I spent Tuesday with Wayne, the corneal eye retrieval nurse. Wayne's job is to assess the eligability of all deceased patients to donate their eyes for corneal transplant. Obviously this role is immersed in ethical, professional and legal issues and therefore many patients are unable to donate. For example, if "confusion ? cause" is written in the patient's notes, they cannot donate just incase their confusion is due to a degenerative neurological disease (e.g. dementia or Creutzfeldt-Jakob disease). Other contraindications include;
- long-term corticosteriodal use
- Stabbings/traumatic RTA
- HIV, Hep B/C
- Auto-immune diseases
- Diseases of unknown aetiology
So to you doctors out there, please write CLEARLY in patient's notes so that these can be found easily!
If the deceased patient is deemed suitable, the family are contacted and asked about donation. If there's any uncertainty among the family, the donation cannot be carried out. If the family consent, Wayne has 24 hours from time of death to get those eyes out!
This is the fun part: getting into our mortuary greens, plastic shoes and what can only be described as a plastic version of a butcher's apron! The patient was in the mortuary ready: a 99 year old gentleman who had actually been extremely healthy - his eyes were in fantastic condition. And so the removal process began. I was fortunate enough to remove the patient's left eye :)
The process is actually very straightforward, and easy when you know how. We began by securing the patient's eye open with what can only be described as mini tongs! These keep the eyelids out of the way. Then, the muscles need to be cut. Six extrinsic muscles are attached to the eyeball and walls of the orbital cavity; four rectus and two oblique. A small hook is placed down each side of the eyeball to pull the muscle out a little, enabling it to be cut.
Once all six muscles are cut, the only thing holding the eyeball in place is the optic nerve (II cranial nerve). A curved pair of scissors is used to feel for and cut the nerve located at the back of the eye. This is quite tricky - cutting the optic nerve is like trying to cut through electrical cable! Then the eye can be removed.
Saline-soaked gauze is placed into the orbital cavity and covered with a small piece of plastic covered with nicks in order to hold the eyelid shut. The eyes were then packaged up and sent off to Manchester. Someone can now be cured from cataracts because of this donation. Amazing!
I then observed the removal of a heart for organ donation... How morbid do I sound?!