Eye Transplant Organ Donations

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Organ transplants are one of our greatest advances in modern medicine. However, our current technology is limited in the ability to transplant an entire eye. To transplant an entire eye, the eye surgeon would have to sever the optic nerve of the recipient's eye and then re-attach it using microsurgery, to the new transplanted nerve of the donor eye. However, the optic nerve is a CNS nerve and is different than peripheral nerves. At this time there is no effective way to stimulate a CNS nerve. The biggest problem would then be the inability of the recipient's socket to receive any information from the transplanted eye.

Fortunately, there are prosthetic eyes that are realistic and without the risk of complications or rejection.

When a person decides to donate their eyes . They can choose to make them an "anatomical gift" by registering at the Bureau of Motor vehicles. This information is then collected by each state and marked accordingly on a driver's license. Or arrangements can be made as an individual donor; to a specific recipient through designated transplant centers.

Eye banking: The process from donor to recipient :

When the eye bank is notified by a hospital, or an organ procurement organization of an available eye donation. The hospital must have verified that a preliminary criteria for the donation has been met. The eye bank then gets in touch with the donor's family to obtain consent for recovery of the tissue. The eye bank will make the specific request to use the donor's corneas. Most often, this must happen within 12 hours from the time of death. After the consent from the family has been obtained. A donor's medical review is done, including a complete social and donor history, including the cause of death, the medications involved in care and, whether there was any loss of blood. A physical inspection of the eye, and a sample of blood from the donor is necessary along with a screening for any infectious disease.

There is no cost to the donor's family for the donation of an organ. However, they are responsible for the funeral expenses.

A technician that is trained in the recovery of corneas. Will examine the donor's eyes. Then prepare for recovery of the cornea in a sterile field to avoid contamination. However, the cornea itself is not considered sterile. The cornea is placed in a storage medium to keep the cornea viable and to reduce bacterial growth. The technician then transports the cornea to the eye bank for refrigeration.

The cornea must be carefully evaluated microscopically before it meets the eye banks very strict criteria for transplantation. A medical director has the final say on the release of tissue. It is then sealed and packed in a container in wet ice . It must be kept between 2-8 degrees, yet protected from freezing. The container is labeled and numbered with a specific identification number to allow the eye bank to track the tissue from the donor to the recipient..

Eye banks are held to very high standards, all staff is specifically trained and are held to a high level of professionalism by the EBAA{ Eye Bank Association of America.} In 2008 the number of donations reported by U.S. Member Banks showed an increase from 82,000 in 2007 to 92,000. A total of 54,000 corneal grafts were supplied in 2008. There were 41,652 corneal transplants performed . Other tissue was offered for research and used for education and training.

On the recipient side of a donated cornea:

An ophthalmologist must have examined and diagnostically determined and indicated to the patient, their need for a corneal transplantation. The recommendation may be related to the patient , to improve visual acuity by replacing an opaque or distorted host tissue with a clear healthy donor tissue. Or there may be a need to reconstruct the anatomy of the eyes after a corneal perforation. In another case, there may be a need to remove inflamed corneal tissue that has been unresponsive to antibiotics . If the patient has corneal scars or a whitish or opaque hue. The donor cornea will also be a cosmetic improvement.

The ophthalmologist will review with the patient the risks and potential complications. Surgical preparations for a corneal transplant are made in advance, and then put into play. Anesthesia may be general or local and, may include a sedative. Premedication to prevent the drying of the eyes is also used. With the delicate equipment in place and at their side, the surgical team begins the removal of the host cornea from the recipient's eye, however, still leaving the button like area in place. The donor's cornea is then removed from the donor's eye .Then the surgeon returns to the recipients eye and removes the host cornea. The donor cornea is then maneuvered into place with fine forceps, sutured and antibiotics are administered.

The patient or family will be responsible for the administration of antibiotic drops to the eyes and follow up care with the eye surgeon as an out patient. The best prognosis is for full return of visual acuity.

The first corneal transplant was performed in 1905 by Eduard Zirmone of the first types of transplant surgery successfully performed. Through the advances is microscopic equipment, surgeons now have a better view. "Using sutures finer than human hair." In some cases, advances in the area of corneal transplants has progressed to an out patient office procedure.

Corneal transplants is one of the most common transplant procedures in the U.S. The cost is usually covered in part by Medicare and and health Insurers. However, the average cost of the procedure is from $7,500 to $11,000. The patient is responsible for costs above their Insurance coverage..

There have been a larger number of corneal transplants done on those over the age of 65 . Approximately 18,000 compared to 14,840 of those younger. In 2008 there were 41,652 corneal transplants performed. In Sweden, corneal transplants are paid for by their taxes. And, every year about 600 of these operations are performed.

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