The first corneal transplant was performed in 1906 by Dr. Eduard Konrad Zirm, an ophthalmologist born in Vienna, Austria. The first corneal transplant recipient, Alois Glogar, was blinded in both eyes when slaking lime (alkali injury to his corneas) in 1904 and was able to return to work after the successful transplant. The first donor, Karl Brauer, was an 11 year-old boy who was injured in an accident that left metal in both of his eyes, requiring them to be removed.
Since Dr. Zirm’s advancement of mankind through succeeding with the first corneal transplant, organs and tissue (like cartilage, heart valves, skin, bones, etc.) have been transplanted successfully. Unlike other structures of the human body, the cornea does not contain blood vessels, leaving it optically clear. This absence of vasculature allows corneas to be placed with recipients without regard to blood typing. Not only did this lend to the early success in Dr. Zirm’s case, but it has created a culture in which eye banks can best match tissue quality, age, and other criteria with specific patient needs.
The Need for Donation
The basic truth about donation is that there are more people in need of organs, tissue, and corneas than there are donors. With regard to cornea donation, thousands of patients in need of corneal transplants fill surgical schedules at hospitals and ambulatory surgery centers across the U.S. Around the world, the need for transplantable, donated corneas is even greater, since most countries, regions, or local cultures have not developed successful donation programs. Approximately 100,000 corneal transplant procedures are performed every year worldwide, with some estimates reporting that the worldwide need for corneas affects nearly 10,000,000 people.
Legislation and Regulation
In the U.S., there has been significant legislation to facilitate donation, especially with regard to who may make a legal document of anatomical gift for a decedent. In 1968, Congress passed the Uniform Anatomical Gift Act (UAGA), making the donation of organs and tissue legal. The 1968 UAGA stipulated for the first time that an individual, upon death, could irrevocably donate his or her organs for medical purposes by signing a simple document before witnesses. As simple as this seems, this was a departure from centuries of common-law precedent, in which the body immediately after death became the property of the next-of-kin. Revisions to the UAGA on the federal level have occurred in 1987 and 2006, resulting in a few changes, including that a legal document of gift, signed by the individual does not need to be witnessed, and in the event that there is an absence of documentation left by the individual, there is an expanded list of persons, in an order of priority, who may make an anatomical gift on behalf of the deceased.
In 1984, the National Organ Transplant Act (NOTA) established the framework for the Organ Procurement and Transplantation Network (OPTN). In 1986, the United Network for Organ Sharing (UNOS) was established and the Consolidated Omnibus Budget Reconciliation Act of 1986 requires that all families of potential donors be approached for donation. As a result of the 1986 legislation, hospitals not complying with the law would be ineligible for Medicare benefits. By 1988, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) set donor standards and required hospital policies and procedures for organ and tissue procurement.