Device Revives Eyes from Deceased Donors for Transplants

What happened?

A team led by Pia Cosma at the Centre for Genomic Regulation in Barcelona has presented a device called Eye-in-a-Care-Box (ECaBox) that maintains and revives eyes from deceased donors through perfusion. The technique involves pumping an oxygenated, nutrient-rich fluid through the ophthalmic artery, mimicking natural blood flow. In tests with pig eyes, treated organs remained viable for up to 10 hours, and after just 15 minutes of perfusion they regained the ability to respond to light, something that is lost immediately upon eye removal. In human eyes from six donors, the device significantly better preserved the retina compared to untreated eyes.

Why is it important?

Full eye transplantation is a major medical challenge. The surgery is extremely complex, and the eye begins to degenerate as soon as it leaves the body. In 2023, a team at NYU performed the first full eye transplant in a patient with a partial face transplant, but the eye did not regain vision. The main obstacle is the rapid death of retinal cells and the difficulty of reconnecting the optic nerve. ECaBox addresses the first problem: keeping the eye viable for hours, allowing time for transport and surgical preparation. Moreover, by restoring electrical response to light, it suggests that retinal tissue could be functional. If combined with advances in optic nerve regeneration, this device could pave the way for functional transplants.

What consequences will it have?

In the short term, the device will improve the quality of donated eyes for research and tissue banks. In the long term, it could increase the pool of suitable donor eyes for transplantation, as currently eyes must be removed and transplanted within hours. With ECaBox, that time extends to 10 hours or more, allowing logistical coordination. It also opens the possibility of treating donor eyes after death, when they were previously considered non-viable. However, the biggest challenge remains reconnecting the optic nerve to the brain; without that, the transplanted eye cannot send visual signals. Therapies with growth factors, stem cells, and biomaterial scaffolds are being explored but are still experimental. Therefore, ECaBox is a necessary but not sufficient advance for achieving vision after transplant.

What should readers know?

• It is not a bionic eye: The device does not replace visual function, only keeps the donated eye alive.
• Limited human testing: So far, it has only been tested on eyes from deceased donors, not transplanted. It is unknown whether a treated eye could regain vision after implantation.
• Comparison with other organs: Perfusion is already used for lungs, kidneys, and livers, but this is the first time it has been successfully applied to a whole eye.
• Ethical implications: Reviving eyes from deceased donors raises questions about tissue status and consent, though eyes are obtained with authorization.
• Next steps: The team plans to optimize the perfusion fluid and test optic nerve reconnection in animal models.

Context and comparisons

Corneal transplantation is routine, but full eye transplantation is much more complex due to the need to connect the retina to the brain. The failure of the NYU transplant in 2023 underscored the urgency of better organ preservation. ECaBox joins other innovations such as stem cell use for optic nerve regeneration and retinal implants. Unlike bionic eyes (e.g., Argus II), which require external cameras, a biological transplant could offer natural vision. The device represents a critical step toward that goal.

“It’s really cool. It could be a new frontier for retina preservation,” said Shannon Tessier, a perfusion expert at Massachusetts General Hospital who was not involved in the study.