Feature, Orthoptics Australia

Operating the corneal eye bank

The Lions Eye Donation Service plays an essential role ensuring the timely retrieval and allocation of corneal transplant tissue. TERRY COUPER discusses its inner workings.

The eye bank transplant co-ordinator is responsible for hospital documentation and legal requirements for donation, consent processes with the family and the surgical retrieval, evaluation, preparation, distribution of donated corneas. I am constantly humbled by the selflessness and generosity of the donors and their families by which this service is totally dependent.

Terry Couper.

The Lions Eye Donation Service (LEDS) comes under the Centre for Eye Research Australia (CERA) and works out of the Royal Victorian Eye and Ear Hospital Melbourne. Along with other Australian states, LEDS is regulated by the Therapeutic Goods Administration (TGA) and complies with the Eye Bank Association of Australia and New Zealand (EBAANZ) standards and guidance for eye donors.

The retrieval and allocation of eye tissue needs to be performed within a framework of logistical, ethical and time constraints. There is a balancing of the demand for corneas against the process of obtaining donated tissue.

Since I became involved with LEDS more than 25 years ago, there have been many changes that have increased donor numbers. Some through public and internal hospital education, others technological and research innovations.

An example of this was the storage medium for the retrieved tissue going from a 14-day to 30-day storage limit. This is called organ culture storage where corneas are suspended by a suture in a nutrient tissue culture medium at 34°C (close to physiological temperature for cornea) allowing for longer storage.

A sutured transplant in a recipient eye.

This can help alleviate the natural fluctuations in donor numbers relative to requests for tissue. While the sooner the tissue can be retrieved, the better tissue suitability for transplant, we do have a
24-hour window.

There are 300-plus donors a year, of which approximately 500 are transplanted. Any cornea deemed suitable for transplantation can be grafted into any recipient, regardless
of their age, race and blood type.

Traditionally, most transplants were full thickness penetrating grafts (PK), however surgical technique advances and expanded patient selection during the past 15 years have seen increases in the number of endothelial keratoplasties (DSAEK & DMEK) being performed.

Of all transplant surgeries done today, corneal transplants are by far the most common and successful. Overall success rates are better than 90% after one year, and 74% at five years. Some conditions, such as keratoconus, have even higher success rates (98%). While some corneas unfortunately fail the strict microbiological and quality assessment guidelines, these are sometimes consented for essential research within CERA and LEDS

Three permanent staff rotate as the 24-hour on call coordinator for this seven-day-a-week service. Retrieval can take place at a mortuary, hospital ward, funeral home or theatre as part of a multi-organ donation.

This can mean travelling to local or country hospitals such as Bendigo Base or the Tissue Bank located at the Coroners Court complex in Southbank, Melbourne.

Those not on call continue the preparation, testing and processing of the donated tissue along with the associated reporting and quality documentations requirements. There is also the contact follow up with donor families.

My main work with the Melbourne Excimer Laser Group (MELG) complements my involvement with the eyebank. A large percentage of MELGs work is for corneal therapeutic lasers and corneal cross linking, which reduces the need for some corneal transplants. With 13 different surgeons working here as mainly corneal specialists, a large proportion are also users of the Lions Eye donation service.

It has been a varied and fascinating journey so far for me personally and professionally working with the many dedicated people involved in organ and tissue transplant. Something that when I graduated as an orthoptist, I could not have foreseen.

ABOUT THE AUTHOR: Terry Couper graduated as an orthoptist in Melbourne working several years at public hospitals. He also spent 10 years as the southern regional manager for Australia and New Zealand in the Ciba Vision Contact Lens division. He returned to clinical work 25 years ago as the unit manager for MELG and casual eyebank transplant co-ordinator Lions Eye Donation Service with CERA and honorary associate UniMelb Department of Ophthalmology.