Donor selection, testing, and inactivation of the HIV virus in freeze-dried bone allografts

This article is a comprehensive review of the safety of currently used freeze-dried bone allografts. The development of exclusionary criteria for donor procurement is discussed along with the steps taken in processing. The processing includes harvesting in a sterile manner, repeated washings, immersion in ethanol, freezing in liquid nitrogen, freeze-drying, demineralization, and vacuum sealing. The statistical data of laboratory testing for the HIV virus is presented, and the advantages and disadvantages of the ELISA and the PCR tests are outlined. There are four known cases of HIV transmission from bone allograft donors, and the circumstances of these four transmissions are discussed. An overview of hepatitis and other infectious diseases in bone allografts completes the review. The learning objective of this article is to update reader knowledge of measures taken to ensure safety in the utilization of DFDB allografts.