Episode 2 The Human Tissue Squad

This programme contains some scenes which some viewers may find upsetting

Skin, shafts, heads, knees.

OK. Left eye is out.

Every year, thousands agree

for their loved one's tissues to be donated.

We rely on the kindness of people to understand that,

once they're gone, they don't need their eyes, their meniscus,

their skin, their heart valves.

They help change the lives of thousands of people

across the country.

You don't expect it to happen to you.

I'm just appreciative that someone would donate their eyes,

cos it's going to improve my quality of life.

This series follows the staff of Liverpool's

National Human Tissue Bank...

OK, you ready? Should we get cracking?

People expect it to be, like, middle-aged men.

Or kind of massively gothic people, for some reason.

My dad always used to say things like,

"Oh, you'll never get a boyfriend doing that kind of job."

..as they grapple with death...

I don't normally ever get upset, ever, about it all.

..to help the living.

I do think what we're doing is incredible.

This job is really important because

we're saving peoples' lives.

This week, 18-year-old Reuben needs a life-changing operation...

I do miss working. Working's my life really, I love it.

So now I've got barely nothing, really.

My mum's having to support me.

..and the emotional pressure of the job starts to take its toll.

I'm hearing someone's died, maybe 25 times a day

and I can't do it forever, cos I'll...

I'll forget everything else about

nursing isn't just about death, is it?

It's early December at the National Human Tissue Bank.

On the outskirts of Liverpool,

this vast building is stacked with freezers full

of the country's life-saving heart valves, skin, and bone.

PHONE RINGS

My name's Leanne Langford, I'm one of the nurses

calling from NHS Blood and Transplant...

Making such supplies possible are the specialist nurses,

who have the difficult job of calling recently bereaved families.

My name's Laura, I'm one of the specialist nurses

calling you from NHS Blood and Transplant.

A woman has died,

and 28-year-old Laura is calling her husband.

Now, I'm just calling with some information for you.

Before I do that, I just wanted to offer you my condolences.

-'Thank you. Thank you very much.'

-You're welcome.

OK, my role in the tissue bank is

to consent with the family for the donation.

And then follow that up with arranging for the donation

and releasing tissue.

Now, the corneas are the very front part of your eye,

where you'd wear a contact lens,

and that cornea is what is used in transplants, OK?

Now, it is a very delicate part of the eye,

so we do require the whole of both eyes being donated.

It can be quite tough, but it's also very nice when you can follow out

the family's and the deceased's wishes.

It has its bonuses to the job.

The team speak to over 5,000 families every year,

helping them decide whether to donate their loved one's tissues.

I'm just arranging a donation for someone

who passed away with sudden collapse.

Went into A & E and was pronounced dead yesterday afternoon.

The family has agreed to donate their son's tissues.

As the donor is young, it's a rare donation for the bank.

Last year, only 8% of the donors were under 30.

See you in a bit. Bye.

Right, OK, then.

Along the corridor are the tissue donation specialists.

Today, 33-year-old Francesca will be taking the tissues from the donor.

-Right. Any tattoos, piercings, distinguishing features?

-No.

-Is there going to be a post-mortem?

-Yeah.

So what tissue has been consented for?

-Erm... Skin...

-Radius and ulna.

U-L-N-A. Ulna.

Oh!

THEY LAUGH

It were jumpy then. Just write it again.

It would help if I knew how to spell it, wouldn't it?

-OK, thank you.

-Thanks.

Once Francesca's collected the equipment,

she and colleague Mel will head north to the mortuary,

to carry out the donation.

Taking tissue from recently deceased young donors

is never easy.

Some cases you do think about the donors, erm..

..who they were, especially on the ones where it

was like a sudden death or maybe a younger person or things like that

and you might think more about, you know,

who they were or what they had ahead of them and their families

and parents and stuff and how it's going to affect them.

-You all right getting set up, then?

-Yep.

Bit of ethanol in the air.

Just stops the smell sometimes.

Francesca's been in the job for eight years,

and has developed her own way of working with the dead.

That's the only thing

that can be a bit strange,

if people have got their eyes open.

Some people, if they've got their eyes open,

don't quite look dead.

Seeing someone's eyes and stuff doesn't freak me out,

but it makes it more difficult to detach, in a way.

Most people don't die with their eyes closed peacefully,

as you kind of imagine on TV or films,

so that's why I try and make sure, people die,

their eyelids get closed.

It's more peaceful for them.

As the donor is young, they're likely to have

more healthy tissue to donate.

Each donation follows a set order to avoid damaging vital tissue.

So we're doing all three bones in the arms,

so humerus, which is the top part of the arm,

radius and ulna, which is in your lower forearm.

Donated bones are in big demand at the tissue bank,

as they're often used to replace cancerous bones

and repair sports injuries.

One humerus.

So it'd go that way round in that arm.

Here we have the ulna,

which kind of goes underneath

and cos the donor is very young,

the bones are really nice and white and smooth and clear.

While the girls are building up the tissue bank's stocks,

back at base in customer services,

the orders are coming in thick and fast.

Good afternoon, Tissue Services, Daniel speaking, how can I help?

Right. Do you know what size

Achilles' tendon that your surgeon wants?

The most popular tissues are often in short supply.

We have got a 19cm here, so I've allocated that one for you.

That's great, so that's one Achilles tendon at 19cm.

I'll fit deliver tomorrow, before 9am, for Mr Hallstead.

That's great.

All right, I'll send the confirmation shortly.

Thank you. Bye-bye. Bye.

Supplying 350 hospitals nationwide,

it's a constant battle to keep up with demand.

Right, erm, freeze-dried bone,

do you want that fine ground, medium ground, or coarse ground?

And, with regards to delivery, do you need this before 9am,

or are you happy for it to come in before noon?

One patient, who is on the hospital waiting list for a donor bone graft,

is 18-year-old Reuben.

We're going off to the site that I was working at

before my knee become how it is now.

But I haven't been back here since, actually.

So it'll be quite interesting to find out

how it's looking and all that, really.

Reuben was working as a carpenter

when, eight months ago, he noticed a problem with his knee.

When I first started the job, it was OK,

my knee weren't too bad, it was all right,

and then I first sort of noticed the trouble

when I was doing the walls and that.

And then when I had to get down on the floor

and when I had to sort of stand up quite quick to grab tools

and whatnot, that's when I found it most hard.

Yeah, my knee at the end of the day was really,

really hurting at the end of the day.

It was aching and that's when I had the MRI scan

to tell me, like, you've got a tumour.

If the doctors don't remove the tumour,

Reuben's knee could be destroyed.

I was a bit upset, really, big ball in my throat and all that.

You don't expect it to happen to you.

You just have to get along with it and be positive, really.

It was my first big job that I've ever done.

I loved it, I loved every minute of it.

Well, you see, I done the old stud walls, these are the partitions.

This is, obviously, the kitchen to the living room.

And also I done the...

I put these door linings in.

I done all these door linings

and also you can see here the stud walls and stuff.

I do miss not working, working's my life really, I love it.

It's just like it gives you something to wake up for, don't it?

For my age and that, I was earning a good 300...

300 a week.

Now, I've got barely nothing, really.

My mum's having to support me.

Gutted, absolutely gutted.

For now, all Reuben can do is wait for his surgery.

Back in the mortuary, after three hours,

Francesca and Mel are halfway through a donation

that could improve the lives of dozens of people.

What we're doing next is bones in the leg, the whole knee

and then once we've done all that, we've got Achilles tendons as well.

Very big femoral heads there, being a young, fit, healthy donor.

-'God, it is massive.'

-Nice strong bones.

It's a femoral head, like this,

that will be ground down into tiny pieces

and used to help repair Reuben's knee.

Er, I wouldn't say it's difficult to cut through bone

because the blades are very sharp and they're battery-powered.

We used to have handsaws, but they were near-enough impossible to use.

# Cos it's your heart

# It's alive

# It's pumping blood... #

While Reuben awaits news of his operation,

he can only dream of happy footballing days.

I played for reserves for about a season and half,

but I just couldn't play at all.

-All right, Tom, me old mate?

-Hi, Reuben.

-How did you get on today?

-We won 2-1.

-Did you?

-Yeah.

-Excellent.

-I scored the winner.

-Did you?

-Yeah.

-Excellent.

-What sort of goal was it like?

-Chip-cross in the air.

-Really?

I was a substitute, really, I weren't that good.

HE LAUGHS

So, erm, he's got my job now.

I was just there if they needed me, sort of thing, really.

I loved it, though, it was a good laugh.

Playing footy on a Saturday, you can't beat it.

After five hours in the mortuary,

the girls have retrieved valuable arm and leg bones

for the tissue bank.

Now, they'll use reconstructive techniques so that the donor

looks the same as when they arrived.

So, this is the full arm prosthesis, Meccano pieces if you like.

So, like, the leg one we can make it longer or shorter.

Erm, I do think, you know,

the concept of what we're doing is incredible,

that we can take bones and skin from somebody else

and then they can be processed and transplanted into somebody else.

It's amazing.

For Mel and Francesca, every job is a physical and mental challenge.

It's been just over six hours from getting into the mortuary

so far, so ready for a cold drink.

You know, it is a long day,

it does take its toll when you've done it a few days in a row,

but I'd much rather do this

than be sitting in an office nine to five, definitely.

After seven long hours in the mortuary,

the donation is complete and the girls are off home.

My mum is just completely proud of me, she absolutely loves my job,

she loves that I'm saving lives and that I'm happy, so.

My dad always used to say things like,

"Oh, you know, you'll never get a boyfriend doing that kind of job."

And, again, I think it's just because it's the unknown,

cos for my dad, he just thinks, you know,

you're cutting up dead people and it's a bit weird.

My dad always wanted me to be a weather girl,

or in marketing, that's it,

that's basically all my dad wanted me to be.

"I think you should be a weather girl."

I think it's probably because he loves watching the news

so I'd be there every day like, "And today, it's going to be raining

"and tomorrow, it's going to be snowing."

It's either that

or he didn't think I was intelligent enough to do anything else.

On the other side of Liverpool,

Francesca is getting home to husband Mike.

Smells good, smells very good!

How long have we got to wait?

I'm fine with meat after doing donations and things.

Erm, the worst thing is liver, raw liver...

to cut up is more...

I don't know. Not that we...

We don't retrieve organs or anything

but I don't know why but I think raw liver is the thing that

I just get a bit funny about.

While Francesca might have a strong stomach for the job,

hubby Mike certainly doesn't.

We were watching Silent Witness, there was an autopsy scene

and I'm like that, ugh,

and Chess is like, "That doesn't even look real."

I'm looking, thinking, "It looks pretty real to me."

It's an unusual job, but she's just a normal person,

just like everyone else on the team.

Well, you'd imagine you'd go in there and they'd all

look like the Addams family or something, something like, you know,

you'd think, "Oh, they look...yeah, they look a bit strange, them lot."

Well, I'm not saying they all don't look strange,

but Chess looks pretty normal.

For every donation that Francesca carries out,

a difficult, but necessary call will have been made to a family.

Would you be comfortable with the bone donation from his arms?

-'Yep.'

-Yeah, OK.

It's the week before Christmas and for the nurses,

one of the toughest times of the year.

Now, he would also be able to donate his Achilles tendons,

so these are the tendons at your back of your ankle

so it's giving people back their mobility and their independence

and things like that.

There would be a small scar down the back of the ankle

and we would also take a small part of the heel bone, OK?

But again, you know, he would be dressed if you want to go

and see him so that would be fine.

-Is that OK for you?

-'Yep, that's fine.'

-All right.

Speaking to over a dozen bereaved families every day

can be hard and especially during the festive season.

Brave, brave family.

-Make me a brew.

-All right?

-Yeah.

It's just his dad was so brave, and just, honestly...

..I don't know where they get their strength from, ever.

Always helps, always helps.

Ladies...

After a chocolate lift,

Laura's ready to make her third consent call of the day

in the designated family liaison room.

My name's Laura, I'm one of the nurses just giving you a call back.

Erm, just before I go any further, I want to offer you my condolences.

# One night to be confused

# One night to be speed up truth

# We had a promise made... #

I know you were having some time to think about becoming a donor

and I just wanted to know what your thoughts were now?

OK.

Oh, dear.

You'll decline.

You have every right to decline, OK.

If it doesn't make you both comfortable,

then it wouldn't make me comfortable either.

You only get one chance when someone's dying

or when someone's died to make things right for somebody else.

I know that I can make such a bad situation for families

a little bit better.

And I like to do that.

I want to be a nurse because I like to help people.

Although they're working with the bereaved daily,

the nurses try hard not to let it affect their personal lives.

I think if we let it change our opinion on the way

-we do things, we wouldn't go out of the door.

-Yes.

You wouldn't move, you wouldn't do anything adventurous,

you'd just wrap yourself and your family up, wouldn't you?

And never leave the house.

You end up doing more as well because you know that,

-you know, life...

-Yes, you don't know what's around the corner.

-You're aware of your own mortality.

-Absolutely.

-Definitely.

While the consent calls can be difficult,

they're vital to maintain the tissue bank supplies.

For donation specialist Becky it often means an early start.

We've got a donor today, me and Chris have got to do

pretty much everything,

so it's going to take a while.

We could be there for, I don't know, six hours.

We've got skin, bone, heart, eyes.

Do you want some breakfast?

Hello.

Yes, this job can really affect your home life because, you know,

cos I've got the dog and the cat and stuff,

if I don't come back until about 11 or 12 at night.

Luckily, I've got a friend around the corner

who's got a spare key and he's got dogs and stuff so he'll come

and pick her up and look after her for a bit if I need him to,

but I don't know what I'd do if I had kids and stuff, you know,

childcare and... It'd be a nightmare.

Oh, God, it's freezing.

You see, this is the kind of weather where you just want to

get back into bed and not emerge until spring.

I could quite happily hibernate.

A donor has died in the early hours of the morning

and his family has agreed to donate his skin and leg bones.

We're going to retrieve the bone from the legs,

so we're going to retrieve the femur and the knee.

This bit can be one of the most physical parts of the job,

especially on larger donors as well because you have to lift the skin

and muscle and any fat that's there away so you can expose the bone.

Then you have to dislocate the hip joint

which you kind of have to do a bit blind.

You just have to pop your hands in and feel around which is difficult

when you've got a sharp blade so you have to be really, really careful.

You can get donors every day of the year

and I think especially at this time of year families are maybe

more keen to donate because it's kind of the season of giving.

While Becky and Chris are hard at work on the donation,

nurses Linda and Laura have drawn the short straw,

to man the phones at Christmas...

I'll see you next week I think.

You're in New Year's Day with me, aren't you?

..meanwhile their colleagues enjoy Christmas lunch downstairs.

It is particularly difficult at Christmas.

Everybody's getting ready for Christmas and this family,

within an instant,

are now not getting ready for Christmas.

Christmas is all on the back burner, in fact, it's gone.

And they're just getting on with dealing with what they have to deal with here.

Back in the mortuary Becky and colleague Chris are still

hard at work collecting life-saving tissues

while most of the country is out Christmas shopping.

We try not to think about families and stuff

but I think when it's this time of year you do a bit more, don't you?

You know, someone has just lost someone at Christmas.

It's the last gift they can give as well.

That's very poignant, Chris!

It's hard to organise a social life.

If you're on a retrieval shift, there's no point in booking anything,

you can't book to go out for tea,

you can't say you'll be home for such and such a time because you've got no idea

and you can't predict when people are going to die!

I think all of our friends and families are just used to us

saying, "I'm sorry, I can't make it.

"I'm out in a mortuary in the middle of nowhere somewhere, so..."

But you can use it to your advantage

so if someone says you're invited to such and such, if you don't

want to go, you just say, "Oh, I can't, I'm on a retrieval shift!"

Cos you've never done that before, Becky(!)

Never made up a retrieval shift(!)

Most of us have worked here for a long time

so we've known each other for, you know, through marriages

and buying houses and all sorts so I think we are like a family.

There's definitely kind of the mums and dads

and the naughty kids in the group.

And families argue and families stick together and stick up for

each other but bicker and stuff,

so I'd definitely say we act like a family.

Yes, a dysfunctional one.

-Right, we finished then, Becky?

-Yes, job done.

By nine o'clock in the evening, Chris and Becky are finally finished

and off to celebrate Christmas with their families.

Thankfully someone else is on the Christmas Day shift.

With Christmas gone and most of January,

Laura's in the thick of it.

Today she has to call the family of a young man

who died in the last few hours.

This is a 21-year-old male who passed away in the London area

following a cancer diagnosis.

He expressed his wishes to donate anything he could.

Because of his condition he could only donate his eyes.

Can you tell me what diagnosis Reece had, please?

'Reece was diagnosed with kidney cancer.'

Kidney cancer, OK.

Donors who die of cancer can't donate their tissues

because of the risk of infection to the transplant patient.

There is one exception, the cornea, the lens of the eye.

Did Reece drink alcohol?

'Reece never drank alcohol. Very, very rarely.

'He was going to be a fitness instructor.'

Has Reece travelled outside the UK in the last 12 months?

'He has been to Spain, Portugal,

'Tenerife, oh, that is Spain,

'Um, he's been to Thailand,

'Egypt and France.'

In the last 12 months has Reece had any treatment like acupuncture,

tattoos, piercings, cosmetic treatment, anything like that?

'Yes, Reece has had a tattoo.'

There's a hitch.

Strict rules around the safety of tissue may mean Reece could be

barred from donating his eyes. Laura has to break the news to the family.

So, when somebody's had a tattoo,

they can't donate if it's been in the last four months.

Now, I know we are at the end of January, OK,

so when in the September did he have it?

'I'm only guessing September.'

To protect transplant patients from disease or infection,

donors must not have had any recent tattoos or piercings.

For Laura, it's bad news on a tough call.

I've had in the last few days really young donors.

I think just listening to the fact that he has not long been diagnosed,

you know, it has been a year, he's done all this travel in a year,

he's maintained a relationship with his girlfriend,

she's stayed there, and then his family are obviously distressed,

it's really sad but...

It's hard sometimes when you have a lot of emotion behind

what's happening on that donation, during that conversation.

I didn't want to make a mistake

because we didn't want to take the donation and then have to,

you know, dispose of his donation because we can't give it back.

Hopefully it can go ahead,

but obviously it's going to be really sad if it can't

because that's his wishes.

If the donation can't go ahead, it's not only frustrating

for the family, it also means a longer wait for people like George.

Our first paddle this morning.

We haven't been out on the water

since Christmas due to high tides and a bit of a push on gym work.

In Chester, 25-year-old amateur rower George

is waiting for a corneal transplant.

Diagnosed with a degenerative condition of the eye

he has already had one transplant on his right eye.

Now the left eye has deteriorated.

Stuff's there, it's just nothing really focuses, blurred vision.

I couldn't really read anything.

So, yeah, this is sort of the next step now with the operation

to get things better, make it a bit more stable

and then I can rely on having two eyes again.

George's condition means his best chance of success

is a cornea from a donor of a similar age,

but last year only 3% of corneas donated were from those under 30.

It was tough as a kid really.

You know, my big love as a kid was rugby.

I played a lot of rugby.

I had to stop that because my vision was a bit poor

and the contact lenses weren't working for contact sports,

so that's why I turned to rowing.

It turns out I am a bit of a better rower than I am a rugby player!

So every cloud's got a silver lining.

George works in the construction industry

and needs good vision to do his job.

Without a corneal transplant, he could find himself unemployed.

This is a soft lens

so this is a lens that I put on on my grafted eye at the moment

so I use this lens with a glasses prescription as well.

So, yes, that's done.

George's cornea is currently so deformed

that the contact lens is difficult to wear.

I lost a lens for a while and I couldn't get a replacement,

I had to take a week off work. I managed to lose it on a night out,

flicked out of my eye

and my reflexes weren't quite quick enough at the time to catch it

so I was sprawling around on the floor, trying to find my lens.

So, yeah, not ideal.

The hospital waiting list for corneal transplants

can be up to two years.

So George could be scrambling on nightclub floors

for a long time to come.

For every patient like George, there is a need for a donor.

I've just consented his daughter

and she's happy to go ahead with donation and he was also

on the organ donor register with no restrictions as well.

Almost 500,000 people in the UK die every year

but less than 1% of them will donate their tissues.

I'm just ringing to see is the death certificate for Reece being issued?

It's the end of the day

and Laura is still trying to grant the dying wish of a young man.

He's just had his 21st birthday.

21-year-old Reece wanted to donate his eyes to help

save someone's sight but a recent tattoo may now prevent this.

Hi, is that Lorna? Hiya, Lorna.

Laura needs to confirm that the tattoo is more than four months old,

otherwise Reece can't donate.

As a last attempt, she calls his girlfriend.

There's just one concern that I've got about Reece having tattoos, OK?

-'Yes.'

-First of all, do you know when he had his last tattoo?

'He's only got one on his arm which he had done ages ago in Portugal,

'about two years ago and then he's got my name on his bum

'but that was done about a year ago as well.'

-It was a year ago?

-'Yes, yes.'

-OK.

OK. Well, that's brilliant to know that, Lorna.

That is all the answers that I needed from you, Lorna.

-You take care now.

-'OK, thank you.'

-Bye.

-'Thanks, bye.'

-Bye.

So it's all good.

And he hadn't had a tattoo recently.

It's sad, isn't it?

I don't normally ever get upset ever about it all.

I think it's just because he was so fit, he was going on holiday,

he's so young, he's got his girlfriend, he's got her name

tattooed on his bum, he sounds like he's been a right laugh.

You know, up for a good time,

and then he's got kidney cancer.

And now he's died.

While it's a positive outcome to a long day and another valuable

donation for the bank, the pressure is starting to get to Laura.

It is really hard listening to sad stories all the time.

It's hard for anybody else to understand your job and how,

like, what you've been through on that day.

People don't want to talk about it to you

cos they don't want to think about death, illness.

In Suffolk, 18-year-old Reuben is hoping

donated bone will be his chance to get back to work and a normal life.

Better pack my slippers.

I've got to have my baggy top.

I've got to have my Muppets PJs.

Reuben's been lucky. Because his knee operation doesn't require

a special size of bone, he hasn't had to wait months for a match.

I'm grateful that someone's took that sort of choice,

that they've give their bone in, you know.

I think we need more like that really,

we need more people like that. I would be up, I would do it.

When I'm dead and gone I would definitely,

I would give my organs or whatever away.

It's just... I think people, it's one of them things

that people should do, to be honest with you.

Whilst you're here, you might as well enjoy your body and that

but when you're gone, you should just give your parts away, you know.

Reuben?

Hurry up.

Reuben has been referred to us with a tumour in his left knee.

It's a rare tumour called a chondroblastoma.

Now, we know how to treat these in that they needed detailed curettage,

which really means scraping out the tumour

and then we're going to pack this with bone graft.

It's a specialist operation

so Reuben, his mum and nan have to travel 160 miles north

to Birmingham's Royal Orthopaedic Hospital.

The nerves are sort of kicking in a little bit now.

I know everything will be all right,

it's just you always get a bit nervous.

Once the surgeons remove the tumour, he'll fill the space left with

donor bone, but first he has to use a medical meat grinder to crush it.

This is the grinding machine.

As you can see, it's a fairly substantial piece of equipment

and essentially we're going to be putting these femoral heads

through the mincer and grinding it into bone chips.

It'll look like a pile of wood shavings really,

from the carpenter's workshop.

Most of the techniques we use are much the same as a carpenter.

Reuben - I'm sure he would be quite capable of doing this as well.

This is making beautiful bone graft which we'll incorporate

and then gradually grow into healthy new bone for Reuben.

Look at this. This is the bone graft that we've milled

and this is all going to go in very nicely

and that will fill the bone cyst in Reuben's leg.

With the bone ground down, Reuben is brought into theatre.

There you are.

We're making a vertical incision.

I'm now going to use this diathermy to make a little window

into the knee joint very carefully.

So we're now going to pack the cavity

with our beautiful bone graft.

We want this nicely compressed in there.

I'm pushing quite firmly there.

The outcome following packing with this type of bone graft is

generally excellent and therefore this should do the trick

very, very nicely.

Reuben's operation is complete and his knee is stitched closed.

I was very pleased with the way things went.

I think there's a good chance that this is going to cure his

chondroblastoma, it was one of those that we were able to get at

reasonably well, better than I feared.

Why don't you rest back with your head on the pillow?

Oh, I'll be all right, mate.

Reuben should be able to walk again after eight weeks.

You're a bit like one of those Yogi bear dolls,

you might fall over if I let go of you.

It's February and Becky and Adam on their way to

a mortuary in Salford, 30 miles from the tissue bank.

Right, so am I getting on the M60 here or not?

Am I staying on the M602?

M602, Salford.

All right, smart-arse.

Well, we live in the north, let's head north.

Let's dance!

-Oh, you've dropped your phone.

-Yeah, I know. I didn't drop it.

It's your erratic driving.

You know, little bit more... little bit less gas,

a little bit more composure.

The donor is a man in his early 50s who passed away suddenly last night.

We've got consent for skin and for bone

and for Achilles tendons as well so it's quite a lot.

Ideally we try and take 20cm strips minimum

and it needs to be a certain width as well.

I think minimum width is something like six or 5.5 centimetres,

so when we're taking it now we're trying to get it anything from

20 to 60 centimetres in one strip

and above 5.5 centimetres in width.

Lovely. It's really good skin.

Nobody talks about death,

which I think is part of the problem why we don't have enough donors,

is because people still think of death and dying

and donation as well, to a certain extent, as like a taboo subject.

But everybody has to die so it seems a bit daft that

no-one actually talks about it as if it's never going to happen.

Even though Adam has carried out hundreds of donations,

some still affect him.

There's a certain age range, where it's harder

and then also if there's a donor that's the same age as

your parents that always can be a little bit like...

they're not going to be here forever, you know what I mean?

It makes you think more about the fact that

life's quite short

and that you need to... if you want to do something

just go out and do it and not to worry about it too much.

The job may affect the teams emotionally,

but it's thanks to their work

that life-changing tissue is available for patients nationwide.

Over in Doncaster, 27-year-old rugby coach Daniel

is waiting for the right meniscus to be found.

I'm going to be really naughty and park in my space...

..the disabled space!

I suppose I could class myself as that. Well, nearly.

Daniel's knee was seriously injured playing rugby.

The dream was to play professional rugby all my life.

I twisted my knee,

my left knee, in a tackle where I just collapsed on the floor

and the guy looked at it and he says something's wrong and I was gutted.

Daniel had torn the meniscus,

the shock absorber that protects the knee.

My knee locked out and I couldn't move it so I went home

and iced it and slowly started moving it ever so gently

and took the painkillers as I always do,

and it was OK for another day after

but then it started again so I rang the surgeon up

and he had a look at it and he said something's not right.

Daniel needs a meniscus that's an exact fit

from a donor of a similar age and size.

The alternative is a metal prosthesis, meaning an end to playing rugby.

As soon as I first trained and played, I just got the bug

straightaway and I was actually good at it...

Cos I was quite fast in them days,

I'm not any more, but as a kid I was lightning fast.

The height of it, led me to play for England under-18s

which was probably the highlight of my career.

Playing for your country is massive.

So this is the game we always play,

well, I always play by myself at training,

cross-bar challenge, and they all hate me for it cos

nine times out of ten I hit it, so we'll see.

A meniscus transplant is a major operation.

Until he gets back on his feet,

Daniel is moving back home to his mum's.

This is the dog. This is Archie.

What's the matter?

I will be bed-bound, I won't be moving much.

I will need someone to get my things,

get me something to eat, get me something to drink.

It will be nice, I suppose, for the first week or so

but then I will be wanting to get up and do it myself

but I know I won't be able to so,

yeah, she's got a lot of work to do, my mum.

My poor mum!

While Daniel prepares for his operation, back at the tissue bank

donation specialist Mel is with the nurses,

learning more about their side of donation.

I've been in and listened to the actual consent taking place.

Most of us would say we can do our job but we could never do their job,

we couldn't speak to bereaved families and take consent.

I couldn't imagine doing that kind of job,

whereas my job a lot of people would say,

"Oh, I don't know how you do that,"

but I suppose it's just each to their own,

but, yeah, I couldn't do this job.

For the nurses, ensuring the donations go ahead

requires emotional stamina that only comes with experience.

The staff at the hospital asked me to give you a ring and speak to you

about the possibility of your husband donating his corneas for transplant?

'I don't think you'd get them, darling,

'cos his eyes were buggered.'

-Ah, were they!

-'His eyes were buggered, bless him.'

I know that Henry was only 13,

but I obviously do have to ask these questions.

When you're speaking to bereaved people constantly,

there are days when it will really get to you.

Eve, we did talk about Henry possibly donating his heart

-for the two heart valves.

-'Yep.'

We have a right to show our emotions

and to feel quite, you know, quite upset,

but it's upset in a different way because, as I said, it's not our grief.

Speaking to families so soon after a death

is hard for everyone concerned.

Are you OK? MUFFLED SPEECH

Do you want to take a minute?

WOMAN SOBS

SHE SIGHS

-'I'm OK.'

-Are you OK?

-'OK, yes, thank you.'

'It's really difficult. I do appreciate

'you going through it with me.'

What happens now, as I said earlier,

from a practical point of view, you know, I go away

and organise the donation to happen within this 24 to 48 hours.

-'Right, OK.'

-Are you OK?

-Well, thank you very much indeed for that.

-'OK.'

You just take care now. I will speak to you later.

-'All right, thanks, Linda.'

-Take care, bye-bye.

That was hard for me. Um...

My husband's 63 and as fit as a fiddle, like this guy was.

It just...it's a bit...

It's too close to home sometimes.

But I'm OK.

I think it is difficult when it's something that you relate to.

We all relate to the children and different things...

..and we do particularly relate to donations of...

like this.

Sorry about that.

All of the nurses find it tough,

but for one of them it's the end of the road.

It's rare for the nurses to leave the job,

but, after two years at the tissue bank, Laura has decided to move on.

I'm hearing someone's died maybe 25 times a day

and I can't do it forever cos I'll forget everything else

about nursing isn't just about death, is it?

I need to do something else whilst I still can.

So I've got a job as a district nurse,

so I'll be starting that in six weeks.

So I'm looking forward to doing that.

Be a new chapter. New experience.

But without the nurses and the donations,

people like George would never get the operations they need.

Today, after months of waiting,

he'll finally receive a donated cornea.

Being donor tissue,

and that sort of thing, you think about the fact that it is sort of

coming from somebody who's passed away, and that sort of stuff.

I sort of, not block it out, but I don't know really, it's a bit weird

sort of thinking where the tissue has come from

and that someone else has been using it and now it's going to be

sort of stitched into my eye instead, so, yeah, it is weird.

This will be George's second corneal transplant.

I'm going to have two people's sort of donor tissue now.

There is, like, a two-year waiting list at the moment

for corneal transplants, so it is important that people do sign up

to be donors and that the donor tissue keeps on coming in really.

The corneas collected by the tissue team are stored at Manchester's eye bank.

Next door is the eye hospital,

where George's new cornea is being prepared for transplant.

I hope that I wake up and I can hopefully see...

see a little bit more... maybe out of my right eye.

The graft was quite slow to get some vision back last time.

George is having a partial graft, so a donor cornea, split into two,

will be used to replace his damaged cornea.

There is always the risk of complications, you know,

you can lose your sight

or you can have a sudden haemorrhage within the eye.

That can lead to the contents of the eye coming out.

It is very rare but they can occur.

What we're going to do now is split the layer.

It's called the "big-bubble technique",

which splits the deeper layer from the front layer.

The surgeon uses a super-fine blade to slice through the cornea,

removing the front layer.

He then stitches the donated cornea in place.

When he wakes up, he'll be able to see out of that

but everything will be very blurred.

Deep breaths, George, it's all finished for you.

George, operation's finished.

Open wide and we'll take this out for you.

George should know in a matter of days whether his sight is restored.

It's a busy Monday morning at the tissue bank,

with four donations under way.

Becky and Chris are on duty in house.

We've got a donor coming in to retrieve

pretty much as many of the tissues as we can retrieve really.

We've got heart, pericardium, skin,

bone, tendons,

and we're even retrieving arms.

It might be worth saying that we're retrieving the bones from the arms,

-not the ARMS!

-Yes, true.

Among the tissues Becky and Chris will be taking is the much sought-after meniscus.

The meniscus are... they're like the shock absorbers in the knee joints

so you've got the two bones in the knee joint like that

and as they move, as they articulate,

obviously because there's a lot of weight on the knee joint,

they are little cartilage kind of D shapes under in the knee joint

so it helps absorb all of the shock and the force in the knee.

A lot of the tissues we provide aren't termed as life-saving,

they're life-enhancing. So you know rugby players that they can't play

their sport any more because of their injury,

you know, their life, you could say, is over

because what their passion is, what they love to do,

they can't do any more, so if we provide a meniscus to somebody so

they can get back on their feet,

get back on the pitch and start playing again,

then potentially you could say, well, you are saving their life,

cos what life would they have if they had to give all of that up?

The meniscus can only be taken from donors aged 18 to 45.

In the last year the team took 12 of them,

but with hundreds of people on the waiting list it's not enough.

We've taken this out as a whole knee,

as opposed to the separate bone grafts

and then, within the knee joint as well, we've also got the meniscus

so we're going to package this all up together in some fluid which will

protect everything, keep everything moist, and then that will go to

the production team and they will then dissect the various parts off.

There will definitely be a point when I say I can't do this any more.

I definitely don't think that will be because of the donation aspect

of it and the physical donor part and the dead body side of things,

and thinking that's too hard, that's too emotional,

because I've been doing it so long it doesn't...it doesn't bother me.

While Becky's staying in the job, for Laura it's time to move on.

Today is my last day in Tissue Services.

So I'm on the early and it's a Sunday morning, 7am.

A part of me just wants to go up to bed. I've got my P45.

They didn't waste time giving me that! Came straightaway yesterday.

I was like, "Oh, Cheers, I won't come in tomorrow!"

OK, bye, cat.

The sad thing is there's not going to be a big...

..celebration.

That'll be when I've actually gone.

-Hi, Jill.

-Hello.

-Last day.

-I know! Can't believe it.

-Any from overnight?

-Yes, just getting them up.

-Cool.

Tomorrow I start my new job...

in the district.

I'm having a panic attack about it now.

I watched too many Call The Midwifes.

I thought I'd end up in this glamorous role

but I don't think it is going to be like that.

SHE GIGGLES

Down the corridor the customer service team are busy fulfilling orders for patients.

Good morning, Tissue Services. Daniel speaking, how can I help?

It looks like the perfect meniscus has finally be found for rugby coach Daniel.

OK, just bear with me for a moment and I will get the order form up.

Well, with the meniscus we generally get the request

through from the surgeon with all the information

they can provide, measurements of the patient's knee.

It's then down to ourselves to allocate a match

based on the surgeon's measurements.

OK, so the request for a left meniscus lateral for your surgeon...

Mr Spalding being one surgeon, in particular,

he is very fussy on the size of the grafts that he receives

for the knee. It does have to be pretty much exact.

Right, so delivery this Friday.

The one I've just had is one he's been enquiring about for a while.

We eventually found a match for him

and we've been holding it on reserve till he can allocate a surgery date.

It has been a long wait for the patient

but it has been worth it to find the match at the end of it all.

OK, that's great. You have a nice day now.

OK, thank you. Bye-bye.

Without the donors, I'd be out of a job, I suppose.

With the meniscus on its way,

Daniel in Doncaster is about to set off for the hospital.

We are going to St Cross Hospital in Rugby.

That's where the operation's taking place, so just on the motorway now.

Looking forward to getting it done and coming home

and starting the boring recovery process.

I'm not bothered at all where it's come from.

I know it's healthy cos they do all various testing and stuff for it,

so I think it's a great thing to do, I think it's something worth doing,

putting your name down for donors, donor cards and stuff like that.

So, no, just really grateful for it

and I know it's going to give me a better quality of life after it.

Hopefully, fingers crossed!

So, today we're doing lateral meniscal transplant.

So that is a donor meniscus,

a dead person's meniscus,

harvested and then kept in a tissue bank.

We size the meniscus from measuring it

and then the patient has a particular size of their knee.

We match that up, and then this is to insert that meniscus in the knee.

This is where it was and then it's been taken out in the middle part

after a tear. This is the passport device that pops in here.

Then we can pass through there.

The instrument in the meniscus is going to go in here.

We've got our posterior horn, the back-end,

and then the middle part to pull through.

So we're going to pull on the posterior...

Pulling a bit on the middle now to give it some traction...

..letting it just slide into the joint,

pull a bit more in the middle, keeping it orientated that way.

So, there's the meniscus, we've got to set it in there.

We got the word "top" in the right place?

Yes.

So we're happy.

We're happy with that. That went well.

Good hold, good fix, good size meniscus.

And the joint surface is not too bad so he should have a good result.

For Daniel there'll be no chance of rugby for a long time to come

but at least he'll be able to walk again.

Back at the tissue bank, it's the end of Laura's last shift.

-Right, well, good luck in your new job.

-Thank you.

All right, you take care.

The job may have had its highs and lows but Laura is sad to go.

I'm going to really miss the people that I worked with.

Really miss them.

It's a new start for Laura, but for the rest of the tissue team,

dealing with death to help the living goes on.

I don't think we see ourselves as superheroes.

We are still really grounded in what we do and humbled by the donors,

the families, and what this tissue is doing.

So, even if just one person's life has been able to be changed

dramatically or saved, I think that makes it worthwhile.

We rely so much on the kindness

and the selflessness of people

to understand that once they're gone, they don't need their eyes,

their meniscus, their skin, their heart valves,

and that, if somebody is alive,

if they can use it, then why not give it to them?

Three months after his meniscus operation,

Daniel is back home with his girlfriend.

It's a bit sore and a bit stiff but generally it's not been too bad.

Well, it's 15 weeks since I had the operation

and he said it was successful. I've took everything slowly.

I'm quite optimistic. Hopefully it will work.

If I do go back to sport that will be 18 months.

I'd love to play again. I'm only 27, I don't want to retire just yet,

but if it all goes well, and it's back to normal,

I don't want to risk it and risk damaging it again.

But my heart will probably rule the head and I will play.

I think I will play.

In Chester, George is back down the pub with his rowing mates.

How's your eye?

So subtle!

Yeah, it's all right, really.

I had my left eye corneal graft operation three months ago now.

Everything seems to be going quite well.

They seem to be happy with it. I can see out of it.

I don't think it ever will sort of get amazing vision out of it

uncorrected, it just means that they can correct it

with contact lenses or glasses,

so it will be nice to have vision out of two eyes again.

And in Saxmundham, Reuben is back at work.

It's been three months since I had the operation

and it's just 100% better.

It's like having a new knee.

It's healing up quite nicely.

He did apologise about the scar but as my muscle's grown

it's stretched and it's opened up the scar a little bit here,

but I'm not too bothered about that.

It's something cool to tell my mates, so, you know,

it will be there for the rest of my life.

It will be all right, you know.