China'S Huge Donor System For Corneal Transplant Donor Needs To Be Improved

Recently, 64 year old Song Juan (a pseudonym) toss and donate donated cornea, successfully carried out a cornea transplant preserved the left eye.

But not everyone is as lucky as Song Juan to do corneal surgery. According to the annual corneal transplant volume and population ratio in China, Li Shaowei, a well-known corneal transplant specialist, estimated that China should have 16-20 keratoplasty operations per year, but the actual situation is that the number of keratoplasty in China is less than 10 thousand units per year.

The reason behind this is a serious lack of cornea. Li Shaowei believes that at present, the cornea and organ can not be donated to the grid, making the donor source limited, so it is hoped that the organ donation system can be linked to the corneal donation system. Pan Zhiqiang, chief physician of the cornea Department of Beijing Tongren Hospital, said that the operation of eye bank in China was far behind the organ donation system, and a national corneal donation system should be set up to guide volunteers to donate corneas.

"Dangerous" corneal transplantation

The left eye of Song Juan, 64 years old, has been puzzled by viral keratitis for more than 20 years. He has been relied on medication for the maintenance of his left eye.

Two months ago, she felt that her left eye suddenly had symptoms of photophobia, tears, and increased secretion. She thought it was just another recurring keratitis. It was good to use some medicine, so she didn't care much about it. At that time, it was in the most serious period of the epidemic, and there were many inconveniences to go to the hospital.

Song Juan did not get better at home and did not get better. She went to hospital after suffering pain. The doctor tried to use her antifungal, antiviral and anti bacterial drugs, but little effect. Her cornea ulcers became bigger and bigger, resulting in empyema in her eyes.

In desperation, local doctors helped Song Juan connect with a well-known cornea transplant specialist, Li Shaowei, director of the eye hospital of Beijing AI Er Chi, and President Li Shaowei gave treatment advice. "Corneal transplant as soon as possible, remove the infection area and keep the eyeballs".

But the local hospital has neither corneal origin nor the ability to perform keratoplasty. Li Shaowei expressed willingness to receive a clear diagnosis in Beijing and then undergo a corneal transplant. Affected by the epidemic, according to Beijing's epidemic prevention and control regulations, Song Juan needed 14 days' isolation after Beijing to operate.

On the eleventh day of Song Juan's isolation, Song Juan left her eyes with tears. Li Shaowei gave the judgement: perforation, surgery to save the eyeball. The Li Shaowei team urgently contacted the eye group of the Al group and rushed to find the cornea for emergency treatment.

Affected by the epidemic, the reduction in corneal donation has made it even more difficult to get scarce corneas. Three days after Song Juan's cornea perforation, a cornea was donated by the Chengdu eye eye bank.

In April 1st, the day of Song Juan's keratoplasty was scheduled, but the cornea was accidentally damaged by the glass container contained in the cornea, and the cornea was contaminated and unusable. Li Shaowei sent out help information again to the eye group platform of the AI group. In the afternoon, the Changsha El eye library reported that they had made two fresh corneas. One cornea perforation patient had used one, the other one was planned for a patient with leukoplakia, the patient had been hospitalized for surgery, but after communication and consultation, the patients and their families were willing to give up the cornea. Song Juan flew the cornea to Beijing that night.

After the song and Juan cornea transplant operation was very successful, the left eye was saved.

Behind the "scarcity" cornea

It is reported that as the world's fourth largest blinding disease, about 20000000 of the world's blinding patients with corneal diseases now have 400-500 million illnesses of corneal diseases, and this data is increasing year by year. Corneal transplantation is to replace the cornea with normal cornea, so that the eye can be regain or control corneal diseases, so as to achieve ophthalmic treatment for improving vision or treating certain corneal diseases.

But not everyone is as lucky as Song Juan to do cornea surgery to keep his eyes intact.

The main reason is lack of cornea. "Wait a minute" has become the most widely used word in many corneal transplant patients. Depending on the distribution of donor resources in different areas and different eye banks, the waiting time varies. Taking Beijing Tongren Hospital as an example, although the Tongren Hospital has a cornea bank, the supply of cornea resources is also intense, and it is fast for two weeks. When donors are scarce, they can not be determined for the first half to a year. In Beijing Tongren Hospital, there are about 1000 patients who need corneal transplantation every year, but only 100 patients can get donated corneas. The rest of the patients rely on domestic or foreign brother's eye bank to support or adjust the cornea.

It is also known that although the eye Ophthalmology Group has the largest corneal donation system in the country, there are 10 eye banks and 29 donor sites for corneal donation in the country, with 1000 donations per year, but the number of corneas is far from enough.

In December 28, 2017, the former national health and Family Planning Commission issued a circular prohibiting the use of human blood (including plasma and other blood components) from overseas sources and tissues and organs for clinical medical purposes.

At present, the donor source of corneal blindness in China can only rely on voluntary donation. Since January 1, 2015, voluntary donation has become the only legal channel for organ transplantation. Corneas, as human tissues, are not enough attention and have not been included in the national organ donation distribution system, and lack of corresponding laws and regulations.

Li Shaowei believes that at present, the cornea and organ can not be donated to the grid, making the donor source limited, so it is hoped that the organ donation system can be linked to the corneal donation system.

According to Pan Zhiqiang, chief physician of the cornea Department of Beijing Tongren Hospital, the operation of the eye bank in China is far behind the organ donation system. Almost all of them are "empty libraries" Without libraries. Our country urgently needs to change the "small workshop" mode of eye donation, and set up a national corneal donation system to guide volunteers to donate organs while donating corneas.

In addition, the highest social concern is the corneal allocation problem, that is, how to ensure that every cornea can be used in patients with urgent needs, and how to distribute the most fair?

The current status of corneal allocation in China is that the organ donation center will give the cornea priority to the ophthalmology in the third grade hospital. There is a lack of motivation in the third grade hospital because of its easy access to the cornea, which is limited by the lack of motivation for corneal donation. Compared with organ donation, corneal donation is lagging behind. The corneal donor gap is huge and can not meet the needs of corneal blindness prevention.

In June 30, 2019, the national health and Health Committee issued the notice on the issuance of the regulations on the management of eye bank, etc., to carry out the pilot project of human cornea acquisition and distribution in 10 provinces (cities, including Beijing, Shanghai, Zhejiang, Anhui, Shandong, Hubei, Hunan, Guangdong, Hainan and Shaanxi provinces). The provincial health and health administration departments in the pilot provinces should guide the standardized use of the human corneal distribution system in the area of the area to allocate the donated corneas. The provincial health and health administration departments in the non pilot provinces should guide the eye bank in the area to distribute the cornea scientifically and fairly in the service area according to the principle of corneal distribution by the human body.

In Li Shaowei's opinion, the approval of the eye bank is not going to lack the cornea. "Eye bank should refer to the construction mode of blood bank."

Li Shaowei believes that "as long as we allow the development of eye bank, standardized operation, the cornea is naturally not scarce, and this professional field has naturally developed."

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