I don't know, but I had a different take on it. In the AA version Oro talks about wartime medical advances created by sacrifices (like ninjas sacrificing their lives for their village). Then he talks about not realizing the importance of something until it is lost (I assume he's talking about the arms, legs, etc lost by ninjas in the war but is thinking about his own arms). Then he talks about Tsunade's specialty coming from the sacrifices.

IMO he is talking about transplantation, where one person regains something they have lost as a result of someone else's sacrifice (death), and he is hoping to force or pursuade Tsunade to transplant someone else's arms onto his shoulders... The manga translation is a little more sinister and may refer to using enemies as unwilling donors.

I could be totally off, but I would bet money that Tsunade is responsible for Kakashi's sharingan.