It will also be a hub for post-graduate training with recent collaborations with the UWA, Curtin and Notre Dame medical schools.
“Principally, research will focus on orthopaedic surgery, which is specifically the targeted use of bone material for limb-saving procedures for people with cancer, mostly young children and adolescents,” he said.
“There will also be an emphasis on dental products as a significant amount of bone is needed for jaw reconstructions. One of the most common uses for bone nowadays is in ordinary, fairly routine dental treatments such as implants.”
“We pride ourselves on producing materials of the highest quality and ultimately the highest safety in the country.”
Expanded vision
“Our move to Midland has ensured that WA will be nearly self-sufficient in bone for the sort of purposes that we need, and it will also allow us to expand into new areas that we have really only just started to develop, mainly the maxillofacial and dental aspects, where a lot of bone grafting is done now days.”
“More bone is transplanted for dental purposes worldwide than for any other. Dental implants are often augmented by a bone graft, and frequently after dental extractions bone grafts are put in to maintain the bone stock in the jaw.”
“Obviously there are very emotive areas, such as the limb-saving procedures performed by surgeons such as Richard Carey-Smith using our products so that children, and others, don’t have to have amputations.”
“And then we do a lot of work in the spinal areas.”
Andrew told Medical Forum that the new facility also gave PlusLife a profile nationally and international.
“We’re interested in a national market, but the important thing to stress is that all of our product, the bone is only from Australian sources, and the testing and the way the material is processed is done to the highest possible standards. We are not convinced that these standards are mirrored by some other material that appears in Australia and WA.”
“We are confident that as long as that product is Australian in origin there is not a problem, but some very big companies have moved into the business of bone, which is supplied to Australia and there very little information available on the source or the biosecurity of that bone.”
“I’m certainly not saying it’s illegal – it is completely above board – but central surveillance, we believe, is required to ensure quality. This is not us trying to be anti-competitive. We’ve done some research that we will be shortly publishing which will compare what we believe are the safety levels of the Australian bone product compared to the safety levels from bone sourced elsewhere in the world.”
There has been a lot of focus over the past couple of years on organ donation, with inquiries and soul-searching about donor rates.
Plus of hip work
Andrew said the majority of the bone donation to PlusLife is from people having hips replaced.
“Our criteria for accepting bone is exceptionally strict and that means sometimes we can’t accept the donation. In the future, some of that bone that might not be able to be used for transplant could certainly be used for research purposes.”
In WA, organ donors and their families are also counselled at the same time about tissue and bone donation, which is not the case in every other state.
“We’ve got a building relationship with Donate Life here in WA. Tissue and organ donation often get confused, so sometimes opportunities do get missed,” Andrew said.
“We hope to increase our number of cadaver bone harvesting procedures. In terms of donation from living donors, we find people are very positive about it. We make it quite clear to them that we are not for profit and nobody makes money out of the bone they donate.”
This is not the case in other places in the world and Andrew said PlusLife sought to reassure donors that their harvested tissue is for clinical rather than corporate gain.
Future proofing?
In a world where just about anything, it seems, can be grown in a petri dish, we asked Andrew if there would be time when PlusLife grew its own bone product.
“There is lots of research about growing bone from tissue culture and other material but I think our lab is more likely to be doing research on new technologies with the bone that we have, looking at different structures and properties of materials. Exploring what various growth factors added can to the rate of bone healing,” he said.
“That’s how I see our laboratory developing. We probably won’t be kitted out for molecular biology style research, more for translational research into clinical activity.”
Anne Cowie said the $10 million provided by the WA Government in 2016 to build the new PlusLife headquarters in Midland was a one-off contribution, which safeguarded our organisation’s future but there is no ongoing government contract or funding. The building is owned by the State Government.
Funds come from a servicing the community.
“When a graft is provided by PlusLife, a fee for service is charged and paid by the hospital, which is recoverable via health funds. This fee is intended to cover the costs associated with retrieving and preparing the graft for transplantation,” Anne said.
Lotterywest’s $250,000 was a one-off grant to equip the laboratory, but the establishment of a new charity foundation will help finance ongoing research through philanthropic means and to source other grants.
The number of PlusLife donors and recipients
| Average | 2013 | 2014 | 2015 | 2016 | 2017 | |
| Donors | 630 | 706 | 629 | 595 | 596 | 624 |
| Recipients | 521 | 560 | 498 | 540 | 554 | 457 |
| Grafts (total) | 827 | 844 | 758 | 859 | 908 | 767 |
| Grafts (interstate) | 180 | 225 | 209 | 199 | 160 | 107 |
| Interstate % | 0.21 | 0.27 | 0.28 | 0.23 | 0.18 | 0.14 |