August 6, 2013 in Features, Health

In the blink of an eye

Technicians race the clock tracking down corneas of the recently deceased with hopes of restoring sight to the living
By The Spokesman-Review
 
Jesse Tinsley photoBuy this photo

At the SightLife office in the Providence Sacred Heart Medical Center complex, Mike Meyer, left, holds the containers used to store and transport donated human corneas that Kelly Uttke, eye bank technician, right, recovers from donors around the region.
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The team of Spokane technicians who collect corneas from the newly dead respond as needed, 24 hours a day, traveling their expansive territory – from the Cascades to the Idaho-Montana border, from the Canada border to the Oregon border – to recover tissue from unseeing eyes.

Their mission: to help restore sight in the living.

Working from the Eastern Washington offices of SightLife, the eye bank serving the Northwest, the technicians run two Subaru Outbacks from their lab at Maria House at Providence Sacred Heart Medical Center. Corneas must be “recovered” within 24 hours of the donor’s death, but the sooner they’re placed into preservation fluid to be flown to Seattle for storage, the better.

Where the technicians’ work will take them is as impossible to predict as the moment of death.

“It ebbs and flows,” said Mike Meyer, the eye bank’s regional director. “You never know what’s going to happen.”

Meyer and SightLife’s traveling technicians are part of the largest eye bank in the nation. And, boasting the highest donor-registration rates in the nation, the Northwest has helped cut the wait time for corneas by residents who need them to restore their sight, also providing corneas for transplants elsewhere in the U.S. and overseas.

‘Taking the contact lens off’

It’s easier to donate corneas and other eye tissue than hearts, lungs or other organs, which is why more people do it.

“You’re almost more likely to win the lottery than be an organ donor,” said Jennifer DeMatteo, director of regulations and standards at the Eye Bank Association of America in Washington, D.C. “You have to be basically brain-dead, and die in a hospital and not die on the road somewhere from trauma or at home in your bed.”

Less than 1 percent of all deaths in the U.S. meet the criteria for organ donation, Meyer said. But like other types of tissue donation, cornea donation is possible after the donor’s heart stops beating. And many factors that limit organ donation, such as cancer, don’t necessarily rule out cornea donation.

Still, some potential cornea donors or surviving family members hesitate, whether it’s because they want to keep their eyes for the afterlife or because of cultural values. Others, assuming their whole eye will be removed for transplantation, worry donation will rule out an open-casket viewing.

But for use in most transplants, technicians remove only the cornea. In his discussions with family members, Meyer compares the cornea to a contact lens.

“I had a mother not too long ago say, ‘I can’t bear the thought of him not having his beautiful brown eyes,’ ” he said. “And I was able to say, ‘He will still have his beautiful brown eyes. We’re just taking the contact lens off.’ That was comforting for her to know.”

While the need for corneas is generally met in the U.S., the need is severe in much of the developing world. Ninety percent of the 10 million people around the world suffering from curable cornea blindness live in developing countries, according to SightLife.

These days, eye banks are working with one another to send corneas where they’re needed, including overseas, Meyer said. Surgeons in the U.S. generally transplant corneas within five days, although they can be used as long as 14 days after they’re recovered.

While Northwest surgeons get first crack at tissue donated in the region, more corneas leave the area than stay. In 2012 and so far in 2013, a little less than 40 percent of the corneas donated in Eastern Washington and northern Idaho were transplanted within SightLife’s service area: Washington, Idaho, Montana, California and Alaska. Five percent were transplanted in other parts of the U.S.

Most – 55 percent – were transplanted in other countries.

“If that tissue can be transplanted, we want to help somebody see,” Meyer said.

‘Suddenly these people can see’

More people than ever are receiving corneal transplants in the U.S., with nearly 69,000 grafts performed in 2012, a 62 percent increase over the number performed in 1992.

The cornea is the outer, clear part of the eye that covers the pupil and the colored iris. A cornea can become scarred, misshapen or clouded as a result of injury, infection or disease.

“When it clouds, you’re blind,” said DeMatteo, of the eye bank association. “It would be the same as if you were to take black paint and paint on the window: You suddenly can’t see out of it. But if you were to remove that diseased cornea and transplant a donor cornea, suddenly these people can see.”

A farm accident injured Gary Boone’s right cornea in 2004. The Pullman resident, now 56, was working on a piece of farm equipment when fertilizer shot into his eye.

Everything looked “pretty much just white” through that eye, Boone said. He was awake, “drugged up pretty good,” while a surgeon removed his damaged cornea and grafted a donor’s cornea in its place. His vision isn’t perfect now, he said, but it’s a lot better.

Without surgery, “I wouldn’t have been able to see anything,” said Boone, who’s since registered as an organ donor.

His surgeon, Dr. Randall Jacobson, said he and two other doctors at the Spokane Eye Clinic perform about 50 corneal transplants a year. Common causes of their patients’ corneal damage include degeneration following cataract surgey, inherited conditions and infections.

Patients are awake but sedated during the transplant, numbed by an injection near the eye. Surgery takes roughly 45 minutes.

“I describe it to patients as basically using a cookie cutter to remove the center part of their cornea and the same cookie cutter on a donated cornea,” Jacobson said. “It’s sewn into place typically with about 16 tiny stitches. The stitches usually stay there for several months, and then we slowly remove them.”

After surgery, the major risk is of trauma to the eye – fights, car accidents – disrupting the wound, Jacobson said. Patients’ bodies could reject the tissue, a lifelong risk, or surgery could lead to infection. But success rates are estimated at between 80 percent and 95 percent.

Meyer said patients faced a six-month waiting list for a corneal transplant in Spokane in 1997, when he started working for SightLife.

In 1996, SightLife recovered corneas from 774 donors. Last year, that number had risen to nearly 4,000, Meyer said.

Since 1998, federal law has required hospitals to report all deaths to organ banks, as opposed to the previous voluntary system. Meanwhile, SightLife has amplified its efforts to reach out to families after their loved ones’ deaths – workers contact them from a call center.

While you don’t have to be registered to be a donor, it helps, Matteo said, by clarifying your wishes for your relatives. The Northwest eye bank’s job is made easier by the region’s high donor-registration rates. Compared with a national average of 48 percent, 78 percent of Washington licensed drivers are registered organ donors, according to 2012 data from Donate Life America. In Idaho, it’s 61 percent. Montana leads the nation at 84 percent.

“We’re the last frontier,” Meyer said. “We’re used to stepping out and helping people.”

Because she knew her daughter wanted to be an organ and tissue donor, Debi Hammel never hesitated to donate her corneas after the 16-year-old, Lorissa Green, died in an auto accident in 2009.

But when the Cheney woman met the recipient – now a college student living in Western Washington – she looked into his eyes for hints of her daughter’s. She found none.

“They tell you there’s no chance the eyes are going to look the same, and they don’t,” Hammel said. “She had very bright blue eyes. His are very deep brown.”

The man who received Lorissa’s corneas was among at least 19 people who’ve received her organs or tissues.

“Cornea donation – people don’t look at it as being needed for life,” Hammel said. “But I’ll tell you, it sure enhances people’s life. It makes it a lot easier for them.”


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