Gifting Sight: Become an Eye Donor

This past Saturday, M&S participated in the Illinois Eye Bank “I Can Make a Difference” 5K Walk. It was a beautiful day and a nice crowd turned out in support of loved ones who had received or given the gift of sight via donation. I’m a big fan of organ donation but I realized that I didn’t really know much about the cornea donation process or the surgical procedure, so I’m sharing here what I found out.

One of the most commonly transplanted tissues each year (more than 45,000) is the cornea. The cornea—a transparent covering over the eye—is the eye’s primary focusing component. A cornea transplant restores sight to recipients blinded by an accident, infection or disease. Corneas can be transplanted whole or in parts, from donors of any age, and require no anti-rejection drugs in the recipient. The prognosis for visual restoration and maintenance of ocular health is generally very good. The majority of corneal transplants result in significant improvement in visual function for many years or a lifetime. In cases of rejection or transplant failure, the surgery generally can be repeated.

History
The first cornea transplant was performed in 1905 by Eduard Zirm (Olomouc Eye Clinic, now Czech Republic), making it one of the first types of transplant surgery successfully performed. Another pioneer of the operation was Ramon Castroviejo. Russian eye surgeon Vladimir Filatov’s attempts at tranplanting cornea started with the first try in 1912 and were continued, gradually improving until 1931 when he successfully grafted a patient using corneal tissue from a deceased person. He reported of another transplant in

1936, disclosing his technique in full detail. In 1936, Castroviejo did a first transplantation in an advanced case of keratoconus, achieving significant improvement in patient’s vision.

Advances in operating microscopes enabled surgeons to have a more magnified view of the surgical field, while advances in materials science enabled them to use sutures finer than a human hair. Instrumental in the success of cornea transplants were the establishment of Eye Banks.

How it Works
When someone passes away, a Federally-designated organ procurement agency collaborates with the hospital or other facility involved in caring for the deceased person. When the agency is notified of a death, staff members check the local Organ/Tissue Donor Registry to determine whether the individual had registered as an eye, organ and tissue donor in their state. If the name appears on the Donor Registry, they contact the local Eye Bank to handle the possible cornea donation.

Before any organs or tissues can be recovered, the individual’s family is notified and a medical history is gathered. Donation eligibility is based on your medical records and interviews with family members. Additionally, a blood sample is obtained and tested for communicable diseases, such as HIV and hepatitis. (Although joining the Donor Registry guarantees that a person’s wishes will be carried out after his or her death, the Eye Bank still works with family members in an attempt to make sure that everyone is comfortable with the decision).

Once the tests determine that a person is eligible to be a donor, specially-trained eye tissue recovery technicians (on-call 24/7) are dispatched to recover the tissue. Eye tissue must be recovered and preserved within a few hours of a patient’s death. Healthcare professionals caring for the donor’s body help the process by keeping the donor’s eyes irrigated and prepared for recovery. When the Eye Bank technician arrives, he or she confirms the consent for donation and determines the type of procedure to perform. A
corneal excision, the most common procedure, uses a tiny scissors to gently separate only the cornea from the donor’s eye. This is the procedure used when the Eye Bank anticipates that the cornea may be suitable for transplantation.

An eye enucleation is the removal of the donor’s entire eye, also known as the globe. This procedure is generally performed when transplantation of the donor’s cornea is not a possibility, but the globe can be used for specialized research or training purposes. Whichever procedure is performed, there will be no visible signs following the donation, and families may make funeral arrangements – including viewings – as desired.

After eye tissue is recovered, the technician carefully places it in a special container, where it is submerged in a chemical preservation solution to keep it healthy during transport, storage and laboratory evaluation. If stored properly and refrigerated, corneas can be preserved for as long as 14 days after their recovery, though most are usually used much quicker. At the lab, every cornea, globe and piece of scleral tissue receives its own special identification, which is used to keep track of the tissue through the entire donation and transplantation process. Tissues used in research and training or those that cannot be used are also tracked in compliance with Federal and eye banking regulations.

After donated corneas arrive in the lab, they are carefully unpacked, evaluated and rated on a scale that helps transplant surgeons assess the condition of the tissue. Evaluation requires the use of a slit lamp, which can detect imperfections in the donor cornea that may cause vision problems after transplantation, and a specular microscope, which is used for cell counting. We are born with a finite number of corneal cells that diminish as we age. Therefore, corneas recovered from older donors tend to have fewer cells than corneas from younger donors. Surgeons often prefer to use corneas from younger donors when treating younger patients because there is a greater possibility that the cornea will remain clear and healthy throughout the patient’s life.

Types of Cornea Transplants
A traditional cornea transplant is a full-thickness graft of the cornea, meaning the patient’s entire damaged or diseased cornea is removed before the healthy, donated cornea is put in place. The procedure, also known as penetrating keratoplasty, is usually performed on an outpatient basis with a local or general anesthetic and a sedative. The healthy corneal is stitched into place using tiny, ultra-fine sutures.

One of the newest developments in corneal transplantation is a procedure called EK, which stands for endothelial keratoplasty. This procedure is a partial-thickness graft that involves replacing only the innermost layer of a patient’s cornea with a layer of a healthy, donated cornea. Surgeons performing this relatively new procedure must undergo highly-specialized training. A tiny incision is made in the patient’s cornea, and the incredibly thin layer of donor tissue is carefully folded and inserted through the incision. Once it’s in place, the new tissue layer is able to return to its original shape, and does not usually require suturing to stay in place. The incision can heal by itself.

Sources: Illinois Eye Bank and Wikipedia

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