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HOW DOES THE TISSUE DONATION PROCESS WORK?

The Donor Registry

The Colorado donor registry is a confidential database that contains all the people who have signed up to be organ and tissue donors. In Colorado, 69% of the adult population is registered to be a donor. Signing up for the donor registry is considered first-person legal consent under law. The Uniform Anatomical Gift Act (UAGA), which established the registry and guides the donation process, was passed by the Colorado legislature in 1998.

Anyone can sign up to be a donor regardless of age, health, or lifestyle. Even people with chronic medical conditions and infectious diseases may be able to donate. 

Screening and Evaluation of Cornea Donors

Initially, our recovery technicians do a penlight exam of the eyes prior to recovery. Once the recovered tissue is brought back to the eye bank, our quality control coordinators look at it under a slit-lamp microscope to evaluate its condition. Then they do a specular microscopy analysis to look more closely at the cell count and health of the  endothelial layer.

 

Cornea Transplantation

A diseased or damaged cornea is removed from the recipient using a trephine, an instrument much like a cookie cutter. The diameter of the graft is determined by the eye bank during the microscopic examination of the donor's cornea. 

A similarly sized graft from the donor cornea is made in the same manner and then placed into the recipient's eye. The graft is put into place by hand using microfilament sutures.

Here is the result:

 

Another, newer procedure transplants just the endothelial layer of the cornea. This allows the eye bank to transplant corneas that otherwise couldn't be used. For example, if the cornea is scratched heavily because of trauma in a car accident, the eye bank can split the cornea lengthwise and transplant just the back half for certain recipients who have diseases of the endothelium. 

After the eye bank removes the outer portion of the donor cornea in the lab, the resulting endothelial graft is very, very thin. Here is an optical coherence tomography photo of the split graft of the donor cornea. It is only 65 microns thick. By comparison, a human hair averages 180 microns in diameter!

 

In surgery, the patient's endothelium is removed through a small incision in the periphery of their cornea and the new, very thin endothelial graft is placed inside. There are no stitches, and many patients see 20/20 within a few days!

 

This video shows an ultra-thin DMEK graft being prepared for a surgeon to use in a procedure:

 

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