Ophthalmic organ sharing principles
Donor Organ
Sharing Scheme
Operating Principles for
Ophthalmic Transplant Units
in the UK and Republic of Ireland
Published: July 1999
UK Transplant
Organ Sharing Scheme Operating Principles
for Ophthalmic Transplant Units in the UK and Republic of Ireland
| Change No. | Advisory Group Ref: | Date of Change | Details of Change |
|---|---|---|---|
| 1 | updated Annex B January 2004 | ||
| 2 | January 2006 | add section A3.3 and Annex C |
UK Transplant
Donor Organ Sharing Scheme
for Ophthalmic Transplant Units
in the UK and Republic of Ireland
A-1 Registration of New Recipients
A-2 Group 1 & Group 2 Recipients
A-3 Paediatric Cases
A-4 Donor Information
A-5 Contraindications
A-6 Offering Time
B. Cornea Donors and Allocation
B-1 Donor Definition
B-2 Allocation - Un-matched Corneas
B-3 Allocation - Tissue Matched Corneas
B-4 Surplus Corneas
C. Donor Sclera Allocation and Use
C-1 Supplies of Sclera
C-2 Requests for Sclera
Annex A: Direction of the Secretary of State for Health: 1st October 2005 - The NHS Blood and Transplant (Gwaed a Thrawsblaniadau’r GIG) (England) Directions 2005 (133Kb) - Guidance
Annex B: Contraindications to ocular tissue transplantation, January 2004 (91Kb)
UK Transplant
Donor Organ Sharing Scheme Operating Principles
Ophthalmic Transplant Units in the UK
The Donor Organ Sharing Scheme principles set out below are those specified by Ocular Tissue Advisory Group for the UK and Republic of Ireland. The Scheme is administered on the transplant community's behalf through UK Transplant (UKT).
A.1 REGISTRATION OF NEW RECIPIENTS
1.1 All patients awaiting a tissue matched transplant must be registered on the National Transplant Database at UKT.
1.2 A standard registration form must be completed and sent to UKT. Patients will be placed on the National Transplant Database waiting list on the day on which details are received at UKT. Discrepancies or missing information will be followed up with the local unit and might cause a delay.
Contents...
A.2 GROUP 1 & GROUP 2 RECIPIENTS
2.1 Recipients are categorised as Group 1 or Group 2 (as defined by Direction of the Secretary of State for Health: 12 February 1996 - Directions on the Allocation of Human Organs for Transplantation - Guidance, copy at Annex A). Nationals of a non-UK country may only be registered on a transplant waiting list after they have been accepted by a consultant as suitable for treatment. It is the responsibility of the consultant registering such a patient on the waiting list to confirm that they have been accepted under E112 or similar arrangements.
2.2 Group 1 patients have priority for available tissue above Group 2 patients. Group 2 patients registered in the UK and Republic of Ireland will be offered corneas before offers are made to European Organ Exchange Organisations or Group 2 countries abroad. No cornea should be offered to a Group 2 patient in the UK or Republic of Ireland if there is a clinically suitable Group 1 patient in the UK or Republic of Ireland.
Contents...
3.1 Paediatric recipients, defined as patients aged under 8 years at the time of offer, will receive priority within the offering sequence for any corneas available from a paediatric or adult donor. For the purposes of these Operating Principles, a paediatric donor is defined as a patient aged 10 years or under at the time of death.
3.2 Paediatric corneas will be offered first to paediatric recipients, then to adult recipients before being offered to European Organ Exchange Organisations. No paediatric cornea should be offered to a Group 2 patient if there is a clinically suitable Group 1 patient.
3.3 Corneas for paediatric patients (aged 10 years or under) can be requested via the UK Transplant Duty Office using a separate procedure (see Annex C). This method is optional rather than mandatory but does guarantee graft material from a donor aged less than 15 years of age.
Contents...
4.1 All cornea donors in the UK must be reported by telephone to the UKT Duty Office at the earliest possible opportunity.
4.2 The Ocular Tissue Donor Information Form contains the information required for all cornea donors. It must be completed as fully as possible.
4.3 Ideally, a 5-10 ml blood sample must accompany all eyes donated to the CTS Eye Banks for virological and microbiological testing; the minimum acceptable is 2ml. If virology is being tested locally, the results must be passed to the UKT Duty Office when known.
4.4 No eyes should be retrieved or used for research unless there is expressed permission from the next of kin.
Contents...
5.1 Potential donors found to be positive for Hepatitis B surface antigen, for Hepatitis C antibody, HIV antibody and syphilis are an absolute contraindication to organ donation.
5.2 Potential donors who are untested for Hepatitis B surface antigen, Hepatitis C antibody, HIV antibody and syphilis will only be accepted into the CTS Eye Banks if a blood sample accompanies the donated eyes.
5.3 Where a donor is found to fall into any of the risk categories defined by the Chief Medical Officer as contraindications to donation for organ transplantation, UKT must inform the donating and recipient transplant unit that guidance provided states that organ donation and/or transplant should not proceed. A summary of medical contraindications is enclosed in the eye boxes supplied (copy at Annex B).
5.4 Definitive guidance is contained in the document prepared by the Committee on Microbiological Safety of Blood and Tissue for Transplantation (MSBT) - 'Guidance on the Microbiological Safety of Human Tissues and Organs Used in Transplantation, March 1996'.
5.5 Death from unknown cause is not a contraindication if a post mortem examination is pending and the result will be known before the tissue is transplanted.
Contents...
6.1 Offers of tissue typed corneas will be made in accordance with the cornea recipient matching run on the basis of two firm offers followed by two provisional offers as detailed below:
6.1.1 A full offer will be made to the first suitable patient identified in the matching programme; a centre has 48 hours to respond to this offer.
6.1.2 Following a full offer, the same cornea will be offered to the next patient identified; this will be a provisional offer. The centre will be notified within 48 hours if the cornea has been accepted by the first centre.
6.1.3 If the provisional offer is made over 24 hours before it becomes a full offer the second (or subsequent) centre has 24 hours to decide. If the provisional offer becomes a full offer in less than 24 hours, a full 48 hours is available for a decision.
6.2 For offers of whole eyes, centres must advise UKT within 60 minutes whether they wish to accept or decline the offer. If there is no response within 60 minutes, the offer will be withdrawn automatically.
Contents...
B. CORNEA DONORS AND ALLOCATION
1.1 An adult donor is defined as being aged over 10 years at the time of death.
1.2 A paediatric donor is defined as being aged 10 years or under at the time of death.
1.3 An infant donor is defined as being aged under 3 years at the time of death.
Contents...
2.1 All cornea donors in the UK should be reported to UKT whether they are used locally or offered to the Ophthalmic Transplant Service Eye Banks (currently in Bristol and Manchester and referred to in this document as the CTS Eye Banks to distinguish them from other local tissue banks). The CTS Eye Banks operate to agreed standards for selection, testing and storage of tissue. UKT provides the link between the CTS Eye Banks and Units in the UK and Republic of Ireland which require tissue for grafting.
2.2 If corneas are used locally details of recipients should be passed to UKT.
2.3 If not used locally, corneas may be offered to the CTS Eye Banks through the UKT Duty Office, who will arrange collection and transfer to the nearer of the two CTS Eye Banks.
2.4 Whether tissue is retrieved locally or is obtained through the CTS Eye Banks, priority for its use will be for Group 1 patients in the UK and Republic of Ireland before Group 2 patients.
Contents...
B.3 ALLOCATION - UN-MATCHED CORNEAS
3.1 Requests for routine un-matched grafts must be received by the Duty Office at least 4 days in advance of tissue being required. However, in the case of an emergency where advanced warning cannot be given, every effort will be made to accommodate the request as soon as possible after notification.
3.2 If a graft has to be cancelled, centres must advise UKT immediately to ensure that the cornea can be made available for other patients.
Contents...
B.4 ALLOCATION - TISSUE MATCHED CORNEAS
4.1 Corneas from tissue typed donors will be offered using the cornea matching programme.
4.2 Corneas will not be offered for patients with more than two mis-matches at HLA-A and HLA-B combined, regardless of HLA-DR mis-matches. Where there is more than one equally mis-matched patient, the cornea will be offered to the patient who has been on the waiting list the longer.
4.3 All tissue typed corneas will be offered in the following priority order:
4.3.1 Group 1 patients ranked in order of mis-match with those patients with the least degree of mis-matching appearing above those with a higher degree of mis-matching.
4.3.2 Group 2 patients ranked in order of mis-match with those patients with the least degree of mis-matching appearing above those with a higher degree of mis-matching.
4.4 This priority order is over-ridden in cases of genuine emergency (e.g. perforation).
Contents...
B.5 SURPLUS CORNEAS
5.1 From time to time, the CTS Eye Banks declare a surplus of stored corneas. To ensure that they are not wasted, such corneas are offered through the UKT Duty Office using the following priority order:
5.1.1 For Group 1 patients at: local units which have elected to be offered surplus tissue;
5.1.2 Group 2 patients at: ophthalmic units in the UK and Republic of Ireland.
Thereafter, UK Transplant will offer any corneas which remain surplus to Organ Exchange Organisations in Europe and elsewhere as follows:
1 Organ Exchange Organisations in EC and Other Group 1 countries;
2 Organ Exchange Organisations in Group 2 countries.
C. DONOR SCLERA ALLOCATION AND USE
1.1 A limited supply of donor sclera will be kept by the CTS Eye Banks for non-graft surgical procedures and will be issued in line with the procedures for corneas.
1.2 No sclera will be issued to Ophthalmic Units for stock.
Contents...
2.1 Routine requests for sclera must be received by the UKT Duty Office at least 4 days in advance of being required.
2.2 Sclera will only be issued on request for named patients. A record of the transplant will be required for the National Transplant Database.
2.3 A single sclera must not be used on more than one patient. Where more than one sclera is required for one patient, Ophthalmic Units will be asked to confirm the condition/procedure; for such patients, both sclera will be issued from the same donor.
2.4 Where sclera is required in an emergency, the CTS Eye Banks will keep a certain number re-hydrated for immediate use.
Contents...
| Index | Paragraph Number |
| Allocation - Unmatched Corneas | B.3 |
| Allocation - Tissue Matched Corneas | B.4 |
| Contraindications | A.5 |
| Cornea Donation | B.2 |
| Donor Definitions | B.1 |
| Donor Information | A.4 |
| Donor Sclera Allocation and Use | |
| - Supplies of Sclera | C.1 |
| - Requesting Sclera | C.2 |
| Group 1 & Group 2 Recipients | A.2 |
| Offering Time | A.6 |
| Paediatric Cases | A.3 |
| Registration of New Recipients | A.1 |
| Surplus Corneas | B.5 |
