The answers to all your questions
1. What is an Eye Bank?
An eye bank is a special type of facility that manages the donation and distribution of tissues ready for use in transplantations, training, and research. Within Australia and New Zealand, Eye Banks are non-profit organisations often associated with a health department, hospital, university, medical institute, or beneficiary association.
An eye bank – that acts as the Custodian of tissue, is responsible for recovering the donation, medically evaluating the donor’s history, assessing the risk of potential infectious disease, preparing the tissue and allocating the tissue ready for use. Tissue is obtained only after consent is given by the donor’s family after death. It is only allocated to training or research if consented.
2. Are the Eye Banks ethically and legally managed?
EBAANZ Eye Bank Members practice in accordance with the beliefs and attitudes of all major religions, national regulatory and governing bodies, the International Declaration of Human Rights; The Barcelona Principles; the EBAANZ bioethical framework and the WHO Guiding principles on human cell, tissue and organ transplantation.
3. Who can be a donor?
Almost anyone can donate. Cataracts, poor eyesight, wearing glasses – including some eye diseases, do not necessarily prohibit someone from becoming a donor. There are medical standards the donor must fall in to, to be eligible, and the donation coordinator will go through these criteria with the donor’s next-of-kin before consent and recovery of the donation.
It is important to know that patients with cancer diagnoses can still donate their eyes, and that people who are eligible to be eye donors may also be able to donate other tissue, organs, and cells for other life-saving treatment. For further information on other types of donation please visit Donatelife Australia or Organ Donation NZ.
4. Are there any religious reasons not to donate?
No. Most major religions in Australia and New Zealand support donation.
5. What can I donate to help eye transplants?
A majority of eye transplantations are for corneal repair, and so, a majority of donations are corneas. Additionally, and lesser known, is that the white of the eye (sclera) can also be donated for other issues such as repair after a tumour is removed or to cover a valve implanted into the eye to help people with glaucoma.
Sometimes, eye banks can also manage the care of amnion tissue, obtained from the placenta from a consenting mother. Its delicate nature makes it ideal for patch-repair after a chemical burn on the surface of the eye. It is because of amnion, and recent explorations into adult stem cell treatment for eye transplantation that has resulted in eye banks tending to use the term ‘tissue of ocular application’ as amnion does not come from the eye but helps to heal the eye.
6. Why should I donate?
Donation is the final altruistic act a person can make. It can help restore the sight of people who are unable to benefit from other treatments. Transplantation is their final remaining option to regain or maintain vision. Donation for training and research has additional value of preventing eye conditions and treating people in need, in the future.
7. How prevalent is corneal transplantation?
Corneal transplantation is the most frequently performed human transplant procedure. There are more corneal transplants performed than any other tissue or organ transplant. In the last 10 years alone, more than 20,000 corneal transplants have been performed within Australia and New Zealand, to restore sight to men, women and children ranging in age from nine days to 103 years.
8. How soon after a donation must a cornea be transplanted?
Depending on the storage (preservation) system at the nearest eye bank, a corneal transplant could be transplanted within 2-14 days when using a preservation that cools the tissue, or at around 30 days when using a preservation that keeps the tissue close to body temperature.
9. Can the whole eye be transplanted?
No. The cornea (at the front of the eye) and the sclera (the white of the eye) are usually transplanted separately. The eye bank recovers the donation and stores the cornea and sclera for waiting recipients.
10. Will eye donation affect the appearance of the donor?
No. Great care is taken to preserve the appearance of the donor at the time of the donation. No one will notice that anything has been done. Families may proceed with funeral arrangements, including a viewing if so desired.
11. Is there any delay in funeral arrangements?
No. This is because the eyes must be recovered within a certain timeframe well before the funeral will takes place.
12. Should eye donation be included in a will?
No. Eye tissue recovery by the eye bank is performed within hours after death, while Wills are not read until sometime later, by which time it would be too late to donate.
13. Are all donated eyes used for research?
No. Donations allocated to research in Australia and New Zealand, can only occur if consented. This ensures the donor’s wishes are adhered to accordingly. Research tissue may also be allocated to training.
14. Can donors donate to transplantation and research at the same time?
Yes. Consent can be provided for both options. In this instance, the eye bank determines if a recipient is in need of a transplant at that time. If not, the eye bank will allocate toward research and training.
15. Is there any cost to the donor family?
There is absolutely no cost to the donor family. It is illegal to buy or sell human eyes, organs, cells, or tissue. Any costs associated with procurement are absorbed by the eye bank placing the tissue.
16. Is the gift anonymous?
Yes. The gift of sight is made anonymously. Identifying information about the donor family is not available to the recipient and vice versa. The eye bank is able to convey any non-identifying correspondence between donor and recipient.
17. What is the cornea?
The cornea is the clear ‘window’ covering the front of the eye which allows the light to pass through to the retina at the back of the eye (the retina is the main focusing element of the eye). To stay clear, the cornea must be healthy. If the cornea is damaged it may become swollen, blurred, or scarred. This may be due to injury, disease, infection, or hereditary corneal failure. In these cases either the cornea’s smoothness or clarity may be lost. The scars, swelling or irregular shape cause the cornea to scatter or distort light resulting in loss of vision.
18. Who will receive the donations?
Firstly, donations are allocated locally for transplantation. Thereafter the donation may be allocated nationally. In this instance, arrangements to transfer the donation are made between the eye banks in each location, or an eye bank and the requesting ophthalmologist. This ensures the tissue is allocated appropriately and safely moved between the two locations.
From time-to-time Australia and New Zealand may share donations for transplantation between the two nations. This is part of a Trans-Tasman arrangement to assist recipients in need in both nations.
Occasionally, EBAANZ Eye Bank Members are approached by other nations who are in need of tissue. This is for humanitarian aid purposes. If tissue is allocated, the eye bank checks to ensure the international allocation does not undermine access for Australian and New Zealand recipients, and they validate the request by vetting the surgeon and hospital in the other nation. This ensures Australian and New Zealand donations are respectfully managed, used and monitored when shared internationally.
19. Can waiting recipients arrange access to tissue?
No. Eye banks, like all other tissue, cell and organ facilities in Australia and New Zealand can only provide tissue to recipients scheduled for surgery. The surgeon is responsible for scheduling the surgery. Therefore, individuals in the community are not able to arrange their own tissue. Instead, those who feel they need a transplant are advised to discuss this treatment option with their treating physician, who will then place them on a wait list if required.
20. Why are corneas transplanted?
The two most common reasons for requiring a transplant are:
- The clouding over of the cornea, with the loss of transparency in the cornea in later life – as is the case with Bullous Keratopathy, or the loss of the smooth rounded shape of the cornea. This means that light cannot be regularly focused into the eye, as occurs in Keratoconus;
- Other problems which may require a transplant include herpes virus infection of the eye, accidental injury to the eye, corneal scarring due to other trauma, hereditary or congenital corneal clouding, or severe bacterial infection.
21. What are some eye conditions that need a corneal transplant?
Keratoconus (or conical cornea) is a disease that results in thinning of the central zone of the cornea, the front surface of the eye. As this progresses, normal eye pressure causes the round shape of the cornea to distort and an irregular cone-like bulge develops, resulting in significant visual impairment. For further information please visit Keratoconus Australia
Bullous Keratopathy is a generic term for corneal swelling (oedema) in a bullous-like fashion. When this happens, the outer surface of the cornea – called the epithelium – becoming covered in raised-blisters. It involves a loss of clarity and the development of clouding over of the cornea – which in turn results in reduced or a loss of vision.
The loss of clarity, and the development of the clouding, is due to the gradual impairment of the precious surface-endothelial-cells which are responsible for keeping the cornea clear and healthy. Without these cells the cornea cannot remain clear.
It can occur for many reasons including hereditary (family/genetics) susceptibility, previous eye surgery, or just simply advancing years. In Australia, it is the second most common condition requiring a transplant, accounting for 25% of all transplants performed. The success rate of a transplant for this condition, as measured by transplanted corneas surviving one year post-operatively, is 90.6%.
Fuchs’ dystrophy is a disease of the cornea. It is when cells in the corneal layer called the endothelium gradually die off. These cells normally pump fluid from the cornea to keep it clear. When they die, fluid builds up and the cornea gets swollen and puffy. For further information please visit AAO