DOCSLIB.ORG

Ethical Issues in Transnational Eye Banking

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ethical Issues in Transnational Eye Banking REVIEW Ethical Issues in Transnational Eye Banking Dominique E. Martin, PhD, MBBS, BA (Hons),* Richard Kelly, MD, BBiomed,† Gary L. A. Jones, BSc (Econ),‡ Heather Machin, RN, MBA,§ and Graeme A. Pollock, PhD, MPH, BSc (Hons)¶ discussion of issues relating to tissue-derived products and Purpose: To review ethical issues that may arise in the setting of musculoskeletal tissue banking, rather than eye banking transnational eye banking activities, such as when exporting or specifically.2,5 As recognized in the recent World Health importing corneal tissue for transplantation. Organization (WHO) Initiative on MPHOs, which aims “to Methods: A principle-based normative analysis of potential common support the development of global consensus on guiding dilemmas in transnational eye banking activities was performed. ethical principles for the donation and management of [MPHOs],”6 a number of ethical concerns are common to Results: Transnational activities in eye banking, like those in other all MPHOs, including ocular tissues used in transplanta- fields involving procurement and use of medical products of human tion.1,7 Common concerns associated with transnational origin, may present a number of ethical issues for policy makers and movement of MPHOs include national self-sufficiency, donor professionals. Key ethical concerns include the potential impact of autonomy, equity in resource distribution, and care of donors export or import activities on self-sufficiency of corneal tissue supply and recipients.1 In this article, we briefly review several within exporting and importing countries; potential disclosure ethical issues that may be associated with transnational eye requirements when obtaining consent or authorization for ocular banking activities, using the example of importation and tissue donation when donations may be exported; and difficulties exportation of corneas for transplantation. inherent in assuring equity in the allocation of tissues available for In 2012, an estimated 11% of corneal transplants export and in establishing and respecting standards of safety and performed worldwide used imported tissue, with 27 countries quality across different jurisdictions. wholly dependent and 43 countries partially dependent on imported tissue.4 Eight percent of corneal tissue procured Conclusions: Further analysis of specific ethical issues in eye annually was reportedly exported, primarily from the United banking is necessary to inform development of guidelines and other States, which accounted for 85% of corneal exports, Sri governance tools that will assist policy makers and professionals to Lanka (9%), and Italy (3%).4 Thus, of the 116 countries support ethical practice. currently active in corneal transplantation, at least 70 of these Key Words: ethics, eye banking, corneal transplantation are directly involved in transnational eye banking activities.4 Although such transnational eye banking activities may be (Cornea 2017;36:252–257) a rare occurrence or represent a small proportion of activity for many eye banks, for others, the export or import of corneas may substantially influence their capacity to meet the thical issues concerning the transnational movement of transplant needs of the population they serve. In reviewing medical products of human origin (MPHOs) such as E ethical dilemmas that may arise in the setting of import or organs, gametes, and blood products have been extensively – export of corneas, we lay the foundations for further ethical explored in the academic literature in recent decades.1 3 In analysis of global eye banking activities, which is necessary contrast, issues related to the transnational movement of to inform the development of guidelines for governance of human ocular tissues such as corneas have received little 6 attention, despite a significant volume of global activity.4 MPHOs such as those being prepared by the WHO. To our Corneas are usually referenced only in the context of broader knowledge, there are no analyses dedicated to the ethics of eye banking activities in the extant peer-reviewed literature. Throughout the text, we highlight recommendations for Received for publication May 22, 2016; revision received October 6, 2016; practice grounded in our analysis, which we summarize in accepted October 9, 2016. Published online ahead of print December 1, Boxes 1–4. 2016. From the *School of Medicine, Deakin University, Geelong, Australia; †St Vincent’s Hospital, Melbourne, Australia; ‡Veneto Eye Bank Foundation, Box 1. Recommendations for promoting self-sufficiency Zelarino-Venice, Italy; §Lions Eye Donation Service, Centre for Eye Research With the exception of transnational eye banking Australia, Royal Victorian Eye and Ear Hospital; and ¶Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia. activities involving a reciprocal exchange of tissues and/or The authors have no funding or conflicts of interest to disclose. collaboration in the pursuit of regional self-sufficiency, Reprints: Dominique E. Martin, PhD, MBBS, BA (Hons), Geelong Waurn import or export activities should be designed as temporary Ponds Campus, Locked Bag 20000, Geelong 3220, Australia (e-mail: strategies that are implemented in conjunction with, rather [email protected]). 8 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. than as substitutes for, eye bank development programs. 252 | www.corneajrnl.com Cornea Volume 36, Number 2, February 2017 Copyright Ó 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Cornea Volume 36, Number 2, February 2017 Ethical Issues in Transnational Eye Banking 1. Export activities should be conditional on the exis- the Eye Banking association of Australia and New tence of a feasible “exit plan” outlining steps for the Zealand.9 These principles should be reviewed to development of local infrastructure and resources ensure that they are fit for the purpose and required to provide services in the long-term; or; consistently applied to local and transnational 2. If local eye bank service development is considered activities. Consultation of an ethicist and relevant unfeasible in the long term, for example, because of stakeholders will assist in development of guide- a low population, then a long-term plan for meeting lines to support ethical policy and practice. patient needs should be elaborated. 2. Checklists identifying requirements or expectations of import or export activities should be developed. These may include items such as • Code of ethics to be followed; • Required documentation such as evidence of Box 2. Recommendations for promoting autonomy legislation governing procurement, import or 1. Donation decision makers should routinely be export, and use of human tissues as well as informed of the possibility that donated tissue may consent forms, and of accreditation by an appro- be exported if there is no suitable local recipient. priate licensing body; details of operating systems 2. Information about regional or international tissue and standards, etc; fi • Mechanisms for reporting of outcomes; sharing programs and the bene ts of export activi- • ties, etc, should also be made available to donation Fees and charges. decision makers. 3. Potential recipients of corneal tissue should routinely be informed that their transplant will involve use of a product of human origin, and, where this possibility exists, that it may be obtained from tissue donated in POTENTIAL ETHICAL CONCERNS IN THE a foreign country. CONTEXTOFEXPORTANDIMPORTOFCORNEAS Self-Sufficiency in Donation and Transplantation fi Box 3. Recommendations for assuring quality and safety Self-suf ciency in corneal transplantation refers to the Before engaging in import or export of corneal goal of meeting needs for transplantation within a given tissues, both sending and receiving agencies or individuals population using transplant services and corneal tissue 1 fi should confirm: obtained from within that population. Self-suf ciency in 1. The procurement of corneal tissues in a manner that many MPHOs such as blood or organs is commonly pursued respects donors and the integrity of donation at the national level, but regional collaboration often occurs to decision making; ensure that smaller populations can together meet their needs for transfusion or transplantation in a timely manner.1,10 2. The necessary written authorization from relevant fi health authorities for the export, import, and/or Economies and ef ciencies of scale in procurement and application of these tissues; processing systems as well as distribution networks may be 3. The availability of professionals who are suitably better achieved through regular or ad hoc subnational or qualified and legally authorized to use the supranational collaborations, in which donor tissue is shared, imported tissue; which involves potential export and import of tissue by all 4. That recipient health services are adequately equip- collaborating partners as required. Australia, for example, has ped with operating rooms and staff responsible for a cooperative relationship with New Zealand in which postoperative follow-up; resources such as organs or corneas for transplantation are 5. Mechanisms for traceability and reporting of out- shared between both countries to meet urgent needs and fi 11 comes of tissue use. ensure that available resources are used ef ciently. Although controversial in the context of some MPHOs such as plasma-derived products,12 the pursuit of self-sufficiency in other MPHOs
Load more

Recommended publications
  • Euro GTP Guidance
    EURO­GTP Euro GTP Guidance European Union Project in the framework of the Public Health Program Agreement number: 2007 207 Coordinator: Transplant Services Foundation 1 List of Authors ‐ Euro GTP Project Coordinator TSF ▪ Transplant Services Foundation | Spain Project Partners BISLIFE | Netherlands BTV ▪ Banca Tessuti della Regione Veneto | Italy CBC ▪ Hornhautbank Berlin Charite Universitatsmedizin | Germany EHB ▪ European Homograft Bank | Belgium ESB ▪ Euro Skin Bank | Netherlands HBM ▪ Hornhautbank München Gemeinnutzige | Germany ISS‐CNT ▪ Istituto Superiore di Sanita Centro Nazionale Trapianti | Italy KCBTiK ▪ Krajowe Centrum Bankowania Tkanek I Komórek | Poland QAMH ▪ Queen Astrid Military Hospital | Belgium REGEA ▪ Tampere Yliopisto. University of Tampere | Finland i Table of Contents PURPOSE AND SCOPE ................................................................................................................................................1 SECTION A: GENERAL REQUIREMENTS .......................................................................................................................3 A.1. PERSONNEL ............................................................................................................................................................... 3 A.2. FACILITIES AND EQUIPMENT ..................................................................................................................................... 8 A.2.1. FACILITIES, EQUIPMENT AND MATERIALS FOR RECOVERY...............................................................................
    [Show full text]
  • Freezing of Surplus Donated Whole Eyes in the Central Eye Bank of Iran
    RESEARCH Freezing of Surplus Donated Whole Eyes in the Central Eye Bank of Iran Use of Defrosted Corneas for Deep Anterior Lamellar Keratoplasty and Report of Postoperative Eye Bank Data Mozhgan Rezaei Kanavi, MD; Mohammad Ali Javadi, MD; Fatemeh Javadi; Tahereh Chamani, MS ABSTRACT especially when a shortage exists for fresh donor corneas for transplantation. PURPOSE: To describe the method of freezing and thaw- KEYWORDS: cornea, freezing, whole eyes, DALK, ing of donated whole eyes (DWEs), which were surplus to eye banks, thawing....................................... requirements in the Central Eye Bank of Iran (CEBI), and to report the 3-year results of using defrosted corneas in deep anterior lamellar keratoplasty (DALK) in keratoconic eyes. he Central Eye Bank of Iran (CEBI) is the METHODS: The method of freezing and thawing of only eye bank in Iran and is located in Tehran. surplus DWEs in the CEBI is described. Surplus DWEs Tissue requirements for corneal and scleral at the CEBI were disinfected, processed, and transferred T transplantation in Iran are supplied and preserved to the freezer (-70°C) for long-term preservation. In case 1 of a shortage of fresh and refrigerated corneas for DALK, by the CEBI. There has been an increasing trend in a frozen DWE was defrosted and distributed for trans- corneal transplantation in Iran, from 200 grafts in plantation either as a whole eye in moist chamber or as 1988 to 6,053 in 2012 (unpublished data). Keratoco- an excised corneoscleral disc in Eusol C at 2˚C to 8˚C. nus is the most common indication for penetrating Furthermore, eye bank data of the frozen DWEs as well 1 as postoperative eye bank reports of implementation of keratoplasty in Iran, accounting for 34.5% of cases.
    [Show full text]
  • Exploring Vigilance Notification for Organs
    NOTIFY - E xploring V igilanc E n otification for o rgans , t issu E s and c E lls NOTIFY Exploring VigilancE notification for organs, tissuEs and cElls A Global Consultation e 10,00 Organised by CNT with the co-sponsorship of WHO and the participation of the EU-funded SOHO V&S Project February 7-9, 2011 NOTIFY Exploring VigilancE notification for organs, tissuEs and cElls A Global Consultation Organised by CNT with the co-sponsorship of WHO and the participation of the EU-funded SOHO V&S Project February 7-9, 2011 Cover Bologna, piazza del Nettuno (photo © giulianax – Fotolia.com) © Testi Centro Nazionale Trapianti © 2011 EDITRICE COMPOSITORI Via Stalingrado 97/2 - 40128 Bologna Tel. 051/3540111 - Fax 051/327877 [email protected] www.editricecompositori.it ISBN 978-88-7794-758-1 Index Part A Bologna Consultation Report ............................................................................................................................................7 Part B Working Group Didactic Papers ......................................................................................................................................57 (i) The Transmission of Infections ..........................................................................................................................59 (ii) The Transmission of Malignancies ....................................................................................................................79 (iii) Adverse Outcomes Associated with Characteristics, Handling and Clinical Errors
    [Show full text]
  • EBAA Medical Standards – October 2016
    Medical Standards These Standards have the approval of the Eye Banking Committee of the American Academy of Ophthalmology October 28, 2016 Published by: EBAA th 1015 18 Street, NW, Suite 1010, Washington, DC 20036, USA www.restoresight.org ©2016. EBAA. All rights reserved. Page 1 EBAA Medical Standards – October 2016 Table of Contents A1.000 Introduction and Purpose ..............................................................................................5 A1.100 Scope ......................................................................................................................5 B1.000 Active Membership .........................................................................................................5 B1.100 Eye Bank Inspection...............................................................................................6 B1.200 Inspections by Official Agencies ...........................................................................6 C1.000 Personnel and Governance .............................................................................................6 C1.100 Director...................................................................................................................6 C1.200 Medical Director ....................................................................................................7 C1.300 Staff Performing Eye Banking Functions ..............................................................8 C1.400 Change in Governance ...........................................................................................9
    [Show full text]
  • Ethical Issues in Living-Related Corneal Tissue Transplantation
    Viewpoint Ethical issues in living-related corneal J Med Ethics: first published as 10.1136/medethics-2018-105146 on 23 May 2019. Downloaded from tissue transplantation Joséphine Behaegel, 1,2 Sorcha Ní Dhubhghaill,1,2 Heather Draper3 1Department of Ophthalmology, ABSTRact injury, typically chemical burns, chronic inflamma- Antwerp University Hospital, The cornea was the first human solid tissue to be tion and certain genetic diseases, the limbal stem Edegem, Belgium 2 transplanted successfully, and is now a common cells may be lost and the cornea becomes vascula- Faculty of Medicine and 5 6 Health Sciences, Dept of procedure in ophthalmic surgery. The grafts come from rised and opaque, leading to blindness (figure 1). Ophthalmology, Visual Optics deceased donors. Corneal therapies are now being In such cases, standard corneal transplants fail and Visual Rehabilitation, developed that rely on tissue from living-related donors. because of the inability to maintain a healthy epithe- University of Antwerp, Wilrijk, This presents new ethical challenges for ophthalmic lium. Limbal stem cell transplantation is designed to Belgium 3Division of Health Sciences, surgeons, who have hitherto been somewhat insulated address this problem by replacing the damaged or Warwick Medical School, from debates in transplantation and donation ethics. lost limbal stem cells (LSC) and restoring the ocular University of Warwick, Coventry, This paper provides the first overview of the ethical surface, which in turn increases the success rates of United Kingdom considerations generated by ocular tissue donation subsequent sight-restoring corneal transplants.7 8 from living donors and suggests how these might Limbal stem cell donations only entail the removal Correspondence to be addressed in practice.
    [Show full text]
  • AMRITA HOSPITALS AMRITA AMRITA HOSPITALS HOSPITALS Kochi * Faridabad (Delhi NCR) Kochi * Faridabad (Delhi NCR)
    AMRITA HOSPITALS HOSPITALS AMRITA AMRITA AMRITA HOSPITALS HOSPITALS Kochi * Faridabad (Delhi NCR) Kochi * Faridabad (Delhi NCR) A Comprehensive A Comprehensive Overview Overview A Comprehensive Overview AMRITA INSTITUTE OF MEDICAL SCIENCES AIMS Ponekkara P.O. Kochi, Kerala, India 682 041 Phone: (91) 484-2801234 Fax: (91) 484-2802020 email: [email protected] website: www.amritahospitals.org Copyright@2018 AMRITA HOSPITALS Kochi * Faridabad (Delhi-NCR) A COMPREHENSIVE OVERVIEW A Comprehensive Overview Copyright © 2018 by Amrita Institute of Medical Sciences All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means —electronic, mechanical, photocopying, recording, or otherwise without permission of the publisher. Published by: Amrita Vishwa Vidyapeetham Amrita Institute of Medical Sciences AIMS Ponekkara P.O. Kochi, Kerala 682041 India Phone: (91) 484-2801234 Fax: (91) 484-2802020 email: [email protected] website: www.amritahospitals.org June 2018 2018 ISBN 1-879410-38-9 Amrita Institute of Medical Sciences and Research Center Kochi, Kerala INDIA AMRITA HOSPITALS KOCHI * FARIDABAD (DELHI-NCR) A COMPREHENSIVE OVERVIEW 2018 Amrita Institute of Medical Sciences and Research Center Kochi, Kerala INDIA CONTENTS Mission Statement ......................................... 04 Message From The Director ......................... 05 Our Founder and Inspiration Sri Mata Amritanandamayi Devi .................. 06 Awards and Accreditations .........................
    [Show full text]
  • Organ Transplant Transplants E.G
    New Layout-Dt 14-2-2009 - final.pmd 1 2/14/2009, 5:16 PM FROM THE EDITOR’S DESK / CONTENTS 2 From the Editor’s Desk Dr. Reeta J. Dalal 3 Guest Editorial Dr. Sudeep Shah 4 Cadaver Transplantation Dr. Rasika Sirsat 8 Corneal Transplant Dr. Nisheeta Agarwala & Dr. Pradyna 12 Heart Transplant Dr. Kaushal Pandey 16 Frontiers of Immunosuppression in Renal Transplant Dr. Jatin Kothari 20 Liver Transplant Dr. Sudeep Shah From the 24 Live Related Renal Transplant Dr. Alan Almeida Editor’s Desk 30 Stem Cell Transplant (SCT) Dr. Asha Kapadia Worldwide tens of 32 Lung Transplant - thousands of lives are Where does it stand today? transformed by the miracle Dr. Manoj Agni of organ donation. Tissue 36 Short History of Organ Transplant transplants e.g. skin, Dr. R. A. Bhalerao cornea, bone-marrow, 38 Hinduja News vessels are invaluable. In 40 Welcome the last half century transplant surgery has transformed from research to life-saving surgery. For every successful transplant there are Editorial Board thousands who are on the waiting list and Dr. Philip Abraham Dr. Tester Ashavaid probably die waiting to receive the graft. Organ Dr. C. Balakrishnan transplants are complicated by scarcity of organ Dr. Sudeep Shah Dr. Gauri Mankekar donors, various ethical and social issues. Editor In this issue Dr. Sudeep Shah, Liver Transplant Dr. Reeta J. Dalal Surgeon at Hinduja Hospital has put together Editor Emeritus articles from various specialities to give you an Dr. V. R. Joshi ‘Update on organ transplants’. Guest Editor Dr. Sudeep Shah Photography Pramod Tandel Dr. Reeta J.
    [Show full text]
  • First Report of the National Transplant Registry 2004 BLOOD and MARROW TRANSPLANTATION
    FIRST REPORT OF THE NATIONAL TRANSPLANT REGISTRY 2004 Editors Hooi L.S. Lela Yasmin Mansor With contributions by: Alan Teh K H, Chan L L, Shamala R, Choong YY, Michael Law SH, Mohamed Ezani, David Chew SP, Ganesalingam K, Lim CB, Tan SS, Goh BL, Hamdan Leman, Suzina Sheikh August 2005 © National Transplant Registry, Malaysia ISSN 1823-5719 Published by: National Transplant Registry 2nd Floor MMA House 124, Jalan Pahang 53000 Kuala Lumpur Malaysia Tel : (603) 4045 5948 Fax : (603) 4044 0613 e-mail : [email protected] Website: http://www.mst.org.my This report is copyrighted. However it may be freely reproduced without the permission of the National Transplant Registry. Acknowledgement would be appreciated. Suggested citation is: Hooi L.S., Lela Yasmin Mansor (Eds). First Report of the National Transplant Registry Malaysia 2004. Kuala Lumpur 2005. FOREWORD We are pleased to launch the first report of the National Transplant Registry (NTR). The Registry was formed in November 2003 with the primary aim of establishing a national audit to analyse and understand the demography and outcomes in the complicated field of transplantation. This first report has been made possible by the dedication, hard work and support from the various transplant source providers and data management team. Working in close collaboration with the Clinical Research Centre the NTR has made encouraging progress since its recent formation. We would like to thank the participating centres for their cooperation. Currently the Registry collects data from all centres performing organ and tissue transplantation in this country. Heart, blood and marrow transplantation data is now reported online.
    [Show full text]
  • Gamma-Irradiation Reduces the Allogenicity of Donor Corneas
    Gamma-Irradiation Reduces the Allogenicity of Donor Corneas The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Stevenson, William, Sheng-Fu Cheng, Parisa Emami-Naeini, Jing Hua, Eleftherios I. Paschalis, Reza Dana, and Daniel R. Saban. 2012. “Gamma-Irradiation Reduces the Allogenicity of Donor Corneas.” Investigative Opthalmology & Visual Science 53 (11) (October 15): 7151. doi:10.1167/iovs.12-9609. Published Version 10.1167/iovs.12-9609 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34428166 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Cornea Gamma-Irradiation Reduces the Allogenicity of Donor Corneas William Stevenson, Sheng-Fu Cheng, Parisa Emami-Naeini, Jing Hua, Eleftherios I. Paschalis, Reza Dana, and Daniel R. Saban* PURPOSE. To evaluate the utility and allogenicity of gamma- orneal transplantation, also known as corneal grafting, is irradiated corneal allografts. Cone of the oldest, most common, and most successful forms of solid tissue transplantation. In 2010, over 42,000 METHODS. Corneal buttons were harvested from C57BL/6 mice corneal transplantations were performed in the United States and decellularized with gamma irradiation. Cell viability was 1 assessed using TUNEL and viability/cytotoxicity assays. Ortho- alone. Despite advances in recognition and treatment, immune rejection remains the leading cause of corneal topic penetrating keratoplasty was performed using irradiated 2 or nonirradiated (freshly excised) C57BL/6 donor grafts and transplantation failure.
    [Show full text]
  • Cornea Donation in Denmark
    RESEARCH Cornea Donation in Denmark Vigdis Magnusdottir, MD; Jesper Hjortdal, MD, PhD; Kim Nielsen, MSc, PhD ABSTRACT Purpose: Shortage of donor corneal tissue exists in Denmark. The Danish Donor Register founded in 1990, contains individuals' consents to donation of a variety of tissues and organs including the cornea. This study describes the registered donors. Methods: Data from the Donor Register was analyzed. Results: Since the beginning of the register, the number of registered citizens has increased and now represents 18% of the total adult population. In addition, the diversity of consents has also evolved. Citizens in the larger cities consent more often than citizens living outside the cities. Females consent more often than men. Of those consenting to donation in the Donor Register, almost 85% of them have agreed to cornea donation. The Danish Cornea Bank however only record less than half of the expected donors among the deceased in hospitals due to the discrepancy in the age among the registered and the age at death. Conclusion: The number of corneas donated and procured is increasing. Corneal transplantation is the most common tissue/organ transplant procedure in Denmark. KEYWORDS Corneal transplantation. Donor register. Eye bank. Keratoplasty. Tissue donation. International Journal of Eye Banking • vol. 3 no. 1 • Mar 2015 • © 2015 Eye Bank Association of America. All rights reserved 1 www.eyebankingjournal.org RESEARCH Cornea Donation In Denmark INTRODUCTION Organ donation is life-saving whereas tissue donation can improve the quality of life. Visual impairment and blindness are strong predictors for reduced quality of life due to difficulties in e.g.
    [Show full text]
  • Landmarks in the History of the Eye Bank Association of America
    INTERNATIONAL JOURNAL OF EYE BANKING GLOBAL PERSPECTIVES The Evolution of Eye Banking in the United States: Landmarks in the History of the Eye Bank Association of America Patricia Aiken-O’Neill, JD; Mark J. Mannis, MD ABSTRACT Established in 1961, the Eye Bank Association of America (EBAA) was not only the first eye bank association in the world but also the first association to represent any group of organ or tissue transplantation profession- als. Its history is one of additional “firsts”: setting medical standards to ensure tissue safety, establishing an accreditation process for individual eye banks, and developing a certification program for eye bank techni- cians, among others. To accomplish these initiatives, the EBAA has fostered collaborations with diverse com- munities, including government officials, corneal surgeons, Lions Clubs members, researchers, tissue and organ banks, and international organizations, thus continuing to evolve its role in pursuit of an unchanging mission: to champion the restoration of sight. KEYWORDS: corneal transplantation, Eye Bank Association of America (EBAA), eye bank methods, eye banks, history of eye banks The Preamble to Eye Banking plasty development to North America. He became the chief proponent of pen- A date familiar to ophthalmologists and eye banking profession- etrating keratoplasty and developed ba- als alike is December 7, 1905, when Karl Edward Zirm, a young sic surgical techniques and instrumenta- physician in Moravia, performed the first successful penetrating tion, many of which remain the basis of graft into his patient.1 This single event catalyzed renewed en- contemporary surgery.3 thusiasm for the feasibility of penetrating keratoplasty. (See the From the beginning, what distin- related article in this issue, “Eye Banking in the 21st Century: guished keratoplasty from other ophthal- How Far Have We Come? Are We Prepared for What’s Ahead?”) mic procedures was the requirement for Fig.
    [Show full text]
  • In Vitro Corneal Tomography of Donor Cornea Using Anterior Segment OCT
    BASIC INVESTIGATION In Vitro Corneal Tomography of Donor Cornea Using Anterior Segment OCT Edgar Janunts, PhD,* Achim Langenbucher, PhD,* and Berthold Seitz, ML, MD† n cases of corneal donation, either the entire globe or just Purpose: The aim of this study was to establish a tomographic Ia 15-mm corneoscleral piece of tissue is taken. Having screening method for revealing potential pathologies in corneal confirmed the absence of obvious scars on the cornea and donors before keratoplasty so they may be excluded as candidates for a medical history without any corneal surgeries or infectious corneal transplantation. diseases, the corneoscleral button can be excised and stored in fi “ ” Methods: Donor corneal tomographies were measured in a viewing a special chamber lled with a transport medium before chamber filled with preservation medium and with the use of transplantation. At present, only a visual examination using a clinical optical coherence tomography (OCT) device. Custom- a handheld slit lamp is performed before the corneoscleral written software was developed to extract corneal surfaces from the excision, in addition to blood and smear tests. Further slit- raw data, which were analyzed in the central and peripheral regions. lamp examinations and microbiological tests are usually An adaptive nonlinear edge-enhancement algorithm was used to performed under laboratory conditions in eye banks. There observe scars within the corneal volume. The thickness distribution is no tomographic screening routine presently available that map was analyzed to detect keratoconus and corneas with extreme discounts corneas that might be unsuitable for future trans- topographic irregularities. Measurements were repeated 5 times to plant, such as those which have suffered previous surgeries assess reproducibility.
    [Show full text]