Ensuring sustainable availability of frozen bone allografts: experiences and lessons from a university hospital bone bank.

University hospital bone banks are vital to tissue transplantation, providing safe bone allografts for surgical procedures. The bone bank at Universiti Malaya Medical Centre (UMMC) initially sourced femoral heads and knee slices from living donors, which were radiation-sterilized and frozen for internal orthopaedic surgeries. In 2015, through collaboration with the Ministry of Health, the bank obtained long bones from deceased donors. A 10-year retrospective analysis (2013-2022) evaluated the bank's nationwide distribution, which totalled 661 frozen bone allografts across 384 despatch batches. The supply comprised 505 femoral heads and 61 knee slices from living donors, alongside 95 deceased-donor long bones. These allografts were supplied to 57 healthcare facilities: two internal UMMC wings (public and private), 2 university hospitals, 32 government hospitals, and 22 private medical centres. To accommodate rising demand and optimize operations, the bank implemented targeted quality interventions during a remedial phase (2017-2018). Consequently, bone rejections plummeted from 50.8% during the verification phase (2013-2016) to 20.2% in the post-remedial phase (2019-2022). This significant reduction was driven by two major updates: A streamlined consent process that enhanced donor screening for surgeons, and a new bone donor kit with optimized nursing procedures improved collecting and handling bone and blood specimens. Implementing structured procedural interventions effectively mitigated tissue rejection rates and secured a steady supply of high-quality allografts. Furthermore, monitoring national transplantation data and feedback on graft quality served as an invaluable benchmark for continuous improvement in bone banking activities.