Abstract
Purpose :
We established a method and criteria for the revival of in vivo-like ERG a- and b-waves in human organ donor retina after circulatory death (Nature 2022). This platform is a paradigm shift for studying human retinal physiology and exploring new approaches for visual rehabilitation. We will share our 2024 protocol for optimizing our surgical recovery and preservation conditions.
Methods :
We implemented 16 key protocol improvements in three specific areas: a) Improving access to high quality organ donor eyes, b) Improving the surgical protocol, and c) Optimizing the preservation conditions. The key development was the design of a prototype for a closed-loop perfusion system to assist with long-term survival.
Results :
To improve our access to high quality organ donor eyes, a) we added additional diagnostic testing and comprehensive preoperative ocular examinations, b) implemented more efficient and focused electrophysiologic testing, c) expanded our donor pool to include selected DCDs (donations after cardiac death), d) rejected whole eyes with preoperative evidence of ischemia and e) built a stronger communication network with our OPO. To improve viability, we changed the surgical protocol and a) reduced ischemia times, b) minimized the delay between circulatory loss and re-oxygenation, c) coordinated our surgical recovery with the anesthesiologist and other transplant surgeons and d) customized our surgical approach in heart and lung transplant cases. To optimize the preservation conditions, a) we built a prototype for a closed-loop perfusion system to assist with long-term survival, b) used cool preservation media to reduce metabolism, c) reduced transportation delays, d) avoided retinal detachment.
Conclusions :
The protocol updates for 2024 provides vision scientists across multiple disciplines with up-to-date recommendations for optimizing the viability of human eyes for the study of the human retina in health and disease. This platform overcomes the limitations of using animal models which poorly mimic the human eye in health and disease. Additionally, this platform can be used to explore innovative approaches for visual rehabilitation to restore sight to the blind.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.