The end of another busy week has come to its conclusion. I think I'm getting the hang of my daily schedule as well as integrating into some of the daily activities at the tissue bank.
The first topic I'd like to mention is when we are supposed to study. That's because I haven't found the time to hardly study yet! I expect the pace of things to settle down a bit because now we have completed a lot of the administrative things that needed to be done such as applying for UPMC accounts, receiving UPMC IDs and attending orientations on the various software that we use such as CoPath. The lack of time after arriving at home at the end of the day actually makes me want to stay at work longer. During the weekdays, I actually like it better at work than at home. Home has become a place where I basically sleep, shower, cook and eat. My daily itinerary is something like this:
6:00 AM - Wake up
7:00 AM - Leave for work
7:45 AM - Arrive at work
12:00 PM - Break for lunch
1:00 PM - Return to work
4:30 PM - Head home
6:45 PM - Arrive at home, shower, cook dinner, eat, wash dishes
8:15 PM - Where did my day go???
10:00 PM - Sleep
I'm not saying this to scare anyone or complain. I'm just pointing out that when you do this rotation (and perhaps others), you're going to have to make time to study. One strategy that I've been doing is studying while I eat lunch and while I ride the bus. I'm grateful for the three-day weekend that we have ahead of us because I need to play some catch up.
It's great that I've been busy in the tissue bank because there have been so many different things that I've been exposed to. I actually think that I'll learn more (in volume) here at the tissue bank than at the gross room.
There are so many experiences I want to write about that it's difficult to choose where to start.
You can think of the tissue bank as a special kind of salad bar. Just as a salad bar has all sorts of different vegetables, a tissue bank has all sorts of different tissues and blood specimens. The purpose of the tissue bank is to serve as a repository full of different biological specimens that researchers/scientists can use for their research. Think of the patrons of the salad bar as the researchers. They are hungry for a certain salad and they're really picky. They want 15 lettuce leaves, 5 baby tomatoes, 7 croutons and 3 tablespoons of Italian dressing. Before the patron can get their salad, they have to write their order down and hand it to the salad chef. Once the salad chef approves of the order, the salad chef hands off the salad items to the patron.
Ok, it's actually a lot more complicated than that, but that's the best I can do.
Why do we need tissue banks?
In order to test the effectiveness of certain therapies, discover new pathways for drugs, etc... often, the only thing that is suitable for research is real human tissue. Experimenting on mice is better than nothing, but experimenting using human tissue gives researchers more accuracy in predicting the behavior of a drug or therapy. Without tissue banks, researches would have to get their own tissue themselves, store it, prepare their own tissue, etc... Doing all of this on one's own would cost an immense amount of time and money.
Why is there so much fuss about protecting patient tissue? It's just tissue, right?
In the past there have been horrific instances where researchers disregarded human dignity and caused much harm, such as with the Tuskegee syphilis experiments, Unit 731 and Nazi scientists, so you can't just request human tissue willy-nilly. (99.999% of researchers are not the 'crazy mad scientist gone amuck' as may have been suggested in the previous sentence. They are working their butts off to advance health care and save lives all in a day's work.) A researcher who requires human tissue must get approval from a special group called an Institutional Review Board (IRB). The researcher needs to explain what their study is and exactly what tissue is required. Once the IRB approves, the tissue bank can send the requested tissue or blood to the researcher. The IRB is not meant to be a road block to acquiring tissue, but rather a facilitator and a guide to help the researcher get the tissue that they need.
So what does a person who works at the tissue bank do?
The people who work at the tissue bank serve as what are known as 'honest brokers'. An honest broker acts as a mediator between the researcher and the data/tissue/patient. The honest broker protects the private information of the patient by de-identifying the patient's data/tissue. (One de-identifying system that is used is called 'caTIES' or Cancer Text Information Extraction System) The researcher never has a name or face to associate with any of the data or tissue that they receive.The honest broker is the lynchpin who connects the researcher to the data/tissue.
What type of things might a researcher want from the tissue bank?
Many researchers just want data. For example, (the following is entirely fictional) they just might want a list of all white men between ages 40-50 who had a nephrectomy for renal cell carcinoma without metastasis who underwent a certain chemotherapy and then showed relapse after 3 years, etc... In such a case, the researcher still needs to go to the IRB, explain about his study, be explicit in what information he needs and get it approved. The data that the researcher wants is called a an 'LDS' or 'limited data set'. The honest broker then needs to give the LDS to the researcher so that no superfluous information has been revealed. This is easier said than done. Often times, the researcher will discover something else and request more data, in which case they need to get another approval from the IRB.
In the case of tissue being requested by a researcher, it must be handled under similar strict guidelines. Of course, all patient identifiers must be removed. As with data, the tissue must be used strictly for the purposes of the study submitted to the IRB. (You can't decide to do a different experiment with the tissue or give it to your research colleague who also wants it.)
So what tissue exactly does the tissue bank collect?
It can really be almost anything. UPMC Shadyside focuses on genitourinary specimens, so a lot of prostates, bladders and kidneys are stored. You'll also find other tissue that is stored such as lung, liver, soft tissue, thyroid, etc...
Researchers typically need three things all from the same patient in order to do their studies.
1. Tissue containing tumor
2. Tissue free of tumor
3. Blood (particularly white blood cells)
You might be wondering why the researcher wants blood even though they already have the tumor and some normal tissue to serve as a control. A lot of research is done on gene expression or sequencing and either DNA or RNA is needed. White blood cells are needed because they contain the DNA/RNA. (Remember that red blood cells don't have a nucleus.)
You mean I could be unconscious on the operating table and the researcher can sneak in, draw my blood and snip out my organs while I'm knocked out without me knowing? No way Jose.
The above was an exaggeration, but this is where consent comes in. If a researcher needs your blood or tissue for research, they'll notify you and explain to you why yours is needed. Life saving treatments wouldn't exist without tissue donations and although you might not benefit directly, in the future, any person who shares your same malady might not have to suffer through what you did.
Tissue that is needed for research always comes secondary to the clinical diagnosis and treatment. Your care is primary and supersedes everything else. Only excess tissue that is leftover can be used for banking. In the end, people almost always consent when asked for using their excess tissues for research.
In cases where you do consent, during the surgery, the only thing that will be different is that a little bit of your blood will be drawn as well. (Your tumor infected tissue was going to be taken out regardless of whether you consented or not.) This blood is so that researchers can do DNA/RNA research.
What if a person is never asked for their tissue? Can their tissue still be put into the tissue bank?
Yes. As always, diagnosis and patient care come first. Even without a patient's explicit consent, if there is any leftover tissue it can be banked. Of course, all identifiable information is removed by the honest broker, so there's no way anyone else will know who the tissue came from. Because the patient wasn't asked to donate leftover tissue to the bank, blood will not be drawn from them during the surgery. (Drawing blood would only occur for research purposes, not for the sake of the operation, so drawing blood is prohibited.) It would be a waste to let precious leftover cancerous tissue be thrown in the trash, so some of it is frozen and stored for future researchers who might need it. In addition, according to law, once tissue has been de-identified it is no longer considered to be human tissue, but rather non-human tissue.
Without patient consent, research becomes much more difficult, since the valuable DNA/RNA component is not there from the blood.
It's a little strange, but I agree in that you shouldn't let things go to waste, especially if there is no harm in doing so and the thing being thrown away is very precious. Think of it like a person who sifts through a garbage heap to take out the plastic recyclables. It's not like the person who threw out the plastic specifically wanted their plastic trash to be put into a landfill rather than be recycled. Except with tissue it is magnitudes of greater importance.
Man, I haven't even gotten to the general routine duties that we do in the tissue bank. So far what I've typed has just been an outline of the tissue bank. Next time I'll get around to what honest brokers do to prepare and store tissue. That's the fun part!
Oh, and welcome to my humble abode. These pictures are from when I just had moved in with Prashant, my classmate, on the 31st of December. I've got a mattress now, so sleeping has become good once again.
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| Dazed and weary from the moving. My roommate must have had three times as many items as I did. |
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| Traveling light is the way to go. |
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