Critical AORN Guidelines Update: Autologous Tissue Management

AORN recently released several critical changes to its “Guideline for Autologous Tissue Management.” The new release features five new sections, significant reorganization, and important updates that periop teams need to know.

Tammy Hanks, DNP, CNOR®, a perioperative practice specialist at AORN and the lead author,  shared a first look at the guideline updates with AORN Journal, explaining, “The new sections and recommendations in this revision include interdisciplinary team approach, limbs, reproductive tissue, education, and quality.”

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Dr. Hanks says there are also name updates. “We renamed tissue handling, tissue packaging, and labeling to include the word ‘tissue’—and we renamed documentation to tissue tracking to reflect FDA requirements for recording and tracking tissue.”

TL;DR: What’s New for 2026 +

• An interdisciplinary team should provide oversight of managing autologous tissue practices in the organization.
• In procedures involving cranial bone flap, the interdisciplinary team should determine the preservation method based on patient-specific factors.
• Personnel who perform microbial tissue culturing should have demonstrated competency before performing the task.
• Tissue tracking is a notable name change for the section formerly titled “Tissue Documentation.”
• Limbs is a new section because there’s new research on preserving amputated limbs by ectopic banking for future replantation. However, AORN does not currently offer a recommendation as additional research is necessary.
• Reproductive tissue is a new, tissue-specific section, as several studies support cryopreserving ovarian tissue as a fertility option for certain populations.
• Education and competency verification activities (initial/ongoing) should be provided to personnel responsible for any step of autologous tissue management.
• Quality assurance and performance improvement activities consistent with the health care organization’s plan for compliance with current good tissue practices and autologous tissue management should be conducted.

In Focus: Three Key Sections

Interdisciplinary Teamwork

Hanks highlights a major change, a new section calling for an interdisciplinary team to set and maintain standardized, tissue-specific practices for safe autologous tissue handling.

“That includes determining the types of tissue the organization will handle and how they will be preserved,” Hanks explains. “The team will need to establish protocols for whether a storage medium or solutions will be used, whether to add antiseptics or antibiotics to the storage solution, and then what’s the maximum storage duration for the specific tissue types.”

Summary of New Sections

• Section 2.1 – Facilities should leverage a collaborative team to provide oversight of autologous tissue management. Members of the team should include perioperative RNs, surgeons, periop leaders, surgical technologists, risk management, infection prevention, informatics, and clinical lab personnel.
• Section 2.2 – An interdisciplinary, collaborative approach to determining standardized methods for autologous tissue handling can facilitate the implementation of comprehensive protocols within the organization and serve as the basis for clear policies and procedures, as well as team education.
• If your facility has access to eGuidelines Plus, see the full set of recommendations in the guideline section on the interdisciplinary team.

Patient Considerations for Cranial Bone Flap Preservation

AORN added recommendations for the interdisciplinary team to determine the preservation method based on patient-specific factors. “The team also needs to consider how long it anticipates that a cranial flap will be stored and if there’s availability of a freezer with those ultra-low temperature capabilities,” Hanks says.

Summary of Guidance

• Section 3.1.1 – Patient-specific considerations include age, primary decompressive craniectomy etiology, comorbidities, body mass index, history of previous cranial surgeries, presence of hydrocephalus shunts, scalp tissue quality, size of the skull defect, number of cranial flap fragments, and smoking history.
• Section 3.2.2 – The anticipated storage duration of the cranial bone flap and the availability of a freezer with ultra-low temperature capabilities are important considerations when determining the best preservation method.

Reproductive Tissue

AORN is also releasing new recommendations on managing reproductive tissue. This new section includes a conditional recommendation that ovarian tissue may be cryopreserved and autotransplanted. However, in the case of testicular tissue, AORN does not currently make a recommendation for cryopreservation or autotransplantation.

Important Points

• Moderate-quality evidence supports cryopreservation of ovarian tissue as an option for fertility preservation in some patients, including those who are prepubertal or those who have diseases that can cause premature limitation of ovarian reserve.
• Testicular tissue cryopreservation or autotransplantation is currently considered an experimental therapy in humans.
• This is a ‘no recommendation’ because only low-quality evidence exists regarding the viability of testicular tissue cryopreservation in auto transplantation as an option for fertility preservation in prepubertal male patients.”
• See the new sections 7.1 – 7.6 for detailed guidance related to reproductive tissue.

Practical Pointers You Can Implement Now

• Standardize, then educate. Lock in tissue-specific parameters (media/solutions, temperatures, maximum storage durations, prep steps) before training—and keep training current.
  
• Plan for edge cases. Define processes for near-expiration/compromised packages; clarify when/how to culture; specify who communicates results.
  
• Use the briefing. Discuss anticipated preservation/autotransplantation during the procedural briefing so roles, materials, orders, and tracking needs are clear.

The Bottom Line

This update focuses on teamwork, tracking, and targeted tissue sections —sharpening practice where evidence supports it and exercising caution where it does not. Or as Hanks puts it, “Determining and maintaining a team to oversee standardized practices, education, and quality assurance, will be key in ensuring successful autologous tissue management.”

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