Eye transplantation | |
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Specialty | Ophthalmology, neurosurgery |
Complications | Transplant rejection |
Eye transplantation is the transplantation of the globe of the human eye from a donor to a recipient.
Research efforts in whole eye transplantation (WET) are focused on its application in living human recipients, still some obstacles need to be addressed. Apart from the surgical and neurological considerations, there are key ethical concerns such as patients' perceptions and desires for both nonvision-restoring WET and vision-restoring WET, risks and benefits compared to prosthetic alternatives, psychosocial considerations for potential recipients regarding personal identity related to the donor's eyes, public perceptions of whole-eye donation, implications for corneal transplantation eligibility of the donor's eyes, consent for whole-eye donation, and establishment of ethical mechanisms for allocation and distribution of WET. With limited studies available on this topic since the first vascularized composite allotransplantation (VCA) [1] [2] [3] took place in 1998, the understanding of WET is informed by a few studies with limitations. For example, amphibian regeneration cannot directly apply to humans. Ocular transplants may offer a viable option for restoring form in patients undergoing facial transplantation with enucleated orbits. [4]
In 1885, the Revue générale d'ophtalmologie reported that the staphylomatous and buphthalmic eye of a 17-year-old girl had been replaced by the eye of a rabbit by a Dr. Chibret. [5] [6] The operation failed after 15 days due to a lack of effective immunosuppression. [6]
In 1969, Conrad Moore of the Texas Medical Center claimed that he had carried out the transplantation of a whole eye, but he subsequently retracted his claim. [7]
In November 2023, surgeons at NYU Langone Health announced the first successful eye transplantation, [8] which was carried out as part of a partial face transplant in an operation that took 21 hours. [8] The recipient, Aaron James, had lost the left side of his face with his eye, nose and mouth in a high-voltage power line accident. [8] Reuters reported that the transplanted eye has "well-functioning blood vessels and a promising-looking retina". [8] The eye is not using the optic nerve to communicate with the brain, and James has not regained sight through the eye. [8] Adult stem cells have been harvested from his bone marrow and been injected into the optic nerve. [8] The lead surgeon, Eduardo D. Rodriguez, said that "If some form of vision restoration occurred, it would be wonderful, but ... the goal was for us to perform the technical operation". [8]
Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.
A pancreas transplant is an organ transplant that involves implanting a healthy pancreas into a person who usually has diabetes.
The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Along with the anterior chamber and lens, the cornea refracts light, accounting for approximately two-thirds of the eye's total optical power. In humans, the refractive power of the cornea is approximately 43 dioptres. The cornea can be reshaped by surgical procedures such as LASIK.
Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for end-stage liver disease and acute liver failure, although availability of donor organs is a major limitation. The most common technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic position as the original liver. The surgical procedure is complex, requiring careful harvest of the donor organ and meticulous implantation into the recipient. Liver transplantation is highly regulated, and only performed at designated transplant medical centers by highly trained transplant physicians and supporting medical team. Favorable outcomes require careful screening for eligible recipients, as well as a well-calibrated live or deceased donor match.
Xenotransplantation, or heterologous transplant, is the transplantation of living cells, tissues or organs from one species to another. Such cells, tissues or organs are called xenografts or xenotransplants. It is contrasted with allotransplantation, syngeneic transplantation or isotransplantation and autotransplantation. Xenotransplantation is an artificial method of creating an animal-human chimera, that is, a human with a subset of animal cells. In contrast, an individual where each cell contains genetic material from a human and an animal is called a human–animal hybrid.
Allotransplant is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species. The transplant is called an allograft, allogeneic transplant, or homograft. Most human tissue and organ transplants are allografts.
Hand transplantation, or simply hand transplant, is a surgical procedure to transplant a hand from one human to another. The donor hand, usually from a brain-dead donor, is transplanted to a recipient amputee. Most hand transplants to date have been performed on below-elbow amputees, although above-elbow transplants are gaining popularity. Hand transplants were the first of a new category of transplants where multiple organs are transplanted as a single functional unit, now termed vascularized composite allotransplantation or VCA.
A face transplant is a medical procedure to replace all or part of a person's face using tissue from a donor. Part of a field called "Vascularized Composite Tissue Allotransplantation" (VCA) it involves the transplantation of facial skin, the nasal structure, the nose, the lips, the muscles of facial movement used for expression, the nerves that provide sensation, and, potentially, the bones that support the face. The recipient of a face transplant will take life-long medications to suppress the immune system and fight off rejection.
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue. When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Keratoplasty simply means surgery to the cornea. The graft is taken from a recently deceased individual with no known diseases or other factors that may affect the chance of survival of the donated tissue or the health of the recipient.
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Microsurgical techniques are utilized by several specialties today, such as general surgery, ophthalmology, orthopedic surgery, gynecological surgery, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery, podiatric surgery and pediatric surgery.
Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. The first successful kidney transplant was performed in 1954 by a team including Joseph Murray, the recipient’s surgeon, and Hartwell Harrison, surgeon for the donor. Murray was awarded a Nobel Prize in Physiology or Medicine in 1990 for this and other work. In 2018, an estimated 95,479 kidney transplants were performed worldwide, 36% of which came from living donors.
Eye banks recover, prepare and deliver donated eyes for cornea transplants and research. The first successful cornea transplant was performed in 1905 and the first eye bank was founded in 1944. Currently, in the United States, eye banks provide tissue for over 80,000 cornea transplants each year to treat conditions such as keratoconus and corneal scarring. In some cases, the white of the eye (sclera) is used to surgically repair recipient eyes. Unlike other organs and tissues, corneas are in adequate supply for transplants in the United States, and excess tissue is exported internationally, where there are shortages in many countries, due to greater demand and a less-developed eye banking infrastructure.
Phthisis bulbi is a shrunken, non-functional eye. It may result from severe eye disease, inflammation or injury, or it may represent a complication of eye surgery. Treatment options include insertion of a prosthesis, which may be preceded by enucleation of the eye.
Penis transplantation is a surgical transplant procedure in which a penis is transplanted to a patient. The penis may be an allograft from a human donor, or it may be grown artificially, though the latter has not yet been transplanted onto a human.
Transplantable organs and tissues may refer to both organs and tissues that are relatively often transplanted, as well as organs and tissues which are relatively seldom transplanted. In addition to this it may also refer to possible-transplants which are still in the experimental stage.
Keratoprosthesis is a surgical procedure where a diseased cornea is replaced with an artificial cornea. Traditionally, keratoprosthesis is recommended after a person has had a failure of one or more donor corneal transplants. More recently, a less invasive, non-penetrating artificial cornea has been developed which can be used in more routine cases of corneal blindness. While conventional cornea transplant uses donor tissue for transplant, an artificial cornea is used in the keratoprosthesis procedure. The surgery is performed to restore vision in patients with severely damaged cornea due to congenital birth defects, infections, injuries and burns.
A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2018, the most common procedure is to take a functioning heart, with or without both lungs, from a recently deceased organ donor and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart or, much less commonly, the recipient's diseased heart is left in place to support the donor heart.
Nerve allotransplantation is the transplantation of a nerve to a receiver from a donor of the same species. For example, nerve tissue is transplanted from one person to another. Allotransplantation is a commonly used type of transplantation of which nerve repair is one specific aspect.
Intestine transplantation is the surgical replacement of the small intestine for chronic and acute cases of intestinal failure. While intestinal failure can oftentimes be treated with alternative therapies such as parenteral nutrition (PN), complications such as PN-associated liver disease and short bowel syndrome may make transplantation the only viable option. One of the rarest type of organ transplantation performed, intestine transplantation is becoming increasingly prevalent as a therapeutic option due to improvements in immunosuppressive regimens, surgical technique, PN, and the clinical management of pre and post-transplant patients.
A corneal button is a replacement cornea to be transplanted in the place of a damaged, diseased or opacified cornea, normally approximately 8.5–9.0mm in diameter. It is used in a corneal transplantation procedure whereby the whole, or part, of a cornea is replaced. The donor tissue can now be held for days to even weeks of the donor's death and is normally a small, rounded shape. The main use of the corneal button is during procedures where the entirety of the cornea needs to be replaced, also known as penetrating keratoplasty.