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Transplanting hope

 


Alice Campbell Havre Daily News [email protected]

Today, a beautiful day with the sun shining and things beginning to green up, would be difficult for Genevieve Kaftan to see if she had not received a corneal transplant in her left eye more than 40 years ago, or a second in the same eye roughly 20 years later. Before the first transplant, Kaftan developed an ulcer in her eye from a scratch that she said "hurt so bad and developed a lot of scar tissue." Infections that can't be healed except through transplants, diseases and trauma are the three main reasons people need transplants, Jennifer Knight, the regional director for Montana for SightLife, an eye bank that serves Montana, Washington state and northern Idaho said. The transplants replace patients' corneas the clear, outermost part of the eye Knight said. In 1962 Kaftan raced from Sydney to Billings when she received a call from the hospital that a cornea had been secured for her transplant. She "drove in the middle of the night 300 miles and was ready for surgery in the morning" because at that time, "you must go as soon as you can after the donor eye comes in." The cornea's arrival was a surprise since Kaftan had been told it would probably take three to six months. Instead, it only took about a month. Today, surgeries tend to be planned in Advance. "We don't have a waiting list, but we have a constant need," Knight said. The surgeries do not have to be performed immediately either. Instead, a three-tofive- day window dictates when the cornea must be transplanted. "Health of the cornea ... will start to decline after that fifth day," Knight said and added that most surgeons prefer to do the transplant within three days "because that's healthier tissue." In 2008, SightLife used 3,260 corneas in its service area, nationally and abroad. One Havre donor's cornea helped restore the sight of a recipient as far away as Afghanistan. "It's important to stress that we fill our local community need first, but that we also try to help our global neighbors as much as possible," Knight said. Filling the need is made easier because, while corneas are matched to recipients close in age to the donors, "it doesn't have to be a specific blood and tissue type match," Knight said. Before her first surgery, "I was scared to death," Kaftan said. "Just before the surgery I got so nervous because I didn't know what to expect." After the surgery, Kaftan stayed in the hospital for seven days with bandages over both of her eyes and the 14 stitches that were gradually unwrapped. "You do a lot of tearing because you close your eyes over stitches," she said. "It was like I was crying all the time," she added. "I got very sick because I guess I tried to reject it at first," Kaftan said, but she was able to retain the cornea anyway. Roughly 20 years after the first surgery, Kaftan had to receive a second transplant though because she ended up rejecting the first cornea. With a success rate today of 90-95 percent, "most people wouldn't need to receive two (transplants) in one eye," Knight said. When she received word after about six weeks that another cornea had been found for her, Kaftan drove from Havre back to Billings to undergo the surgery. "The second time, because I was expecting the same sort of thing, I was even more scared," Kaftan said. But it wasn't as bad as the first. "It went more smoothly," she said and added that even though about the same number of stitches were used, "I didn't weep so much" because of the finer thread used. Kaftan wasn't in the hospital as long either only a few hours for the outpatient procedure. The wrapping stayed on her left eye for "maybe three weeks or so." There has been a "slight indication that I might be trying to reject this one also," Kaftan said. "I put a drop in my eye every day of a solution, and so far I've been able to maintain it." If the drops don't work, "I don't think I would want to do it again at this age, but I think that for a person of a younger age, it's just a lifesaver," Kaftan said. Even though she views the process as being emotional because "somebody gave their life so that I could have this cornea," she also said "I'm sure that person wouldn't have become an organ donor if they didn't want that person to see." One of Kaftan's donors was 17 and the other 33. Both died in car accidents. "My only regret was that I never got to meet either one of the donors," Kaftan said. "They were just a real blessing." Sometimes, donor families and recipients do make contact with each other, Knight said. "We'll kind of serve as an intermediary in the beginning." Then letters are sent between the parties. "Fewer families will chose to actually meet each other" versus sending letters back and forth, Knight added. Kaftan would recommend the transplant surgery to anyone who needs it. "I would tell them to really search their heart, but ... I would recommend that they try because it's certainly a blessing." The cornea is not the only part of the eye that can be used in transplants. The sclera, or the white part of the eye, can also be used, ophthalmic assistant at Northern Montana Hospital Diane Forsyth said in a press release from the hospital. The sclera is mainly used for reconstructive surgeries, Knight said. While sclera transplants are not uncommon, "there isn't so much need." The hospital does not perform corneal or sclera transplants, instead referring patients to Rocky Mountain Eye Center located in Missoula, a press release from the hospital shared. Joe English, 29, will undergo a corneal transplant on Tuesday, April 21, at the Missoula center. A resident of Great Falls who grew up in Havre, English suffers from keratoconus that causes coning of the cornea. The coning, that English first discovered five years ago while reading a book, makes his vision "very blurred, almost to the point of being useless in the right eye," he said. Due to a busy travel schedule and lack of a substantial insurance policy, English is only now moving to have the transplant performed. Since the discovery of his eye problem he's found other ways to cope with the blurring of his vision that makes seeing anything other than shapes and colors difficult. "I find myself closing my right eye a lot," he said. "My left eye has become a lot more dominant," he added. Because his case is severe, the normal options of wearing a hard contact lens or having a ring inserted around the cornea's edge to hold it down are not options. Instead, English's options are either a partial or full corneal transplant. He's known that a transplant would likely be his best or only option for years. "I've pretty much accepted that, and am not too worried about it," he said. And the confidence of the surgeon who will perform the surgery has given English some more peace of mind. "He explained everything really well." "I'm leaning more toward the full (transplant)," English said, because it would most likely last longer than a partial. The partial transplant might only last 15 years and the bottom half of English's cornea would "still be coned-up pretty good." Even with a full transplant, English might have to wear a contact lens to have 20/20 vision. He's willing to undergo the surgery and wear the lens "to have the best vision possible for the next 15 years" at least, though. His surgery will be an outpatient procedure with frequent follow-up appointments with Dr. Chad Nedrud of Rocky Mountain Eye Center. Nedrud, who has been performing transplant surgeries for the last four years, said that while most ophthalmologists could probably perform the surgery, certain risks are involved including hemorrhaging. Since both of Kaftan's surgeries, many advances have been made in the corneal transplant process that allow for tissue to be kept longer before it is used. Even so, Nedrud prefers to use tissue within five days and said that "in emergent situations ... I can usually get (corneas) within four to six hours." Better suture material causes less tissue damage and a recently developed laser to cut the cornea creates a better fit for the new cornea, Nedrud said. Partial grafts of either the back or the front of a spliced cornea are also possible now. "It's really an evolving process. It's really a neat thing," Nedrud said. Despite the risk of the surgery, most patients have "had a lot of work on their eyes already" and are "pretty accustomed to having people work on their eyes," Nedrud said. "The biggest thing is the patients know their vision is very poor. ... something is better than nothing," he said about patients' attitudes toward the surgery. Hospitals nationwide are required to call a referral line after each death under their roofs. The referral line then determines if the person, registered as a donor or not, is eligible for donation. Then, the family is contacted with more questions about the donor's medical and personal history that are "not necessarily in the medical history," Knight said. "The family is involved even though the patient made the decision to be a donor," Knight added and said that "most families either knew that their loved one was registered or they had a conversation at some time ... most families aren't surprised to learn of their loved one's decision." The donor's family is also involved after the donation has occurred with thank you notes and recipient/ donor family gatherings held twice a year that allow families to see the positive impact that donations can make. SightLife supports the families "and we're kind of a resource for them ... through the next year," Knight said. Bev Heitert, whose daughter Desiree was also a tissue donor when she died nearly 20 years ago, and her family received a thank-you letter from then Montana Eye Bank Foundation. In it, then-Executive Director Elaine Shea wrote to the Heitert family: "I would ... like to thank you and your family for your unselfish and loving gesture ... ." She continued to write, "(Desiree's) eyes will help two people to see just part of the beauty that she found in this world." Knight urged people not to rule themselves out as donors before registering. Cancer patients who have undergone radiation and chemotherapy, people who have suffered from eye problems such as glaucoma and cataracts, and people who have undergone LASIK surgery can still be donors in most instances, she said. Dr. Gary Stremcha of the Havre Optometric Clinic said that the best way to ensure eyes stay healthy enough to donate and healthy enough to avoid needing a transplant is to "have routine examinations and protect your eyes against injuries." According to SightLife's Web site, there is no cost to donor families for the donation process, and afterward, an open-casket funeral is still possible. Kaftan, herself, is a donor. "I think I've always been, ever since I got a driver's license." Last year, eight people donated their corneas out of NMH, Knight said. "This is something that's happening in your community," she added. "I'm very grateful for the donors, of course, because I'm able to see, and before it was like my eye was just covered with a milky substance." For more information on cornea donations and SightLife, visit www.sightlife.org. To register as a donor or get more information, visit http://www.donatelifetoday. com. For more information on tissue and organ donation in general, visit www.nwts.org, http://www.lcnw. org, www.organdonor.gov or call the Havre office of motor vehicle services at 265-3356.

 

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