William Lopez remembers clearly the day in June 2017 when he says he was asked to call the spouse of a college friend who had just died and ask for her eyes.
The spouse hadn鈥檛 responded to calls from other employees at the Rocky Mountain Lions Eye Bank, he said. As Lopez recalled, his supervisor thought a friend鈥檚 personal number would have more success.
Lopez refused. 鈥淚 went for a walk,鈥� he said.
Even without Lopez鈥檚 help, the eye bank that procures corneas from deceased donors in Wyoming and Colorado eventually collected his friend鈥檚 corneas, Lopez said. Lopez, who had entered the field to help people, became increasingly disillusioned during his three years working with the eye bank, despite rising from a technician to the distribution manager, and ultimately quit.
Checking the 鈥渄onor鈥� box on a driver鈥檚 license application, people may picture their heart, kidneys, or other organs saving another person鈥檚 life should the worst happen.
They are less likely to consider that tissues 鈥� corneas, tendons, bone marrow, skin, bone 鈥� are also covered by that checked box. In fact, donated tissues are collected much more frequently than organs, and corneas are the in the U.S., with , according to the Eye Bank Association of America.
Organ and tissue donations are guided by different rules, with less transparency and what critics identify as more self-policing in the tissue donation industry. In Wyoming and Colorado, where the Rocky Mountain Lions Eye Bank estimates it collects eye tissue from about , that has contributed to a tense work environment resulting in damaged or wasted tissues due to accidents, four former eye bank employees say.
鈥淚 think there鈥檚 an urgent need for stricter oversight of the donation process in general, particularly for eye and tissue banks,鈥� said Janell Lewis, who worked at the Rocky Mountain Lions Eye Bank for 12 years, managing public relations and overseeing fundraising before she quit in February 2023.
John Lohmeier, executive director of the Rocky Mountain Lions Eye Bank, declined to be interviewed for this article. In a prepared statement, he said he couldn鈥檛 comment on personnel matters or specific incidents raised by the former employees.
But generally, he wrote, 鈥渢here are internal procedures that have been in place and continue to be followed to investigate and/or report any incident that would impact health and safety concerns.鈥�
Lewis, Lopez, and two other former eye bank employees recalled one or more of the following problems during their time at Rocky Mountain Lions Eye Bank:
- Removal of eye tissue from the wrong body
- Damage or destruction of corneas due to improper removal
- Removal of corneas from a donor with a high-risk family history that could endanger a transplant recipient
- Lack of transparency about whether errors were being reported to federal agencies
- Pressuring and bullying of technicians
- High turnover and brief training of low-paid and inexperienced technicians
The Windshield of the Eye
The cornea is considered the . It is a clear dome that protects the eye from contaminants, maintains fluid balance, and filters light. Recipients of cornea donations typically need transplants because of trauma, infection, or that cause blindness or blurred or cloudy vision.
The Rocky Mountain Lions Eye Bank is one of about 60 eye banks operating in the U.S., in corneal transplants. New technicians often arrive at the eye bank untrained, sometimes with only a high school diploma, to perform the grim job of removing corneas from recently deceased corpses for about the same wages many fast-food workers earn.
But what eye bank technicians may lack in education and training, they generally make up for with a strong belief in the mission, according to the former employees. They said they joined the Rocky Mountain Lions Eye Bank because they wanted to help restore people鈥檚 sight.
The nonprofit employs about 70 people across Colorado and Wyoming, according to a submitted in 2023. Those records also show a net income of less than $1 million and more than $16 million in assets. Lohmeier was paid about $142,000.
Organs vs. Tissue
Organ donations fall under the purview of the Health Resources and Services Administration, and details performance and of organ procurement groups. Tissue donation is regulated by the Food and Drug Administration, as well as national industry groups, and tissue bank transactions, performance, and outcomes are not available to the public.
There鈥檚 no reason tissues and organs should be treated differently, said Robert Dickson, medical director for the Washtenaw County Tuberculosis Clinic in Michigan. A patient in his county died from a bone graft contaminated with tuberculosis just a couple of years after a contaminated bone graft .
He to the Wild West and called it a major public health concern.
鈥淚t鈥檚 fundamentally no different from an organ transplant. You鈥檙e taking tissue from one deceased patient and putting it into a living recipient. But it is not regulated and not tested as rigorously,鈥� he said.
Marc Pearce, president and CEO of the American Association of Tissue Banks, said such cases are very rare.
鈥淲e don鈥檛 believe that we鈥檝e proven ourselves to be not capable of regulating ourselves,鈥� he said.
FDA officials disagree that the tissue industry is largely self-regulated, pointing to that require certain organizations to register with the agency and provide a list of human cells or tissues they recover, store, or distribute.
The rules set donor eligibility requirements, and the agency inspects tissue establishments, including eye banks, said spokesperson Carly Pflaum.
鈥淭he FDA has implemented a tiered risk-based approach for the regulation of human cell, tissue and cellular and tissue-based products,鈥� Pflaum wrote.
KFF Health 暗黑爆料 and WyoFile months ago requested reports of adverse events associated with the Rocky Mountain Lions Eye Bank, but the FDA has yet to provide them. FDA dashboards show the eye bank since 2017, and inspections since at least 2009 in any official action.
The tissue industry is largely self-monitored and the performance of eye banks is tracked internally, whereas the federal government publishes for organ procurement groups. Health care providers are not required to report to the FDA adverse events resulting from tissue transplants.
Organ transplant providers are required to report safety events in recipients within 72 hours to the Organ Procurement and Transplantation Network, which operates under contract with the U.S. Department of Health and Human Services. That includes an organ going unused because it was delivered to the wrong location. They have 24 hours if, for example, the recipient gets an infection or disease that may have been from the new organ.
Other countries have public registries detailing the outcomes of corneal transplants, including Australia, the United Kingdom, and Sweden. A similar registry in the U.S. could help monitor outcomes for patients and identify adverse events from transplant procedures, eye doctors and researchers wrote in .
Tissue bank industry groups are responsible for much of the oversight of their dues-paying members. Transplanting surgeons may report adverse reactions to the tissue bank, which generally then conducts a review and submits a report to the FDA and the Eye Bank Association of America or the American Association of Tissue Banks.
Nearly all eye banks in the U.S. are members of the Eye Bank Association of America, which inspects member banks at least every three years as part of its accreditation process, but such inspection reports aren鈥檛 publicly available. Safety is paramount, association president Kevin Corcoran said, and the association鈥檚 medical standards require eye banks to request patient outcome information from transplanting surgeons a few months after surgery.
鈥淲e want to make sure we don鈥檛 have an eye bank that is slipping in their performance or failing to recover tissue,鈥� he said. He declined to comment on any individual eye bank鈥檚 performance or release quality or transplantation data, complaints filed, or investigations undertaken.
No investigations have resulted in corrective action, he said, in the 13 years he has been at the association. The Rocky Mountain Lions Eye Bank is an accredited member of the association.
Balancing Mission and Stress
Several of the former employees were hesitant to speak about the Rocky Mountain Lions Eye Bank because they didn鈥檛 want to sully the reputation of an industry they believe is essential for improving people鈥檚 lives and honoring the wishes of the dead.
But they described a high-pressure environment that they said led to many of their colleagues leaving and errors that reduced the number of successful retrievals.
Mackenzie Urban started recovering corneas as a technician for the eye bank in 2019 after finishing her bachelor鈥檚 degree. She saw it as a temporary job as she applied for medical school. But within a year of recovering her first cornea, she said, enough employees had left that she became the senior recovery technician and was training others.
She used limes for the training, guiding her students on how to use a scalpel to remove the peel without nicking the fruit beneath. Success meant lifting the peel off the lime without any juice spilling out.
鈥淚f you鈥檙e stressed, you鈥檙e going to shake,鈥� Urban said.
Outside factors can compound the challenges of performing the delicate procedure. Maybe the coroner had drawn fluid from beneath the cornea, making collection much trickier, she said. After a person has been dead for about 24 hours, the eyes tend to deflate to the point of uselessness, adding time pressure to collecting donations, Urban said.
Sometimes, Urban said, another technician would be working on a body simultaneously, so that the entire body was moving around while she was trying to do the delicate procedure.
Interactions with grieving families could be intense, too. Sometimes, families would hug her, thankful that something good would come of their loss. Other times, they were hostile, such as the time one relative of a potential donor told her to 鈥淐ut your own f* eyes out, you b****,鈥� she recalled.
Urban appreciates the work the eye bank performs and doesn鈥檛 regret her time there. She said she respected that 鈥渢hey had a real commitment to serving the community and keeping prices low.鈥� (It鈥檚 illegal to sell human body parts for transplant, but companies get reimbursed varying amounts for the expenses of harvesting, preparing, and shipping tissues.)
But the workplace culture made it untenable for her, she said. For example, Urban said, she was reprimanded and told that she needed to 鈥渂uck up or get out鈥� because she declined to harvest corneas from a person who died from an unknown cause. The body was purple from the neck down, covered in oozing blisters and with opaque flecks in the eyes, Urban said.
When Irish Eyes Are Smiling
The Rocky Mountain Lions Eye Bank has international contracts and ships corneas to Japan and the U.K., among other destinations. It became the exclusive eye tissue provider for Ireland when that country stopped collecting corneas over fears of transmitting mad cow disease. That means anyone who has received in the past two decades likely now sees thanks to a person who died in Colorado or Wyoming, according to the Irish Blood Transfusion Service.
Lohmeier, the eye bank CEO, said local needs are prioritized for donations, while international shipments help fulfill the eye bank鈥檚 mission and 鈥渆nsure that all viable corneas are transplanted, giving the gift of restored sight.鈥�
The U.S. is one of the few nations with a . FDA inspection reports confirmed that the Rocky Mountain Lions Eye Bank procures more tissue than its geographic area can use.
The demand for international orders contributed to the high-pressure environment, Lopez said.
Employee turnover and the stress of the job resulted in the collection of corneas of poor quality, Lewis said. Local hospitals inquired about why so many corneas weren鈥檛 being transplanted, she added.
The leading reason was recovery errors that damaged the tissue, Lewis said.
Lohmeier disagreed that there was a significant decline in corneas being placed. 鈥淲e do not believe this description accurately reflects the state of corneal recovery and transplants,鈥� he said.
Internal records showed that about half of recovered corneas in November 2022 had moderate to heavy stress. The Eye Bank Association of America does not have comparable national data. The closest figure it tracks is the proportion, among tissues that were prepared but not transplanted, that were unable to be transplanted because of damage during processing; in 2022, it was a quarter.
Ashi Moore, who used to lead the Rocky Mountain Lions Eye Bank鈥檚 quality assurance department, said she once filed a report to the FDA after a donor鈥檚 eye tissues were removed despite a family history indicating a high risk of Creutzfeldt-Jakob disease. The disease, which should have been disqualifying for donation purposes, is a fatal brain disorder that through infected tissue.
The issue was caught before the corneas could be placed in someone else鈥檚 eyes, but it should never have gotten to the point that the corneas were removed from the body, Moore said.
At least once, a technician retrieved corneas from the wrong body, according to Moore and other former employees (The FDA was unable to provide records to confirm that report by publication). Moore said she should have been told about the case of mistaken identity immediately but said she wasn鈥檛 made aware of it until after the eye bank鈥檚 leaders handled the situation themselves.
She said she couldn鈥檛 find evidence that the eye bank had reported the error to the FDA. It was one of the major reasons she decided to leave the organization, though she had derived a strong sense of purpose from working at the eye bank, she said.
When Lewis resigned, officials at the nonprofit eye bank offered her $5,000 to sign a severance agreement with a nondisparagement provision. She declined.
Lewis said she would like to see states hold tissue recovery agencies to the same standards as other organizations that handle corpses, such as hospitals, coroners, and funeral homes. And if they fail to meet those standards, they need to be held accountable to build public trust, she said.
Lewis鈥� and Lopez鈥檚 negative experiences with the eye bank had another consequence. Each decided they no longer wanted to be an organ or tissue donor.
鈥淎fter witnessing and experiencing so many issues, I no longer feel comfortable with the potential of my family having to go through that when the time comes,鈥� Lewis said.
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