Using Your Own Tissue vs. Using Donor Tissue

By Jonathan Cluett, MD 

 Medically reviewed by Yaw Boachie-Adjei, MD

Many different orthopedic surgical procedures require the use of additional tissues within the body in order to accomplish the reconstructive goals of surgery. Often when there has been an injury, the tissues that are damaged require the use of the augmentation in order for proper restoration of function.1

In these situations, your surgeon will need to make a decision about where to get additional tissue to augment their surgical repair. The most common ways to obtain tissue are either to obtain the tissue from elsewhere within your body or to take that tissue from a donor. Tissue that is obtained from your own body is called autograft. When tissue is taken from a donor, it is called allograft.

Some of the common surgical procedures that may require tissue augmentation during orthopedic surgery include:

• Cartilage transplant surgery

• ACL reconstruction

• Spinal fusion and reconstruction

• Fracture surgery

When planning for one of these surgical procedures, your surgeon may discuss with you the options for obtaining tissue for surgical repair of any damage. Your surgeon may discuss options for using your own tissue or for using donor tissue at the time of surgery. Both options can work well. However, sometimes people have certain preferences.

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The use of allograft tissue has become very common—about 1.5 million orthopedic procedures using allograft are performed every year in the United States.2 By learning the pros and cons of autograft versus allograft tissue, you are better equipped to discuss these options for orthopedic reconstructive surgeries.

Pros and Cons of Autograft

Pros of Autografts

Healthy, living tissue

Stronger than tissue that has been sterilized

Less possibility of disease transmission

Cons of Autografts

Graft must be obtained from healthy part of the body

Involves a larger surgical procedure and more discomfort

Potential for damage in otherwise healthy part of the body

Pros

One of the primary benefits of using your own tissue is the fact that the tissue is alive and contains your own living cells. Unlike donor tissue, which must be sterilized and preserved, using your own tissue transfers healthy, living tissue to the area of damage. While sterilization and preservation techniques have improved to limit the amount of structural damage to allograft tissue, it is not as strong as tissue that has not been through these processes.

The other primary advantage of using your own tissue is that there is less of a possibility of disease transmission. There is still a possibility of infection where bacteria can enter a surgical wound from your skin or the surroundings, but there is no concern of getting a transmissible disease (such as hepatitis or HIV) from a donor.

Cons

The main reason that people avoid autograft is that it does necessitate obtaining the graft from an otherwise healthy part of your own body. This is problematic for two reasons. First, it involves a larger surgical procedure and more discomfort. Because the graft must be obtained, this typically means the incisions are larger, and there is discomfort associated with the harvesting of the graft.

The second concern is the damage to the otherwise healthy part of the body. For example, the most common graft locations for ACL reconstruction surgery are either of the patellar tendon or the hamstring tendon. Both the kneecap and the hamstring are critical to normal knee function, and damaging these structures can cause problems with rehabilitation. While graft harvesting is done in a way to minimize collateral damage, some people want to avoid this altogether.3

Pros and Cons of Allograft

Pros of Allografts

Early phases of recovery are less painful

Allows for a smoother postoperative period

Cons of Allografts

Sterilization process makes tissue weaker

Rehabilitation takes longer with donor tissue

Pros

People who select allograft tissue are generally looking for an easier, smoother recovery. Although, it is not necessarily a faster recovery because the use of allograft tissue can actually increase the duration of recovery overall. However, using allograft tissue does tend to make the early phases of recovery less painful and somewhat easier.

By avoiding surgery to harvest graft tissue, people who select donor allograft tissue generally have an easier early postoperative recovery and get back to their daily activities a little more quickly.

Cons

The downside of allograft tissue is that there are numerous studies that have demonstrated that this tissue is not quite as strong as tissue that has not been sterilized and processed. Most surgeons performing ACL reconstruction recommend that high-level athletes (such as collegiate or professional athletes) avoid donor tissue because of higher rates of reinjury to the graft.

In addition, rehabilitation timelines are generally longer when donor tissue is used; this can be an issue for a high school or collegiate athlete on a tight recovery timeline. Lastly, concerns about disease transmission are significant for many people. While the risk of getting an infection from a donor graft is exceedingly small, there have been case reports of this happening. Many people choose to avoid this potential risk altogether by using their own tissue.

Safety

Though there are certainly pros and cons to using either allograft and autograft tissues, both options are exceedingly safe.

There is always a risk of infection whenever a surgical procedure is performed, and this is true of both autograft and allograft surgical procedures.

There are some unique risks associated with the use of allograft tissue. Specifically, there is a risk of disease transmission, although this risk is exceedingly small. In addition, there is a possibility of contamination of allograft tissue if it is not properly sterilized or stored. The risks of disease transmission or contamination with allograft tissue are very small.

To prevent these risks, your surgeon should work with a reputable tissue bank and ensure that they are aware of the screening procedures and criteria for selecting how grafts are obtained. If you are concerned about the risks of disease transmission, ask your healthcare provider to provide you with more information about the tissue bank where he or she obtains graft tissue.

Synthetic Options

Significant research efforts have been done to identify possible synthetic options that can be used for various surgical procedures.

While there are some synthetic options that exist, most orthopedic studies have found that synthetic graft options do not perform as well and are not as durable as human tissue.

There are some bone graft substitutes that have worked well for spine fusion and some types of fracture repair, but these applications for synthetic grafts have been somewhat limited. There have been efforts to identify synthetic options to create new ligaments and tendons.

While there are some investigations where these might be feasible, they are generally considered a secondary option. Using healthy human tissue (either autograft or allograft) is generally considered a stronger, more durable graft option.

Orthopedic surgical procedures that involve reconstruction of damaged parts of the body may require the use of tissue augmentation. You and your surgeon will need to make a decision about where to obtain this tissue from. The most common options are either to obtain this tissue from somewhere else in your body (autograft) or from someone who has donated tissue after they have died (allograft).

There are pros and cons to both autograft and allograft tissues, and deciding on which option is best depends on your specific needs and the surgical procedure being performed. You should discuss with your surgeon if you have specific concerns or preferences about where tissue grafts should come from.

Sources

Wydra FB, York PJ, Johnson CR, Silvestri L. "Allografts for ligament reconstruction: Where are we now?" Am J Orthop. 2016 Nov/Dec;45(7):446-452.

Giedraitis A, Arnoczky SP, Bedi A. Allografts in soft tissue reconstructive procedures: important considerations. Sports Health. 2014;6(3):256-264. doi:10.1177/1941738113503442

Wright RW, Huston LJ, et al. Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the multicenter ACL revision study (MARS) cohort. Am J Sports Med. 2014;42(10):2301-2310. doi:10.1177/0363546514549005

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.