A skin bank is a facility that collects, processes, and stores donated human skin for use in medical treatment, primarily for patients with severe burns. It operates much like a blood bank, but instead of collecting blood, it recovers skin tissue from deceased donors, screens it for safety, preserves it, and distributes it to hospitals when patients need it. The first proper skin bank was the US Navy Skin Bank, established in 1949, and today an estimated 30 to 50 tissue banks are active in the United States alone.
Why Donated Skin Is Needed
When someone suffers extensive burns, the body loses its protective barrier against infection, fluid loss, and temperature changes. If the burn covers a large percentage of the body, there simply isn’t enough healthy skin left on the patient to harvest and transplant onto the wounded areas. That’s where banked skin from a donor comes in. Donor skin, called an allograft, acts as a temporary biological covering that protects the wound, controls infection, and buys time while the patient’s own skin heals or grows back enough for a permanent graft.
Banked skin allografts serve several specific roles in burn care. They can cover extensive full-thickness wounds after dead tissue has been surgically removed. They protect widely meshed autografts, which are thin sheets of the patient’s own skin that have been stretched like a net to cover more area. They also help partial-thickness burns heal and prepare wound beds so they’re ready to accept the patient’s own skin later. Beyond burns, donor skin is occasionally used for patients with large soft tissue injuries from trauma or severe skin infections like necrotizing fasciitis.
How Skin Is Donated and Screened
Skin for banking comes from deceased donors, typically within hours of death. The process requires consent from the donor’s family, similar to organ donation. Technicians recover thin layers of skin, called split-thickness grafts, usually from the back, thighs, or legs. The donation doesn’t disfigure the donor’s body in a way that would affect an open-casket funeral.
Every donor goes through rigorous screening before their skin can be distributed. The FDA requires that all tissue donors be screened for relevant communicable diseases using standardized questionnaires that review the donor’s medical and social history. Laboratory testing is mandatory for HIV (types 1 and 2), hepatitis B, hepatitis C, and syphilis. These requirements are designed to ensure the tissue is safe before it ever reaches a patient. The American Association of Tissue Banks (AATB) publishes comprehensive standards covering everything from donor screening and consent to tissue processing, labeling, storage, and distribution. The most recent edition, the 15th, took effect in January 2025.
Processing and Preservation Methods
Once recovered, donated skin must be processed quickly. Fresh skin that’s simply refrigerated offers the best clinical performance: it adheres to wounds faster, controls microbial growth more effectively, and can even reconnect with the patient’s blood supply temporarily. But refrigerated skin has a narrow window. If it isn’t used within 96 hours of collection, it must be either preserved through another method or discarded, per AATB standards.
For longer storage, skin banks use two main approaches. Glycerol preservation involves soaking the skin in a glycerol solution, which replaces water in the tissue and prevents ice crystals from forming. This produces non-viable skin, meaning the cells are no longer alive, but the structural framework of the tissue remains intact and still functions as an effective wound covering. Cryopreservation takes a different approach, freezing skin in a glycerol-based solution at around negative 80 degrees Celsius. At that temperature, skin can be stored for many months. Storage in liquid nitrogen, at roughly negative 160 degrees Celsius, extends the shelf life dramatically, maintaining usable skin for up to 10 years.
The choice between methods involves trade-offs. Cryopreserved skin retains more of its biological properties and living cells, which can be beneficial for wound healing. Glycerol-preserved skin is easier to store and transport since it doesn’t always require ultra-cold freezers, making it more practical in resource-limited settings.
What Happens After Transplantation
Donor skin is not a permanent solution. The recipient’s immune system recognizes the foreign tissue and mounts a strong inflammatory response that ultimately destroys the donor cells and rejects the graft. This rejection is driven primarily by T cells, a type of immune cell that detects proteins on the surface of donor cells and identifies them as foreign. Antibodies and natural killer cells also contribute to the process. Even when the major tissue markers between donor and recipient are well matched, minor differences in proteins between individuals are enough to trigger rejection.
This is by design in burn treatment. The donor skin serves as a temporary biological dressing, protecting the wound for days to weeks while the patient stabilizes and their own skin regenerates or becomes available for permanent grafting. Surgeons typically use allografts to cover excised burn wounds immediately after surgery, control infection in contaminated wounds, or promote the growth of new skin cells at the wound edges. In one large study from an Indian burn center, allografts from 240 donors were used for 158 recipients. About 32% of cases used allografts for primary wound closure after burn excision, 28% for infection control and wound bed preparation, 25% to promote new skin growth, and 15% for patients whose overall condition was too poor for immediate permanent grafting.
How Skin Banks Are Organized
Most skin banks operate within larger multi-tissue banking organizations rather than as standalone facilities. These organizations may also process bone, tendons, heart valves, and other donated tissues. They follow both federal regulations set by the FDA and voluntary accreditation standards from the AATB. The AATB standards cover the full chain of custody: institutional requirements, records management, consent practices, donor eligibility, recovery operations, processing, packaging, labeling, storage, distribution, and quality assurance programs.
Skin banks coordinate closely with organ procurement organizations, burn centers, and hospitals. When a potential donor is identified, the tissue bank dispatches a recovery team, processes and preserves the skin, and stores it until a hospital requests it. Because severe burns are unpredictable and often require immediate surgical coverage, having a ready supply of banked skin can be the difference between life and death for patients with large burns who have run out of their own skin to graft.