A Taiwanese Success Story: Taiwan’s World Class National Eye Bank Sees Donations and Successful Transplants Rise

Owing to a scarcity in cornea and organ donations in Taiwan, 60% of previous corneal transplantation depended on imported corneas from eye banks overseas. However, the bumpy journey and temperature changes experienced during the shipping process can cause endothelial cell damage to affect the surgical success rate of corneal transplantation. Worse still, patients have to pay TWD 50,000 to over TWD 100,000 to foreign eye banks for the imported corneas that makes the more disadvantaged blind people unaffordable. In the past, Taiwan did not have an eye bank on a national scale. Domestic donor corneas were harvested by each hospital without universal well-established SOP for cornea procurement and donor cornea evaluation among each hospital based tissue collecting centers. Besides, endothelial cell density was not determined via specular microscopy. Thus, the quality of donated corneas was not guaranteed. In order to promote cornea donations and provide high quality donor corneas, the National Eye Bank of Taiwan (NEBT) was established with a setup fund from the Ministry of Health and Welfare (MOHW) in 2013. NEBT is led by Prof. Fung-Rong Hu (胡芳蓉) at the Department of Ophthalmology, National Taiwan University Hospital (NTUH) and has an office in southern Taiwan at the National Cheng Kung University Hospital (NCKOH).

The NEBT established a series of standard operation procedures, regulating the quality of corneas and adopting strategies to increase cornea donations. Among them, there are two most important achievements. First, shifting cornea harvesting method from enucleation to in situ corneoscleral rim excision and put eyecap after harvesting to replace the donor’s cornea, thereby both improving the donor’s appearance and increasing the willingness of the family to accept cornea donation. Second, performing presurgical culture of corrneoscleral rim routinely immediately after harvesting and setting up NEBT corneal donor microbial work-up algorithm to increase the donation and utility rate of bacteremic donors. From 2014 to 2017, a total of 697 corneas were donated; the utility rate reached above 98% while surgical success rates reached 99%, and none of corneal transplant recipient using donor corneas from the NEBT had post-op infection.1. These successful results has led to a change in the traditional thought that the bacteremic donors are contraindication of cornea donation. Thus, the good intention of bacteremic donors for cornea donation will no longer have to be forfeited. This study was published in the British Journal of Ophthalmology, a top international journal on ophthalmology.

Since the founding of NEBT, the number of domestic corneal donations increased from 220 cases in 2013 to 537 cases in 2018. This has also increased the availability for urgent tectonic corneal transplant, saving over 60 patients from the misfortune of enucleation. The MOHW has also revised the "Regulations for Distribution and Management of Human Organ Transplantation" by eliminating the stipulation that “those under the age of 65 are prioritized to receive corneal transplants”, improving the quality of life for seniors. Additionally, the services provided to Taiwan citizens by the NEBT are fully covered by the government, providing wellbeing for everyone and restoring the gift of sight for those in need. The institution has truly become a symbol of pride for Taiwan.

Note 1:
The NEBT prides itself in its precise corneal recovery, evaluation, and quality preservation techniques. From 2014 to 2017, it procured 70 corneas from bacteremic donors and 627 from non-bacteremic donors. The research results show the microbial culture rate from the corneoscleral rims of the corneal buttons from bacteremic donors is 7.1%. There was not a single donor cornea grew the same pathogen as that from blood culture. On the other hand, the microbial cultures rate from the corneoscleral rims from non-bacteremic donors is even higher at 9.1%. Moreover, the corneas from bacteremic donors and non-bacteremic donors have similar endothelial cell densities, all averaging 2900/mm2 or above. On top of that, the utility rate and surgical success rate of both groups reaches up to 98% and 99% respectively, and none of corneal transplant recipient using donor corneas from the NEBT had post-op infection. Through strict regulation and research, NEBT has proven that corneas from bacteremic and non-bacteremic donors are of the same quality and safety. This has not only increased both the number of cornea donation and utility rates, but also led to a change in the traditional thought that the bacteremic donors are contraindication of cornea donation. Thus, the good intention of bacteremic donors for cornea donation will no longer have to be forfeited.