In the United States alone during 2019, nearly 69,000 people donated a total of 85,681 corneas for transplants that completely transformed the lives of people from being blind to having sight. More than 95 percent of those corneal transplants were successful, and the estimated lifetime economic benefit for those receiving the transplants was more than $6 billion.
Since the earliest recorded cases of corneal transplants in 1961, the Eye Bank Association of America (EBAA) has counted 2 million people worldwide who have had their vision restored. But as impressive as these statistics sound, the need is far greater, with estimates that over 12 million people worldwide are still in need of the procedures.
One man who knows all about the ever-present need for eye donors is Geoff Brown, the executive director of the Arkansas Lions Eye Bank and Laboratory, located in the headquarters of the Eye Institute at UAMS in Little Rock. While he’s proud of the fact that the Eye Bank has helped handle nearly 200 corneal transplants this year, in keeping with the average he’s seen throughout his 20 years in the post, he frequently travels throughout the state giving speeches exhorting the need for more eye donors.
“We could always use more donors, if possible,” he said. “It would be nice if the norm was that everyone wanted to donate. You’re paying it forward, taking care of your fellow man. That’s what I’d like to see it get to.”
Brown grew up in Little Rock, a Catholic High graduate and son of prominent podiatrist H.F. “Bunny” Brown III. He originally thought he would follow his father in the practice, but after a year at the New York College of Podiatric Medicine, he reassessed his life plans and was about to embark on a career in pharmaceutical sales.
But things changed again in 2001 when his mother, a registered nurse at what is now CHI St. Vincent Infirmary, met Lindell Howdeshell, then-director of the Eye Bank, as he was delivering corneas. Howdeshell said that he was having trouble filling an open position, but when Brown went in for the interview, he discovered the director was seeking a successor.
“He told me right then that he’d be willing to groom me to take over, so I went for it,” Brown said. “Of course, within three months, I had three pharmaceutical sales job offers, but I never looked back.”
In his position, Brown oversees the collection and delivery of ocular tissue for transplants with a specific interest in the cornea, the clear tissue that covers the colored part of eyes and provides much of the eye’s refractive power. The sclera, or white part of eyes, is also harvested for procedures such as patch grafts.
Founded in 1986, the Eye Bank is a distinct enterprise located within the headquarters of the UAMS Health Harvey and Bernice Jones Eye Institute, which was created in 1994 and houses the UAMS residency program for ophthalmologists. The Institute treats thousands of patients from across the state annually, giving yearly exams to diabetics, prescribing glasses, retinal procedures and ocular plastic surgery, in addition to its work teaming with the Eye Bank on corneal transplants.
The Eye Bank finds its donors by working with the Arkansas Regional Organ Recovery Agency (ARORA), sharing a common call center through which doctors and nurses call in deaths throughout each day. In order to get Centers for Medicare and Medicaid Services (CMS) funds, a hospital has to have an agreement with an organ procurement organization (OPO), a tissue bank and an eye bank, with ARORA covering organs and tissues and the Eye Bank providing the eyes.
The Eye Bank can work with the eyes of people ages 5 to 75, testing the tissues of potential donors for sicknesses, such as sepsis and dangerous chronic conditions, like HIV and hepatitis, and screening out the infected. In Arkansas, anyone listed as an organ donor is considered for their organs, tissues and eyes, though people can pick and choose what they might be willing to donate.
When a good donor is discovered, ARORA and the Eye Bank move quickly and carefully to seek consent from the donor’s family to begin recovery, since there is only a 24-hour window from the time of death to successfully complete the process. While Brown isn’t a trained physician, he has been trained in the skills needed to lead the recovery procedures on eyes, personally scrubbing in and using surgical instruments to complete the vital task himself in some cases.
“Once we do a recovery, that’s where the hard work starts,” he noted. “They give us 14 days to find a transplant recipient, and generally we know where it’s going within seven days. Our first priority is helping people within the state of Arkansas, but if there are any extra transplants available, we will transport to other states and have even gone as far as Africa to help people.”
The Eye Bank is accredited and monitored by both the FDA and the Eye Bank Association of America, and follows the FDA’s Good Tissue Practice (GTP) guidelines. That means that corneas are carefully preserved while a specular cell count is taken to ensure that there are 2,000 cells or higher per square millimeter, and the tissue is graded while blood is drawn to test for HIV, Hepatitis B and C and syphilis.
Because corneal tissue is avascular, meaning there’s no blood flowing through it, there is no reason for concern about matching blood types between donors and recipients. This also is a key reason why rejections are rare and transplants are 95 percent successful. While the Eye Bank has performed as many as 300 transplants in a year under Brown’s watch, his dream is to provide 1000, transplants annually.
“With corneal blindness, we’re truly giving sight back to someone who would lose their eyesight without someone else’s donation. The financial impact of being blind versus sighted is huge,” he said. “It’s awful when it’s a tragic death, and all death can be tragic because somebody loved them or they loved somebody. But on the flip side, I’ve seen enough recipients over the years where recipients are tearing up, give me a big hug and thank me because they couldn’t see anymore and were about to have to quit their job. We need to help everyone we can.”