Our Summary

This paper looks at some of the tough ethical decisions that might come up during the process of corneal transplantation, a surgical procedure where a damaged or disease cornea is replaced by donated corneal tissue. The researchers reviewed existing literature and used experiences from eye specialists in three different countries for this study.

They found that there are some ethical issues related to getting consent for organ and tissue donation, deciding who gets the corneal tissues, transplant tourism (where people travel to another country for the procedure), and the export and import of corneal tissue. There’s also the issue of for-profit eye banks where corneas are stored until they’re needed.

There’s a big problem worldwide: the demand for corneal transplants is much higher than the number of corneas that are donated and suitable for the surgery. This shortage has led to some practices that might go against the four main principles of bioethics, which are autonomy (self-rule), beneficence (doing good), nonmaleficence (not doing harm), and justice (fairness).

Because of this, it’s been necessary to come up with ethical rules like the Barcelona Principles and the World Health Organization Principles of Transplantation. These guidelines try to regulate these practices.

FAQs

  1. What are some bioethical dilemmas that can arise during the process of corneal transplantation?
  2. What are the four basic principles of bioethics that can be at risk due to the shortage of corneal tissue for transplantation?
  3. What are the Barcelona Principles and the World Health Organization Principles of Transplantation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to make sure to discuss any concerns or questions they may have about the procedure with their healthcare provider. It’s important for patients to fully understand the risks and benefits of the surgery, as well as the potential outcomes and recovery process. Additionally, patients should be informed about the importance of following post-operative care instructions to ensure the best possible outcome.

Suitable For

Patients who may be recommended for corneal transplant include those with conditions such as keratoconus, corneal scarring or opacity, corneal dystrophies, corneal degenerations, and corneal edema. These conditions can cause significant visual impairment and may not be effectively treated with other methods such as glasses, contact lenses, or medications. Patients who have experienced trauma to the eye resulting in corneal damage may also be candidates for corneal transplant. Additionally, patients who have had previous unsuccessful corneal surgeries or who have complications from previous surgeries may be recommended for corneal transplant as a last resort option.

Timeline

Before corneal transplant:

  1. Patient is diagnosed with a corneal condition that cannot be treated with other methods.
  2. Patient undergoes a thorough evaluation by an ophthalmologist to determine if they are a suitable candidate for a corneal transplant.
  3. Patient is educated about the risks and benefits of the procedure, and gives informed consent for the surgery.
  4. Patient is placed on a waiting list for a suitable donor cornea.

After corneal transplant:

  1. Patient undergoes the corneal transplant surgery, where the damaged cornea is replaced with a healthy donor cornea.
  2. Patient goes through a recovery period, which includes taking medication to prevent rejection of the donor cornea and attending follow-up appointments with their ophthalmologist.
  3. Patient may experience improved vision and relief from symptoms associated with their corneal condition.
  4. Patient may need to make lifestyle changes to protect their new cornea, such as avoiding activities that could damage the eye.
  5. Patient may need further surgeries or treatments to address any complications that arise after the transplant.

What to Ask Your Doctor

  1. What is the success rate of corneal transplant surgery?
  2. What are the potential risks and complications associated with corneal transplant surgery?
  3. How long is the recovery process after corneal transplant surgery?
  4. What is the expected outcome of the surgery in terms of vision improvement?
  5. How long will the transplanted cornea last before another transplant may be needed?
  6. What are the potential factors that could cause rejection of the transplanted cornea?
  7. How will my vision be monitored and managed post-transplant?
  8. Are there any lifestyle changes or precautions I should take after the surgery?
  9. What are the alternatives to corneal transplant surgery, if any?
  10. How can I ensure that the corneal tissue being used for the transplant is ethically sourced and obtained?

Reference

Authors: Córdoba A, Mejía LF, Mannis MJ, Navas A, Madrigal-Bustamante JA, Graue-Hernandez EO. Journal: Cornea. 2020 Apr;39(4):529-533. doi: 10.1097/ICO.0000000000002246. PMID: 31939922