Eye banks retrieve and store eyes for cornea transplants and research. The first eye bank was founded in 1944. Currently, in the United States, eye banks provide tissue for about 46,000 cornea transplants each year to treat conditions such as keratoconus and corneal scarring. In some cases, the white of the eye (sclera) is used to surgically repair recipient eyes. Unlike other organs and tissues, there is an adequate supply of corneas for transplants in the United States, and excess tissue is exported internationally, however, there is a shortage of corneal tissue internationally.
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History
In 1944, the first eye bank was founded in New York City by two physicians, Dr. Townley Paton and Dr. John MacLean.
Recovery of Eye Tissue
"Recovery" refers to the retrieval of organs or tissues from a deceased organ donor. Recovery is currently the preferred term, although "harvesting" and "procurement" have been used in the past, they are considered inappropriate, harsh, and potentially inaccurate.
When an organ/tissue donor dies, consent for donation is obtained either from a donor registry or from the donor's next of kin. A recovery technician is then dispatched to the hospital, funeral home, or medical examiner's office to recover the donor's eyes. The recovery occurs within hours of the death of the donor. The entire eye, called the globe, may be surgically removed (enucleated), or only the cornea may be excised in-situ and placed in storage media. There is a wide variety of storage media used in eye banking. Commercial preparations as well as organ culture medium can preserve corneas. The eye tissue is then transported to the eye bank for processing.
Laboratory Processing
A sample of the donor's blood is also collected to test for infectious diseases such as HIV, hepatitis B, hepatitis C, human cytomegalovirus, syphilis, and sometimes others. The blood type is also tested, although corneas do not receive any blood supply and match typing is not necessary for transplantation.
If the entire eye is enucleated during the original recovery, then the cornea and part of the sclera are removed and placed in a container with preservation medium, and the sclera is cleaned and then preserved in alcohol. The corneas are visually examined and evaluated underneath a slit-lamp, and the number of endothelial cells are counted underneath a specular microscope. The corneas are rated, usually on a scale of 0-4, for donor suitability based on the specular and slit-lamp evaluations.
Shortage and growth of eye banks
An estimated 900 new eye banks are necessary to meet the current demand for eye transplant tissue. There are currently 80 eye banks in the United States.
Regulations
The Eye Bank Association of America (EBAA) was established in 1961, and its members include eye banks that operate not only in the United States, but also in Canada, Europe, the Middle East, and Asia. The EBAA has established comprehensive medical standards for eye banks, and the standardized the training and certification of eye bank technicians. These interventions are considered major contributions to the current safety of eye transplantation. The EBAA is the national accrediting agency for eye banks. Accreditation requires site visits at least once every three years by the EBAA to evaluate adherence to established standards and quality control.
To avoid violating the Health Insurance Portability and Accountability Act, Eye banks must, through their legal anatomical authorizations, obtain consent which allows Eye Bank Association of America representatives access to donor information for accreditation reviews.