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ETHICAL ISSUES IN TRANSNATIONAL EYE BANKING - RECENT REVIEW PUBLISHED IN CORNEA

In 2012, an estimated 11% of corneal transplants performed worldwide used imported tissue, with 27 countries wholly dependent and 43 countries partially dependent on imported tissue. Eight percent of corneal tissue procured annually was reportedly exported, primarily from the United States, which accounted for 85% of corneal exports, Sri Lanka (9%), and Italy (3%). Thus, of the 116 countries currently active in corneal transplantation, at least 70 of these are directly involved in transnational eye banking activities.

In February 2017 Cornea  published a paper on “Ethical issues in Transnational Eye Banking”, written by Dominique E. Martin, Richard Kelly, Heather Machin, Graeme A. Pollock and Gary L.A. Jones, the Veneto Eye Bank Foundation’s International Coordinator. This paper sought, in the absence of existing analyses dedicated to the ethics of transnational eye banking activities in the present peer-reviewed literature, to review a number of ethical issues that may arise in the setting of transnational eye banking activities, such as when exporting or importing corneal tissue for transplantation.

Transnational activities in eye banking, like those in other fields involving organ and tissue procurement and use of medical products of human origin, present a number of ethical issues for policy makers and professionals. Key ethical concerns include the potential impact of export or import activities on self-sufficiency of corneal tissue supply within exporting and importing countries; potential disclosure requirements when obtaining consent or authorization for ocular tissue donation when donated tissue  may be exported; and difficulties inherent in assuring equity in the allocation of tissues made available for export and in establishing and respecting standards of safety and quality across different jurisdictions.

The hope is that this review will encourage further analysis on four principal ethical concerns: regional self-sufficiency; autonomy and awareness of donation decision makers; quality and safety assurance in every donation and transplant process; application of ethical guidelines and tools to assist organizational and professional decision-making.

The Veneto Eye Bank Foundation, established in 1987, is a non-profit, social welfare organization and regional centre of reference for cornea transplantation, certified by the Italian National Transplants Centre and by Certiquality (Quality Management System in conformity with the ISO 9001:2008 standard) that organizes activities relating to the procurement, examination, storage, allocation and transport of human tissues for ocular surgery, obtained from legal donations for the purposes of transplantation. The Foundation receives many tissue requests from non-national transplant centres requiring corneas for transplant and currently collaborates in systematic fashion with 20 transplant centres internationally.

Further details on the Foundation’s policy and procedures regarding the provision of tissues for transplant can be obtained from the Programming and Biostatistics Office (Tel: +39 041 9656422; Fax: +39 041 9656421; email: direzionemedica@fbov.it).