Eye bank in details

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eye banking AND corneal transplantation

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Eye Bank Association of America medical standards donor cornea eye banking process

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Eye bank

An eye bank is a specialized, non-profit or hospital-based service that collects, evaluates, processes, preserves, stores, and distributes donated ocular tissue for transplantation, research, and education. Its main purpose is to supply safe, high-quality donor corneas for keratoplasty, thereby restoring vision in people with corneal blindness.

An eye bank does not transplant eyes. In routine clinical practice, it provides corneal or scleral tissue. Whole-eye transplantation is not currently feasible because the optic nerve cannot be reconnected to restore vision.

International standards describe eye-bank functions as recovery, processing, storage, tissue evaluation, donor-eligibility determination, and distribution, with quality-assurance and traceability systems throughout the pathway. See the EBAA medical standards.

1. Objectives of an eye bank

Procure donor eye tissue after valid consent.
Screen donors to prevent transmission of infection or disease.
Assess tissue quality, especially corneal clarity and endothelial viability.
Preserve and store tissue until use.
Distribute suitable tissue to registered corneal surgeons.
Maintain documentation, traceability, quality control, and adverse-event reporting.
Use tissue unsuitable for transplant, where permitted and consented, for research and teaching.

2. Ocular tissues obtained

Tissue	Main use
Cornea	Penetrating keratoplasty, endothelial keratoplasty, anterior lamellar keratoplasty
Corneoscleral rim	Source tissue for corneal graft preparation; may also be cultured to investigate contamination
Sclera	Patch grafts in glaucoma surgery, scleral thinning, ocular trauma, orbital implants
Amniotic membrane	Usually processed separately from placental donation, but may be handled by some tissue services
Whole globe	Research, education, selected surgical preparations, but not whole-eye transplantation

3. Types of eye-bank services

A. Eye bank

A full-service facility that can retrieve, evaluate, preserve, store, process, and distribute tissue.

B. Eye donation centre or collection centre

Usually linked to a parent eye bank. It may counsel families and recover donor eyes, then transport them to the eye bank for detailed testing and processing.

C. Hospital cornea retrieval programme

A system within hospitals, mortuaries, ICUs, and emergency departments that identifies potential donors and promptly contacts the eye bank. This is often called required-request, grief counselling, or a hospital cornea retrieval programme.

4. Sources of donor eyes

Most donor tissue is obtained from a deceased donor after consent by:

The donor before death, through a legally valid donor authorization
Next of kin or legally authorized representative after death
Organ-donation networks and hospitals
Mortuaries and post-mortem departments
Community donation programmes

Eye donation can be considered in people of many ages. Advanced age alone does not automatically make a cornea unusable. Final suitability depends on endothelial quality, corneal clarity, medical history, and safety screening.

5. Workflow of eye banking

Step 1: Donor identification and consent

The eye bank is notified after death. Staff confirm:

Identity of the donor
Time and cause of death
Valid consent or authorization
Medical and social history
Whether there are contraindications to donation

Sensitive counselling is important. Families should understand that retrieval is respectful, does not usually cause disfigurement when properly performed, and does not delay funeral arrangements substantially.

Step 2: Donor screening

Screening aims to protect the recipient and eye-bank staff. It includes:

Review of hospital and medical records
Interview with family or other reliable informant
Cause and circumstances of death
Risk-behaviour and travel history where applicable
Physical examination of the donor
Blood testing for transfusion-transmissible infections as required by local regulations

Typical reasons to exclude tissue from transplantation include suspected or confirmed serious transmissible infection, certain central nervous system infections or prion-disease risk, unknown high-risk cause of death, and conditions that make the cornea structurally unsuitable. Exact eligibility criteria are country-specific and must follow the applicable national regulator and eye-bank standards.

Step 3: Recovery of tissue

Recovery is performed as soon as possible after death by trained personnel using strict aseptic technique.

Two common methods are:

Whole-globe enucleation
The complete eye is removed and later dissected in the eye bank.
In-situ corneoscleral excision
The cornea with a rim of sclera is excised directly from the donor. This can reduce handling of the entire globe and is widely used.

The exact permitted recovery interval varies by local policy, refrigeration, and preservation method. In all cases, prompt recovery and appropriate cooling are needed because corneal endothelial cells deteriorate after death.

Step 4: Preservation and transport

The retrieved tissue is placed in sterile preservation medium and transported in a temperature-controlled manner.

Common preservation methods:

Method	Typical temperature	Approximate storage period	Comments
Moist chamber	2-8°C	Short term	Mainly for whole globes before processing
Hypothermic storage medium such as Optisol-GS or equivalent	2-8°C	Up to about 14 days, depending on validated medium	Common in many settings
McCarey-Kaufman medium	2-6°C	Usually about 2-4 days	Short-term preservation
Organ culture	About 31-37°C	Weeks, depending on protocol	Used more commonly in some European systems

The choice of medium and duration must follow the product instructions, validated eye-bank procedures, and local regulations. EBAA notes that, in the United States, preservation media can maintain corneal cells for up to 14 days, although transplantation commonly occurs within a week of recovery. See the EBAA eye-donation FAQ.

Step 5: Tissue evaluation

A cornea is examined before it is released for transplantation.

A. Slit-lamp examination

Assesses:

Epithelial defects
Stromal edema or scarring
Infiltrates and opacity
Descemet membrane folds
Previous surgery or trauma
Foreign material and signs of infection

B. Endothelial assessment

The corneal endothelium maintains corneal dehydration and transparency. Its quality is especially important for endothelial keratoplasty.

Assessment may include:

Specular microscopy
Endothelial cell density
Cell morphology: polymegethism and pleomorphism
Areas of cell loss or damage

C. Microbiological assessment

Depending on the eye-bank protocol, cultures may be performed on preservation medium or the corneoscleral rim. Positive culture results require interpretation alongside clinical risk and applicable release criteria.

D. Serological testing

Donor blood is tested for infections required by local law and standards, often including HIV, hepatitis B, hepatitis C, syphilis, and other relevant infections.

Step 6: Processing

Depending on the surgeon’s request, the eye bank may prepare tissue for:

Full-thickness penetrating keratoplasty
Descemet stripping automated endothelial keratoplasty, DSAEK
Descemet membrane endothelial keratoplasty, DMEK
Deep anterior lamellar keratoplasty, DALK
Scleral patch grafting

Pre-cut or pre-loaded endothelial grafts can reduce operating-room preparation time, but each additional processing step requires validated aseptic procedures and accurate labeling.

Step 7: Allocation and distribution

The eye bank matches tissue to the surgical indication and surgeon’s requirements. Important factors include:

Graft diameter
Endothelial cell density
Donor age where relevant
Tissue type and preparation
Serology and suitability status
Surgical urgency, such as therapeutic keratoplasty for severe infectious keratitis or perforation

The tissue is packed, labeled, transported under validated conditions, and accompanied by documentation.

Step 8: Post-distribution follow-up

The eye bank must be able to trace:

Donor → recovered tissue → processing batch → surgeon/hospital → recipient

It must also receive and investigate reports of:

Post-keratoplasty infection
Suspected donor-derived disease transmission
Graft-related adverse events
Tissue mix-up, labeling error, or transport deviation

EBAA standards require long-term record retention and documented quality systems for deviations, investigations, and corrective action. See the quality-system provisions.

6. Important personnel

An eye bank generally requires:

Medical director, usually an ophthalmologist
Eye-bank manager or administrator
Trained eye-bank technicians
Grief counsellors or donor coordinators
Microbiology and laboratory personnel
Quality-assurance officer
Data, traceability, and logistics staff
Corneal surgeons linked to transplant centres

7. Essential equipment

Sterile recovery instruments
PPE and aseptic recovery supplies
Refrigerated storage units with continuous temperature monitoring
Preservation media and sterile containers
Slit lamp or tissue-viewing system
Specular microscope
Laminar-flow or validated clean processing area
Microbiology facilities or laboratory linkage
Barcode or unique tissue-identification system
Validated shipping containers and temperature-control devices
Emergency power backup and alarm systems

8. Quality assurance in an eye bank

Quality assurance is central because corneal tissue is transplanted into a recipient.

Key elements are:

Written standard operating procedures
Personnel training and competency assessment
Aseptic technique and contamination control
Equipment calibration and maintenance
Temperature monitoring
Documentation of every handling step
Unique donor and tissue identification
Prevention of labeling mix-ups
Audits and corrective/preventive actions
Tissue recall procedures
Confidentiality of donor and recipient information

Only tissue meeting defined safety and quality criteria should be distributed. The EBAA overview describes accredited eye banks as organizations that obtain, medically evaluate, and distribute ocular tissue for transplant, research, and education.

9. Importance of eye banking

Eye banks are essential for managing corneal blindness caused by:

Corneal scars after trauma or infection
Keratoconus
Corneal dystrophies
Bullous keratopathy
Failed previous graft
Corneal perforation or severe ulceration
Chemical injury
Endothelial disorders such as Fuchs endothelial corneal dystrophy

They help convert voluntary eye donation into safe, usable transplant tissue. However, not every donated cornea is suitable for transplant. Unsuitable tissue may still contribute to research or training if consent and regulations permit.

10. Eye donation counselling points

Eye donation is possible after death.
It does not normally prevent an open-casket funeral or cause major facial disfigurement.
The entire eye is not transplanted to restore sight. Usually, the cornea is used.
Donation should be reported quickly to the nearest authorized eye bank.
Family consent and medical suitability are both important.
Donation provides tissue for sight-restoring corneal transplantation and may also support research.

Short exam definition

Eye bank: “An organization that obtains, screens, evaluates, preserves, processes, stores, and distributes donor ocular tissue, chiefly corneal tissue, for transplantation, research, and education.”

One-line summary

Eye banking is a controlled chain from donor consent to recipient follow-up, designed to provide safe, viable corneal tissue for sight-restoring keratoplasty.

A recent systematic review specifically examined corneal retrieval and donor consent, reinforcing that consent processes and recovery methods require strong governance and should be adapted to local legal and ethical requirements. See the 2025 systematic review.

Donor screening and selection in details

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eye banks AND donor screening

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EBAA Medical Standards 2024 donor screening eligibility corneal tissue exclusion criteria

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PMID: 40829814

Donor screening and selection in an eye bank

Donor screening and selection is the process used to decide whether donated ocular tissue is safe and suitable for transplantation. It has two separate goals:

Donor eligibility (safety): prevent transmission of infectious or other donor-derived disease to the recipient and protect recovery staff.
Tissue suitability (quality): ensure that the cornea or sclera is structurally and functionally appropriate for the intended surgery.

A donor can be medically eligible but the cornea may still be unsuitable because of poor endothelial quality, opacity, trauma, or contamination. Conversely, a clear-looking cornea cannot be released if the donor fails safety screening.

Kanski notes that eye-bank release evaluation includes donor medical-history review, donor blood screening, microscopic corneal examination, and endothelial cell-count assessment. Donor tissue is generally recovered promptly after death, commonly within 12-24 hours depending on local protocol and cooling conditions. Kanski's Clinical Ophthalmology: A Systematic Approach, 10th ed., Donor tissue section.

1. Sequence of donor screening and selection

Step 1: Verify consent and donor identity

Before recovery, the eye bank must confirm:

Valid eye-donation authorization or consent from the legally appropriate person
Donor's full identity
Date and time of death
Cause and place of death
Hospital, mortuary, or medical-examiner details
Unique donor-identification number

Every eye, cornea, blood sample, report, and final graft must remain linked to this unique identification number. This creates complete traceability from donor to recipient.

2. Donor medical and social history

A trained eye-bank professional obtains a donor risk assessment interview, usually from a close relative, caregiver, treating doctor, or other reliable informant. This is combined with hospital records and death-related reports.

Information sought

A. Medical history

Cause of death
Recent hospital admissions
Fever, septicemia, unexplained infection, or antibiotic treatment
History of tuberculosis, meningitis, encephalitis, or other serious infection
Hepatitis, HIV infection, syphilis, malaria, or other transmissible infections according to local policy
Neurological illness, dementia of uncertain cause, or possible prion disease
Cancer and hematological malignancy
Autoimmune or systemic inflammatory disease
Previous ocular surgery, ocular trauma, glaucoma, corneal disease, or intraocular infection
Recent blood transfusion or hemodilution, which may affect interpretation of donor blood tests

B. Social and behavioral history

The interview identifies risks for transfusion-transmissible infection, such as:

Injection drug use
High-risk sexual exposure
Recent tattoos, body piercing, or acupuncture performed in non-sterile circumstances
History of imprisonment or exposure to blood products, where relevant under local rules
Travel or residence in areas associated with specific infections
Exposure to rabies or animal bites
Exposure to persons with tuberculosis or other serious communicable infection
Previous xenotransplantation or exposure to animal-derived cellular products, where required by regulation

The exact questionnaire and deferral criteria differ by country. A history item should never be interpreted in isolation. The medical director applies the approved local regulations and the eye bank's standard operating procedures.

EBAA standards specify review of relevant medical records, a current donor-history interview, physical assessment, laboratory data, and other available information before a donor-eligibility decision is made. See the EBAA medical standards.

3. Review of medical records

Records are reviewed to corroborate the interview and identify risk that may not be known to the family.

Records commonly reviewed

Hospital case sheets and discharge summaries
ICU records and nursing notes
Emergency department records
Microbiology and culture reports
Imaging reports, especially for unexplained neurological disease
Laboratory values
Medication history
Autopsy report, if available
Death certificate
Treating physician's report
Medical examiner, coroner, or police reports in unnatural deaths

Why it matters

A donor may appear healthy to relatives but have medical-record evidence of:

Sepsis or unexplained fever
Positive blood cultures
Meningitis or encephalitis
Metastatic cancer
Intravenous drug use
Previous positive viral testing
Ocular inflammation or infection
Neurological disease compatible with a prion disorder

4. Physical assessment of the donor

A documented physical examination is performed before or at recovery.

General examination

Look for:

Jaundice
Generalized rash, skin lesions, vesicles, or mucosal ulcers
Needle-track marks
Signs of trauma, surgery, or transfusion
Enlarged lymph nodes
Features suggestive of infection
Suspicious skin lesions or malignancy
Evidence of injection drug use
Signs of systemic sepsis or unexplained illness

Ocular examination

Look for:

Corneal clarity and edema
Epithelial defects
Corneal infiltrates, ulcers, or scars
Conjunctivitis and purulent discharge
Keratitis, scleritis, uveitis, or endophthalmitis
Previous corneal surgery
Major trauma
Previous intraocular malignancy
Severe exposure damage or prolonged lid opening after death

Active ocular infection or inflammation makes tissue unsuitable for transplantation. EBAA specifically identifies active ocular or intraocular inflammation, including conjunctivitis, keratitis, scleritis, iritis, uveitis, vitreitis, choroiditis, and retinitis, as contraindications for transplant tissue. See the EBAA tuberculosis response.

5. Infectious disease testing

Blood samples are collected using validated procedures and tested in an approved laboratory.

Common tests

The panel depends on national law and local policy, but commonly includes:

Infection or marker	Usual purpose
HIV-1 and HIV-2 antibody/antigen or nucleic-acid test	Detect HIV infection
Hepatitis B surface antigen, anti-HBc, and/or HBV nucleic-acid test	Detect hepatitis B infection
Anti-HCV and/or HCV nucleic-acid test	Detect hepatitis C infection
Syphilis screening test	Detect Treponema pallidum exposure/infection
HTLV-I/II testing	Required in some jurisdictions
West Nile virus nucleic-acid testing	Required or targeted in some regions
Trypanosoma cruzi testing	Targeted testing in relevant geographical-risk settings
Other tests	Based on epidemiology, regulations, and medical director assessment

Important points

Samples should be collected before transfusion whenever possible.
Hemodilution after substantial IV-fluid or blood-product administration can produce false-negative serology. The eye bank must assess whether a valid pre-transfusion sample is available.
A reactive screening result generally means that tissue is not released for clinical transplantation unless local regulations provide a specific exception and confirmatory interpretation.
Testing is only one part of screening. A negative blood test does not override a concerning history, physical finding, or medical record.

6. Donor eligibility: safety-based exclusion

A medical director or authorized designee makes the final decision: eligible, ineligible, or sometimes pending further information.

Common reasons to exclude a donor from corneal transplantation

A. Confirmed or suspected transmissible infection

Examples include:

HIV infection or reactive HIV screening
Hepatitis B or hepatitis C infection according to applicable criteria
Active systemic sepsis or uncontrolled bacterial infection
Active tuberculosis or relevant TB risk as defined by the local protocol
Rabies or suspected rabies exposure
Viral encephalitis or meningitis of uncertain cause
Creutzfeldt-Jakob disease or other suspected prion disease
Untreated or active syphilis, depending on testing and policy
Unexplained infectious death
Significant risk of donor-derived infection based on history or records

B. High-risk neurological disease

Donors with unexplained rapidly progressive dementia, suspected prion disease, or certain degenerative neurological conditions may be excluded because of the theoretical or established risk of transmitting prion disease.

C. Certain malignancies

A history of malignancy requires case-by-case review. Ocular malignancies and some hematological or disseminated cancers may preclude transplantation. The medical director follows the current tissue-donation regulations, because acceptability varies with tumor type, stage, treatment, and evidence of transmission risk.

D. Inadequate history or unresolved uncertainty

If the eye bank cannot obtain an adequate donor history, cause of death, record review, or required blood sample, the tissue should not be released for transplant unless a permitted exceptional pathway exists under local regulation.

7. Tissue suitability: corneal quality assessment

After a donor is considered safe, the eye bank assesses whether each cornea suits its intended use.

A. Gross examination

The cornea is inspected for:

Transparency
Corneal edema
Epithelial defect
Stromal scar
Arcus
Infiltrate or ulcer
Foreign body
Surgical incision
Previous refractive surgery
Descemet membrane abnormalities
Trauma or endothelial damage

B. Slit-lamp biomicroscopy

This gives a more detailed assessment of:

Epithelial integrity
Stromal clarity and thickness
Folds in Descemet membrane
Guttata
Endothelial pigment or trauma
Focal lesions and infiltrates
Corneal scars or dystrophy
Evidence of prior surgery

C. Endothelial evaluation

The corneal endothelium is essential for maintaining corneal deturgescence and transparency. Because adult endothelial cells have limited capacity to regenerate, endothelial assessment is central to donor selection.

Specular microscopy may assess:

Endothelial cell density
Cell size variation, called polymegethism
Cell-shape variation, called pleomorphism
Areas of cell loss
Cell borders and overall morphology

A low cell density or poor morphology may make tissue unsuitable, particularly for endothelial keratoplasty. The threshold varies with the preservation method, donor age, intended procedure, surgeon preference, and local eye-bank standards. There is no single universal number that applies to every graft.

D. Preservation-medium and microbiological assessment

The eye bank may test preservation medium and/or corneoscleral rim cultures according to its protocol.

A positive culture does not always prove that the tissue caused infection, but it requires medical review. Tissue may be withheld, recalled, or its use managed according to the organism, timing, tissue status, and local policy.

8. Selecting tissue for the intended operation

The same donor cornea is not appropriate for every procedure.

Procedure	Key tissue-selection considerations
Penetrating keratoplasty	Good overall clarity, adequate endothelium, suitable graft diameter, no major stromal scar or infection
DMEK	Excellent endothelial quality, suitable Descemet membrane, adequate endothelial cell density, careful preparation and handling
DSAEK/DSEK	Adequate endothelial cell density, appropriate posterior lamellar thickness and diameter
DALK	Healthy anterior stroma is important; endothelial requirements are less central because host endothelium is retained
Tectonic keratoplasty	Structural integrity and appropriate graft size may take priority in an emergency
Scleral patch graft	Scleral integrity, sterility, and appropriate preservation are key

Effect of donor age

Donor age is one factor, not an automatic acceptance or rejection criterion.
Older donor tissue can be highly suitable if endothelial quality is adequate.
Very young donor corneas may be difficult to handle surgically and can have refractive and rejection-related issues. Kanski notes that corneas from children aged 3 years or younger are used only occasionally, even in pediatric grafting. Kanski's Clinical Ophthalmology: A Systematic Approach, 10th ed., Donor tissue section.

9. Final release decision

Before distribution, the eye bank confirms:

Consent is documented.
Donor identity and tissue labels match.
Screening interview and medical-record review are complete.
Physical assessment is documented.
Required blood testing is completed and acceptable.
Tissue evaluation is satisfactory.
Preservation conditions and expiry date are within specification.
Tissue is suitable for the requested procedure.
The medical director or qualified designee has authorized release.

Only then is the graft packaged, labeled, and issued to the transplant surgeon.

10. What happens to rejected tissue?

Tissue rejected for transplantation must never be released for clinical grafting. Depending on consent, regulations, and the reason for rejection, it may be:

Used for approved research
Used for surgical training or education
Discarded as biomedical waste

Tissue rejected due to a serious infectious risk must be handled and discarded safely.

Short exam answer

Donor screening and selection in an eye bank consists of verifying consent and identity; obtaining medical, social, and behavioral history; reviewing medical records; performing physical and ocular assessment; testing donor blood for transmissible infections; evaluating corneal clarity and endothelial quality; and making a final eligibility and suitability decision before release of tissue for transplantation.

A recent systematic review found that in-situ corneal excision can have family-consent advantages while giving tissue quality and contamination rates comparable with whole-globe enucleation. See the 2025 systematic review.

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