Governance and Prioritization of Human Spinal Cord Tissue Procurement for Research in an Organ Donation Setting

INTRODUCTION: Procurement of human spinal cord tissue for research is rare and typically occurs through deceased organ donation pathways. Existing tissue banking guidance, largely derived from surgical pathology practice, does not adequately address the ethical, anatomical, and operational constraints unique to donation-integrated spinal cord procurement. OBJECTIVES: The objective of this article is to describe institutionally implemented governance and prioritization practices for donation-integrated procurement and research banking of human spinal cord tissue within a tertiary academic hospital setting. METHODS: This review summarizes practice-based governance guidelines developed and applied within an established organ donation program. The approach emphasizes conservative prioritization, strict separation of clinical and research roles, a tiered informed consent structure, explicit stopping rules, and defined governance structures for procurement decision making. The spinal cord is treated as the ethically defining and rate-limiting tissue, with biologically associated tissues considered only under conditional circumstances. RESULTS: The governance practices delineate clear operative boundaries for when spinal cord procurement may proceed, establish decision hierarchies for inclusion of associated tissues, and define conditions under which procurement must be deferred. Operational experience from the institutional donation-integrated procurement program included 96 authorized research donors, of whom 92 were enrolled under the research protocol and 88 proceeded to successful spinal cord procurement and accessioning into the institutional biobank. Central principles guiding procurement include preservation of donor dignity, noninterference with organ donation workflows, maintenance of anatomical integrity, and irreversible transition of tissue from the clinical to the research domain under institutional custodianship. CONCLUSIONS: Governance-centered, practice-based approaches are essential for ethically grounded procurement of rare human spinal cord tissue in organ donation settings. Emphasis on upstream decision making, explicit scope limits, and conservative default thresholds supports translational research while preserving clinical primacy and ethical clarity. These principles may assist other centers seeking to integrate spinal cord research within established organ donation programs.