THE GIFT THAT KEEPS ON GIVING
By Central Ohio Lions Eye Bank USA
Organ donation is an act we hear a lot about on a regular basis. But eye donation? Not so much. Donating one’s organs (hearts, kidneys, livers, etc.) can save numerous lives.
Only organs like the heart, kidney and liver can be donated.
Not only organs, but tissues like #corneas, skin, tendons, bones, veins and heart valves can also be donated.
As an “eye banker” who has spoken to many cornea transplant patients over the last quarter-century, I have come to understand that these transplants are also life-saving in their own way.
THE GIFT OF SIGHT
When people describe the effects of lost or deteriorated vision they often lament the loss of their abilities to read, drive, work, and watch their children and grandchildren at play. Perhaps the scariest loss is that of independence – something that can usher in feelings of helplessness and hopelessness, even trigger clinical depression. The loss of significant quality in one’s life is a profound experience. Can we go on living without sight? Theoretically we certainly can, under most circumstances. But when the quality of life is diminished to the point where a person feels that they can no longer function as in the past, the reality can be devastating.
People with advanced Keratoconus will know this feeling only too well. 1 in 4 people with severe Keratoconus will need a corneal graft or transplant to replace their diseased cornea with a donated healthy cornea.
“I felt like I was reborn”
The truth is that only a small number of patients with vision impairment can be cured by a cornea transplant or corneal graft. But those who can have their sight restored surgically such as those with Keratoconus, thanks to an eye donor frequently refer to the experience as “a miracle.”
“I felt like I was reborn,” cornea transplant patient Robert Eber told me when asked how his corneal transplants affected him. “I had a tremendous burst of energy – a renewed life.”
Only eye donation can make this possible. Eye donors do save lives. While laws about anatomical donation differ among countries, the processes of recovering, preparing, and delivering a cornea for transplantation are largely standardized. Organized eye banking – through groups like the Eye Bank Association of America – has brought a significant measure of safety and quality to these processes.
WHAT ACTUALLY HAPPENS?
When an individual dies who is medically appropriate for eye donation (e.g., within certain age parameters, without transmissible infectious diseases or a history of certain types of eye surgeries), the first consideration is whether there is consent for becoming a donor. Consent has many variations – sometimes it is given by the donor him/herself through a private or government-sponsored donor registry; in some places only the next-of-kin to the donor can grant consent; and elsewhere there are laws that make anatomical donations the regular practice, with exceptions only for individuals who “opt out” of becoming donors. Regardless of the local laws and customs, the eye bank will need to operate under the assurance that recovering donor eyes or corneas is legally permitted.
Once consent has been ascertained, a trained and qualified eye bank technician will need to recover the eyes as soon after death as possible. This is because corneal cells can remain viable – alive and functioning – for only a short period after death has occurred, and it is ideal to be able to preserve the corneas quickly to maintain their health and transplantability. Corneas are typically stored in special media made exclusively for this purpose, often containing antibiotics and anti-osmotics, as well as nutrients, to reduce the likelihood of bacterial infection or swelling of the corneal tissue, and to “feed” the living corneal cells. The eye bank technician may recover only the corneas – which are the thin, clear front “window” of the eyes – or the entire eyes, after which the removal of the cornea from the whole globe will be done under controlled environmental conditions in a laboratory or operating room.
Before and after placing the corneas into the preservation medium, they will be examined with slit-lamp and specular microscopes. Through these, the technician can see single cells and observe the health of the corneas by calculating a cell count and examining the cells for abnormalities that might lessen their effectiveness as transplant material.
Preserved corneas are typically refrigerated and maintained within a range of a few degrees. The refrigeration unit is equipped with continuous temperature read-out capabilities, carefully calibrated thermometers, and an alarm that will alert the eye bank staff if the temperature should vary outside of the desired range. The prevailing practice is to transplant the corneas as soon as possible after their preservation, but not longer than seven to ten days after the donor’s death.
GETTING THE FACTS
The eye bank must document the donor’s medical history, cause of death, and potential risk for transmitting infectious diseases.
Often a family member or partner of the donor is interviewed to complete a “social/behavioral” history of the donor related to possible health risks. These may include exposure to diseases through travel, sexual activity, or other modes. The donor’s blood is also sampled at the time the eyes or corneas are recovered, and the blood is tested for certain infectious diseases. Additional information must be gathered, such as the results of other types of tests, cultures, and examinations, to determine the donor’s eligibility to provide medically safe transplants. The determination of donor eligibility takes into account all of the data that the eye bank gathers – and this can take several days. If the eye bank finds that the donor meets all of its standard medical requirements, the information is provided to the transplanting surgeon, who is responsible for making the final determination about whether a cornea is suitable for his/her patient’s surgery.
The Eye Bank’s role does not end with the delivery of corneas to the surgical facility. Follow-up with surgeons provides an opportunity to inquire about the success of the transplant, and to take action should a problem arise related to the donor corneal tissue.
SEEING WITH NEW EYES
Eye banking is a process that begins with an eye or cornea donor and ends with a healthy recipient. The “miracle” that offers an opportunity to resume daily tasks and favorite activities, and to clearly see the face of a child or spouse is indeed a life-altering – and some say a life-saving – event.
Post by Central Ohio Lions Eye Bank
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Three Ways To Help
Register with your GP/ NHS/ state as an organ, eye, and tissue donor.
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