Eye Banking: Structure and Function

Key Concepts

Successful eye banking requires the collaboration of ophthalmologists and eye banking professionals.
The steps involved in providing ocular tissue for transplantation include donor screening, authorization, tissue recovery, tissue preservation and storage, tissue evaluation, tissue processing, determination of donor eligibility, and distribution.
Donor screening involves reviewing medical records and interviewing knowledgeable historians regarding medical and social history.
Tissue recovery includes verifying authorization, body identification, ocular penlight exam, physical assessment, and drawing blood for infectious disease testing.
Tissue preservation and processing techniques vary based on the type of transplant for which the tissue will be used.
Recent developments include improved tissue evaluation methods and innovations in tissue processing techniques.

Eye Banking: Past and Present

Eye banks have provided safe, effective corneal tissue for transplantation since 1944, when the first eye bank was established in New York. Eye banks of the past were small community-based organizations providing corneas for local surgeons. Today, eye banks are sophisticated businesses handling all aspects of the ocular donation process to provide multiple tissue types for a variety of surgical procedures performed worldwide. US eye banks supplied over 85,000 corneal grafts for transplantation in 2018, including domestic and international utilization. Eye banking professionals work in partnership with ophthalmologists to provide customized processed tissues for surgeries, develop new techniques to improve patient outcomes, and advance research.

Tissue Acquisition

The steps involved in acquiring ocular tissue for transplantation include donor screening, authorization, tissue recovery, storage, evaluation, processing, and determining donor eligibility. A challenging aspect of the process is controlling the number of qualified ocular donors as in relation to surgical schedules. Although most surgeons now schedule their cases, eye banks have limited control over tissue supply due to its dependence on the death of a medically suitable donor and tissue that meets the criteria for the scheduled type of surgery.

Donor Screening and Authorization

The Center for Medicare and Medicaid Services (CMS) Conditions of Participation (CoP) requires timely notification of all hospital deaths and the communication of information needed to determine potential suitability for donation. Patient demographics, cause and manner of death, medical history, and lab results are used to complete the initial screening.

If a potential for donation exists, the referring facility provides the information necessary to verify the decedent’s donor registry status or to contact the legal next of kin to offer the option of donation. Donor registries are key factors in the success of donation programs in the United States, over 143 million people have registered to donate, which represents more than 50% of the US adult population. After authorization for donation is obtained, additional screening is performed by completing a Donor Risk Assessment Interview (DRAI) with a knowledgeable historian to screen for a possible high risk of relevant communicable disease agents and diseases (RCDADs). ^,

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