Eye Donation - Important Points

What Is Eye Donation?

Who Can Donate?

• Anyone can pledge to donate eyes, regardless of:
  • Age (newborns to elderly)
  • Blood group (corneal transplant does NOT require blood group matching)
  • Eye color
  • Eyesight quality (glasses, contact lens users, cataract, squint, etc.)
  • Systemic conditions like diabetes, hypertension, or asthma
  • Prior laser vision correction (LASIK, etc.) - assessed at time of donation
• People who wear spectacles, have had cataract surgery, or suffered from refractive errors are not disqualified.

Who CANNOT Donate?

• HIV/AIDS, Hepatitis B or C (risk of disease transmission)
• Active systemic infections or septicemia
• Haematological malignancies (leukemia, lymphoma)
• Transmissible neuropathological diseases - e.g., rabies, Creutzfeldt-Jakob disease (prion diseases)
• Syphilis (positive treponema test)
• Active corneal disease or severe eye infections

The Donation Process

1. Inform immediately - Contact the nearest eye bank within 4-6 hours of death (in India). Eye banks in some countries accept donation within 12-24 hours of death.
2. Keep the eyes closed and cover with moist cotton pads; switch on a fan/AC to slow tissue degradation.
3. Eye bank team arrives and retrieves the corneas - the process takes about 20-30 minutes and does not disfigure the face.
4. The appearance of the body is not affected - the procedure doesn't interfere with funeral arrangements.
5. Donated corneas must be used within 14 days (stored in cold storage medium at 4°C, e.g., Optisol-GS).
6. Corneas unsuitable for transplant may still be used for research and training (with consent).

Conditions Treatable by Corneal Transplant

• Fuchs' dystrophy (cornea becomes opaque)
• Keratoconus (cornea thins and bulges)
• Bullous keratopathy (permanent corneal swelling)
• Corneal scarring from trauma, burns, or infection
• Herpes simplex virus eye disease (leading infectious cause of corneal blindness in developed countries)
• Trachoma (leading cause of infectious corneal blindness globally)
• Hereditary or congenital corneal clouding

Eye Banking in India

• Eye Donation Fortnight is observed from 25th August to 8th September every year to promote eye donation and eye banking.
• During 2018-19, nearly 68,409 donated eyes were collected for corneal implantation in India.
• Hospital retrieval programme is the major strategy: motivating relatives of terminally ill patients and accident victims.
• Leading states in eye donation: Gujarat, Tamil Nadu, Maharashtra, and Andhra Pradesh.
• Organizations like Lions International and Rotary International actively promote eye donation.
• Eye donation counsellors are appointed under the National Programme for Control of Blindness and Visual Impairment (NPCB&VI).

Global Statistics

• Over 85,000 corneal transplants are performed each year in the United States alone (Eye Bank Association of America, 2018).
• There are 86 accredited eye banks in the US.
• Corneal transplantation is one of the most commonly performed and successful tissue transplants worldwide.

Key Facts to Remember

How to Register

• Pledge forms are available at eye banks, hospitals, and online.
• Telling your next of kin is the most important step - family consent is required at the time of death regardless of prior registration.

Liver Donation - Important Points

Why Liver Donation Is Needed

• The number of people waiting for a liver far exceeds the number of available deceased-donor livers, with wait times often exceeding one year
• End-stage liver disease is fatal without transplantation
• There are no artificial livers or long-term mechanical substitutes (unlike dialysis for the kidney)
• Globally, liver disease kills millions - cirrhosis, liver cancer, and acute liver failure are leading causes of death

Indications - Why Would Someone Need a Liver Transplant?

Noncholestatic Cirrhosis (most common group)

• Alcoholic liver disease (~39% of all listings - the most common indication)
• Metabolic-associated fatty liver disease (MAFLD/MASH)
• Chronic Hepatitis C and Hepatitis B
• Autoimmune cirrhosis
• Cryptogenic cirrhosis
• Drug or toxin-induced liver failure

Cholestatic Liver Disease

• Primary biliary cirrhosis (PBC)
• Primary sclerosing cholangitis (PSC)
• Caroli disease, choledochal cyst

Acute Liver Failure (ALF)

• Acetaminophen (paracetamol) overdose
• Viral hepatitis (HAV, HBV)
• Wilson disease
• Drug-induced liver failure
• ALF with encephalopathy progressing to Stage II or meeting King's College Criteria is an indication to proceed urgently

Malignant Neoplasms

• Hepatocellular carcinoma (HCC) within Milan Criteria: up to 3 lesions (each 1-3 cm) or one lesion 2-5 cm
• Perihilar cholangiocarcinoma (selected cases with neoadjuvant therapy)

Other Rare Conditions Addressable by Liver Transplant

• Wilson disease, Alpha-1 antitrypsin deficiency, hemochromatosis

Priority Scoring - The MELD System

MELD = 9.57 × log(creatinine) + 3.78 × log(bilirubin) + 11.2 × log(INR) + 6.43

• A MELD ≥ 18 confers a survival benefit from transplant
• MELD 15-18: transplant may still be justified if the patient has significant morbidity
• Status 1A (highest priority): acute liver failure with encephalopathy onset within 8 weeks, no prior liver disease, and ventilator/dialysis dependence or INR >2.0
• The Na-MELD score (incorporating sodium) is now used for adult wait-list prioritization

Types of Liver Donation

1. Deceased Donor (Cadaveric) Liver Transplant

• Donor is brain-dead (or cardiac death in some cases)
• The whole liver is removed and transplanted
• Prioritized by MELD score through UNOS (United Network for Organ Sharing) in the US
• A split-liver transplant is possible: one liver split to serve two recipients (usually one adult + one child)

2. Living Donor Liver Transplant (LDLT)

• A healthy living person donates a portion of their liver (usually the right lobe, approximately 60% of the liver)
• For pediatric recipients, the left lateral segment is used
• Both the donor's remaining liver and the recipient's transplanted segment regenerate to near-normal size within 6-8 weeks
• In many Asian countries (India, Japan, South Korea), living donor transplants outnumber deceased donor transplants due to lower rates of deceased donation
• Recipients of living-donor livers generally have ~5% better long-term survival vs. deceased-donor recipients
• Living donor recipient recovery: shorter hospital stay, less need for blood transfusions or dialysis

Who Can Be a Living Liver Donor?

• Be an adult (18 years of age or older); some centers require age ≤55
• Be in good physical and mental health
• Have no history of liver disease (cirrhosis, hepatitis, steatosis >60%)
• Have no significant diseases of other organs (heart, lung, kidney)
• Have no uncontrolled hypertension, active cancer, or HIV
• Have no active drug or substance abuse
• Have compatible blood group with recipient (ABO compatibility required - unlike corneas)
• Be able to understand and consent to risks and benefits
• Does NOT need to be a family member - friends, coworkers, and even strangers can donate

Who CANNOT Be a Liver Donor (Contraindications)?

For Deceased Donors:

• Liver with >60% steatosis (fatty infiltration) or significant fibrosis
• Bridging portal fibrosis or cirrhosis of the donor liver
• Active malignancy affecting the liver (most cancers disqualify the liver)
• Severe atherosclerosis of the hepatic artery
• Certain infectious diseases (HIV, active hepatitis, systemic sepsis)

For Recipients (Contraindications to Receiving a Transplant):

• Insufficient cardiopulmonary reserve (severe COPD, pulmonary hypertension with mean PA pressure >35 mmHg refractory to treatment, poor ejection fraction)
• Uncontrolled malignancy or infection (fungal/multidrug-resistant infections)
• Refractory noncompliance with medical care
• For alcohol-related disease: most centers require 6 months abstinence before listing (though this is center-dependent)
• Active HIV/AIDS-related illness (relative contraindication; some centers accept stable HIV)

Outcomes

• 1-year survival after liver transplant: >90%
• 3-year survival: ~88%
• 5-year survival: 60-65%
• Hospital mortality: less than 10% even in sick patients
• Living-donor recipients have better short-term outcomes because they are generally less sick at time of transplant

Special Considerations