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Discuss cornea donation with palliative care patients during DonateLife Week

Dr Colby Hart says there is a constant demand for corneas and palliative care patients are able to donate them.

It is DonateLife Week – the perfect time to raise the topic of organ donation, remembering that palliative care patients can donate corneas and restore a young person’s sight.

Having cancer, cataracts or even poor eyesight doesn’t preclude palliative care patients from donating corneas, according to surgical resident Dr Colby Hart from Alfred Health in Melbourne.

Provided patients are younger than 80 and haven’t had surgery on their cornea, Dr Hart says they should be able to leave a physical legacy that will give eyesight to someone who is legally blind.

He says people most likely to need a corneal transplant are typically aged in their 20s or 30s, who are legally blind, having experienced gradual visual loss since their teenage years due to a condition called keratoconus. He says the condition causes a thinning and distorting of the cornea, which means it can no longer bend light entering the in order to focus it on the back of the eye.

A cornea transplant may also be required after experiencing trauma to the eye, an infection that leads to severe scarring, or a condition called bullous keratopathy which leads to ulceration and scarring of the cornea.

As a student and junior doctor, Dr Hart worked on a project with ophthalmology and palliative care staff at Geelong Hospital and the Lion’s Eye Bank to increase local rates of corneal donation.

He says that while organ transplants generally have a high risk of rejection, corneal donation successfully treats corneal blindness in more than 90% of cases. Corneal transplants are the most frequently performed human transplant procedure, according to the Eye Bank Association of Australia & New Zealand.

While there is a constant demand for corneas, Dr Hart says local research suggests that a very low proportion of palliative care patients become donors.

He suspects that this is largely because family and medical staff are not aware that palliative care patients are eligible to become donors.

“Because of where the cornea is and the limited blood supply to the cornea, having metastatic cancer doesn’t stop you from being a donor. Within the medical profession and across the general public, that’s often confused, so one of the main barriers we face is that a lot of health care staff aren’t bringing this opportunity up with their patients.”

Cornea donation also is hampered by the same challenge faced by other forms of organ donation. It is often unfortunate circumstances, like young people dying in car accidents, which provide access to suitable organs, and the organs need to be accessed quickly.

“Eyes have a very personal significance to a lot of people, so what corneal donation does to the appearance of the body is also a commonly asked question,” says Dr Hart.

“People who donate their corneas are given prosthetic eyes, to ensure their appearance is appropriate for viewings at burials or funerals.”

Dr Hart says that while surgeons with specific training are required to remove organs, specially trained technicians able to remove corneas up to 24 hours after death.

“The first step for patients is having a conversation with family and making your wishes clear to them.”

He says patients can then speak to their GP or palliative care physician, and add their details to the Australian Organ Donor Register.

To learn more about DonateLife week, and to add your name to the Australian Organ Donor Register, click here.

An extensive poster program at the Australian Palliative Care Conference 2017 will include ‘Corneal donation in the palliative care unit setting’, compiled by Colby Hart at Barwon Health in Geelong. For more information about the conference and to register or download a program click here.


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