Eye Donation FAQ

Here are some answers to common questions about Eye and Tissue Donation:

Will the quality of medical treatment be affected if one is a known donor?

No. There are strict laws that protect the potential donor. Legal guidelines must be followed before death can be certified. The physician certifying a patient’s death is not involved with the eye procurement or with the transplant. Additionally, it would be an absolutely deplorable act to harm one person, even to help another.

Will the recipient be told who donated the corneas?

No. The gift of sight is made anonymously. Specific information about the donor family is not made available to the recipient. If they so choose, recipients can write anonymously to their donor family, in care of the eye bank, to express their thanks. The eye bank will pass along this communication.

Do I need to tell anyone that I’m a registered donor?

While not required, the decision to donate with Donate Life Virginia should be shared with family and friends. A donor risk assessment interview conducted with a person close to you is required before any donated tissue can be transplanted; so it is helpful if your family and friends know how you feel about donation.

What laws protect my right to donate?

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), legalizing the donation of organs and tissues. The 1968 UAGA stipulated for the first time that an individual, upon death, could irrevocably donate his or her organs for medical purposes. The Revised Uniform Anatomical Gift Act (rev. 2007) has been adopted by all 50 states, and therefore is standardized across the USA. You can read Virginia's law for yourself here.

How great is the need for corneas?

Currently, the need for corneas is so great that U.S. eye banks are frequently unable to meet the domestic U.S. need, let alone help those in need elsewhere in the world. While scientists work to a future in which synthetic alternatives may replace the need for these donated gifts, eye banks continue to serve to meet as much of the need as possible. Eye banks help scientists obtain donated tissue for research that may expedite us to that future. Until then, donated human corneas are needed for transplant use.

Are there any religious objections to eye, organ, or tissue donations?

No. Eye, organ, and tissue donations are consistent with the beliefs and attitudes of major religions. For more information regarding religious perspectives on donation, please see the following website:

https://www.donatelife.net/organ-donation-and-religion/

Are there any delays in funeral arrangements?

Eye tissue procurement is performed within hours of death. Families may proceed with funeral arrangements without delay or interruption.

Will cornea or whole eye donation affect the appearance of the donor?

Great care is taken to preserve the donor’s appearance. Funeral arrangements, including a viewing if desired, routinely proceed as scheduled. The donor's body is treated with respect at all times.

With cornea donation, the clear surface tissues about the size of a contact lenses (the corneas) are recovered, leaving the donor’s iris (the colored part), as well as the rest of the eye, intact. Eye caps are placed where the corneas used to be to maintain round eye shape and keep eyelids closed. These are the same prosthetics used by funeral homes on non-donors. With whole eye donation, the entirety of both eyes are surgically removed. Prosthetic balls and eye caps are placed where the eyes used to be to maintain round eye shape and keep eyelids closed. Following either donation type, open-casket viewings can occur due to the skilled restoration procedures employed by Funeral Directors.

How does the donation process work?

Information about a death in Hampton Roads is conveyed to the two local donation agencies to investigate as potential donors, LifeNet Health (organs and tissues) and Lions Medical Eye Bank and Research Center of Eastern Virginia (corneas/eyes). To be an organ donor, an individual must meet the conditions of brain death with continued cardiac activity (heart still beating) or in rare circumstances of expected brain and cardiac death, processed for organ donation within a few hours of death (a process termed DCD or “donation after cardiac death”). The vast majority of deaths include cardiac death (heart stopped beating) and represent potential tissue and eye donors. After receiving information about a death, the “death referral” representing a recently deceased individual is medically reviewed to determine if the individual is eligible as a donor. If eligible, the donation agency checks the donor registry for authorization to recover tissue, or absent that authorization, then contacts the next of kin for authorization to recover. If eligible and authorized, the donation agency coordinates surgical recovery and preservation of anatomic gifts (e.g. bones, heart valves, skin, corneas, etc.). These gifts are further assessed for recipient safety before being released for transplant use. Once released, the donated gifts are allocated in a fair and equitable manner to persons in need.

How did the eye bank get information about the death of my loved one?

All hospitals are required by federal law to have a relationship with a local organ and tissue procurement organization, and to report all deaths to these local donation agencies in a timely manner (typically defined as 1 hour). You can read the full text of these laws and requirements here:

Deaths outside of hospitals may be referred to local donation agencies by Medical Examiners, law enforcement, hospice or nursing home staff, or next-of-kin.

How does the eye bank determine if a person is eligible to donate?

Eligibility is determined by trained Donor Coordinators according to guidance from the U.S. Food & Drug Administration, as well as Medical Standards determined by the Eye Bank Association of America. Eye bank Donor Coordinators screen medical information to determine if a patient is eligible to donate before discussing donation with families. After recovery of authorized corneas and/or whole eyes, eligibility is further reviewed, including testing blood specimens for HIV I/II, Hepatitis B, Hepatitis C, and syphilis, evaluating tissue microscopically, re-evaluating medical information sources, and interviewing next-of-kin about medical and social history. A final determination of eligibility is made by a designee of the Medical Director in accordance with Eye Bank Association of America’s Medical Standards before tissue is released for transplant use.

How does the eye bank determine what tissue to recover (corneas or whole eyes)?

The decision is a matter of timing. Eye bank staff take into account donor history, specific tissue needs for transplant, and the need for tissue for research, training, or medical education. The eye bank Donor Coordinator makes an initial determination of what tissue is needed before conducting a donor risk assessment interview with the next of kin. However, information learned during discussion may change plans (e.g. scleral tissue may not be used for transplant from donors with cancer history, but corneas can).

What parts of the eye can be used for transplant and for research?

There is a global, infinite need for corneas that all eye banks around the world combined are unable to meet. Additionally, there is periodic need for sclera (the white part of the eye) for prosthesis, support of drooping eyelids, or for wound or medical device patching. There also is fluctuating need for ocular tissue for research, training, and medical education.

How does the eye bank seek authorization to donate corneas or eyes?

The eye bank checks each potential donor to determine if they are on the donor registry. If a decedent is registered as a donor, the eye bank reaches out to next-of-kin to inform them their loved one has given authorization for donation.

If a decedent is not a registered donor, the choice to donate or not legally belongs to the next-of-kin of highest kinship. The eye bank will then reach out to the next-of-kin to offer the option of donation. The Revised Uniform Anatomical Gift Act (rev. 2007), lists the following order of priority for who may make anatomical gift of decedent’s body or part (sec. 9(a)):

an agent of the donor, unless the power of attorney for health care or other record prohibits the agent from making an anatomical gift (as phrased in sec. 4 (2));
the spouse of the decedent;
adult children of the decedent;
parents of the decedent;
adult siblings of the decedent;
adult grandchildren of the decedent;
grandparents of the decedent;
an adult who exhibited special care and concern for the decedent;
the persons who were acting as the [guardians] of the person of the decedent at the time of death; and
any other person having the authority to dispose of the decedent’s body.

How does the eye bank decide who receives the donated gifts?

The Lions Medical Eye Bank and Research Center of Eastern Virginia commits to a policy of fair and equitable allocation of donated gifts. This policy is followed at all times and applied to each gift independently to ensure the best outcome from each gift. The hierarchy of fair and equitable allocation is as follows:

Emergency need (at risk of immediate and permanent loss of vision)
Urgent need (in need of tissue of limited availability)
Local need
Domestic need (outside of Hampton Roads)
Cellular therapy need (emerging technology to grow more sight restoring cellular products from single donated gifts)
International need (outside of United States of America)
Long-term storage for other surgical uses

Tissues that are recovered with intent for surgical use that are not determined eligible for surgical use may be used for research, training, or medical education, if authorization from next-of-kin allows.

What happens if corneas recovered for transplant are found not to be suitable for transplant?

Donors and eye tissues are carefully evaluated. Corneas determined unsuitable for transplant may be used for medical research or education purposes if consent has been given for this use.

How do research and education benefit from donation?

Research on glaucoma, retinal diseases like macular degeneration, eye complications of diabetes, and other sight disorders help advance the discovery of the causes and effects of these conditions. This can then lead to new treatments, and possibly cures. Additionally, the next generation of surgeons may learn surgical techniques on donated tissue. Regardless of whether tissue is used for research and education, there is no substitute for these invaluable gifts.

How does the eye bank ensure only safe corneal tissue is made available for transplantation?

The donated eye tissue and the donor’s medical and social history are evaluated by the eye bank in accordance with the Eye Bank Association of America’s (EBAA) strict Medical Standards, as well as with U.S. Food and Drug Administration (FDA) regulations. In addition to these standards for evaluating safety of donors and donor tissues, the EBAA also provides standards for eye banks to use in training personnel to evaluate donor eyes.

How old is cornea transplantation?

Probably older than you think! 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 (causing an alkali injury to his corneas) in 1904. Two years after his injury, he was able to return to work after the successful transplant. The first donor, Karl Brauer, was an 11 year-old boy injured in an accident that left metal in both of his eyes, requiring them to be removed.

Unlike most of the rest of your body, the cornea does not contain blood vessels, leaving it “optically clear”- this is why we don’t see red all the time. The absence of blood in the cornea allows transplanted cornea tissue to be placed with recipients without having to match their blood type. Not only did this help with the early success in Dr. Zirm’s case, but it created a culture in which eye banks could best match tissue quality, age, and other criteria with specific patient needs.