Depending on the State in Australia, either consent or an absence of objection is required for donation to proceed. This can be indicated by the donor prior to their death, and confirmed by the next of kin after the donor’s death, or more commonly, the next of kin providing consent as long as the donor did not object to donation in their life time.
Eye tissue can be used for transplantation to another person or, as consented, for research.
The cornea and the sclera are the main tissues that are transplantable. The corneal tissue helps restore the vision of persons who may have corneal disease while the scleral tissue can be transplanted for eye-patch-grafts and surgical reconstruction.
The cornea is the clear surface at the front of the eye and is the main focusing element. Should the cornea become cloudy from disease, injury, infection or any other cause, vision will be dramatically reduced. A corneal transplant is a surgical procedure which replaces a disc-shaped segment of an impaired cornea with a similarly shaped piece of a healthy donor cornea.
The first corneal transplant worldwide was performed in 1905 in Moravia (now the Czech Republic). The first corneal transplant in Victoria was performed in the 1940s. Except for blood transfusion, it is the oldest and most common form of human transplantation. In Australia, more than 2000 corneal transplants are performed every year.
The great thing about corneal tissue is that everyone is a universal donor. While there are some disqualifying factors preventing individuals from becoming a donor, overall, a majority of the population has the potential to donate. Aside from those suffering from haematological malignancies or a few communicable diseases such as HIV and hepatitis, most causes of death do not render people unsuitable as donors.
Eye donation is not related or inhibited by eye colour, eyesight or blood type, and donor age is not as important as it is for other organs or tissues – most eye donors are aged in their 70s.
Donors and eyes are carefully evaluated. If consent for research and teaching has also been obtained, corneas determined to be unsuitable for transplant may be used for medical research and teaching purposes; in fact the entire eye may be used for research and education. Research on glaucoma, retinal disease, eye complications of diabetes and other sight disorders helps to advance the discovery of the cause and leading to new treatments and cures.
Donation does not delay funeral arrangements as the eye tissue retrieval is performed within hours of death. Great care is taken to preserve the donor’s appearance and funeral arrangements, including a viewing, may proceed as scheduled.
Strict laws exist to protect the potential donor, and legal guidelines must be followed before death can be certified. The doctor certifying a patient’s death is not involved with the eye donation or with the transplant. Specific information about the donor family is not available to the recipient, and vice versa.
The Lions Eye Donation Service will convey a recipient’s thanks to the donor family and if asked facilitate anonymous correspondence.
For more information:
Tell your next of kin
The single most important step you can take to ensure you will become a donor at the time of your death is to inform your next of kin. If you have made or will be making pre-need funeral arrangements, you may wish to tell your funeral director. There is now also an opportunity to register your wishes with the Australian Organ Donor Registry.
Talk to your family about donation and make sure they know your wishes. Everyone’s individual decision is valid and should be respected.
Why are corneas transplanted?
The two most common reasons for transplantation are a clouding over and loss of transparency in the cornea in later life, as is the case with Bullous Keratopathy, Fuch’s Dystrophy or the loss of the smooth rounded shape of the cornea meaning 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.
Data from the Australian Corneal Graft Registry (one of the largest of its kind in the world) indicate that the Australian one year graft survival for all conditions is 87 per cent decreasing to 73 per cent at four years. Some conditions such as keratoconus have even higher success rates (97 per cent).
Corneal Eye Conditions
This condition involves the central cornea thinning and bulging forward, and may also be associated with central corneal scarring. It is usually bilateral (occurs in both eyes) though frequently one eye is more affected than the other. Onset is usually at puberty, and it’s estimated to affect 1 in every 20,000 people. While contact lenses can be used to maintain the regular shape of the cornea, in 5-10 per cent of patients with keratoconus this will not give satisfactory results, and a corneal transplant is required. In Australia, it is the most common condition requiring a transplant, accounting for 31 per cent of all transplants performed. It also has the highest success rate following transplantation, with 97 per cent of transplanted corneas surviving the first year successfully, and 95 per cent of grafts surviving past four years. Most recipients are between 20-45 years of age.
Corneal dystrophy is a term to describe a group of disorders where abnormal material accumulates in the outer layer of the cornea. The accumulation of material may cause the cornea to lose its transparency and may cause a loss of vision or blurred vision. Most forms of corneal dystrophy affect both eyes, progress slowly and tend to run in families. In Australia, it is the third most common reason for a transplant, accounting for 11 per cent of all transplants performed. The success rate of a transplant for this condition, as measured by transplanted corneas surviving one year post-operatively, is 94 per cent.
Bullous keratopathy is a generic term for corneal oedema (swelling) where the epithelium is raised in blisters. It involves a loss of clarity and clouding over of the cornea, due to the gradual impairment of the endothelial cells responsible for keeping the cornea clear and healthy. It can occur for many reasons including hereditary susceptibility, previous eye surgery, or just simply advancing years. In Australia, it is the second most common condition requiring a transplant, accounting for 22 per cent of all transplants performed. The success rate of a transplant for this condition, as measured by transplanted corneas surviving one year post-operatively, is 83 per cent.
For further information, please visit:
- Australian Organ Donor Registry
- Donatelife Australia -National Organ and Tissue Organisation
- Eye Bank Association of Australia and New Zealand