THE EYES ARE the windows to the soul', says Craig Rabbetts, cornea retrieval coordinator at James Cook University Hospital in Middlesbrough. 'That makes the idea of eye donation one of the hardest things to consider. But our job isn't to persuade, it's to raise awareness and offer an effective service.'
Since March this year Mr Rabbetts has been working for one of eight new units across England designated as eye retrieval centres. Each unit will receive £70,000 a year for the next three years from NHS UK Transplant. Mr Rabbetts' mission is to increase cornea donation across the Tees Valleyarea and run a robust retrieval team. Once he is fully trained, he will carry out the procedure himself. But his first priority is to raise awareness of the importance of eye donation within the health service and the wider community.
After being a staff nurse in the prison service, this new role is a departure for Mr Rabbetts - though a spell as a rapid response driver during his training gave him some insight into the nature of organ retrieval. 'As a driver, you go from a very negative situation into a very positive situation, leaving a hospital and three hours later turning up at another hospital with a totally different vibe. Often you are the only one to experience that change.'
Although there is no specific waiting list for cornea transplants, there is always a need. 'Some people have a disease or trauma to the eye that is irreparable without a cornea transplant,' he explains. 'At present there are over 2,000 recipients in the UK. Without this system these people will go blind and the costs are far increased. It really affects their quality of life.'
The long-term aim of the scheme is to create a robust and auditable ocular retrieval system, with the eight centres feeding two eye banks in Manchester and Bristol. In the past a local doctor would have performed the operation only occasionally. In the future specialist nurses will regularly carry out the procedure, making the whole system increasingly efficient.
But the first challenge is awareness. Even among nurses, there is a distinct lack of understanding of cornea transplants.Mr Rabbetts explains. 'When a patient dies on the ward and the relatives agree to cornea donation, the National Blood Service first verifies the consent and then hands over to our team. The technician goes to the mortuary, removes the whole eye to protect the cornea and the donor's face is carefully reconstructed.
'UK Transplant then organises a courier to collect and deliver the eye to the eye bank in Manchester or Bristol. The cornea is removed and stored for up to four weeks before being redistributed to one of 150 cornea transplant units around the country. 'The entire process is carried out with the greatest respect', adds Mr Rabbetts. 'If we can get a donation that is handled with the integrity I would personally expect, then I'm happy.'
For Mr Rabbetts, the most surprising thing about his new role is witnessing the impact of a good reconstruction. 'It is amazing. You cannot tell,' he says. 'It is a real craft - one that I am slowly and surely learning.'
And the learning curve has been steep. 'I came from a totally different environment', he explains. 'In prison it's all uniforms and it runs like clockwork. Here you get a call and then it's all go. That has been difficult. Because you're beginning a new project and there are only eight other people like you in the country, sometimes it has been bewildering. But my understanding has increased and working closely with the mortuaries has helped.'
One of the most immediate jobs is raising staff awareness. In the past the issue has often been avoided through embarrassment and lack of knowledge.
'It is an emotive subject and you find yourself not asking the question for fear of offending people', says Mr Rabbetts. 'If you bring up the subject you are bound to be asked for advice and staff feel it's a can of worms because they don't know enough to answer those questions.
'It's about changing the culture to enable staff to ask those questions. And as long as everything is handled with sensitivity, discretion and honesty, then it comes across in an acceptable way.'
But it is a long process. For the next six months, Mr Rabbetts will work with every single ward in the hospital to ensure that the difficult questions are asked and donation rates increase.They may be in the early stages but perception is already changing and staff are already beginning to ask relatives about cornea donation. Since March referrals have increased, although retrievals currently remain the same.
Though it has been challenging, it has also been terrific experience for Mr Rabbetts. 'I now have a trust-wide remit so I spend a lot of time travelling to different hospitals and meeting people. 'I enjoy the responsibility and the freedom it gives me. Ethically, I enjoy the fact that transplantation creates a positive out of a very negative situation. That's what I strive to achieve.'
And having met recipients, Mr Rabbetts has witnessed the dramatic impact it can have. 'I can really see what a difference it makes to people's lives. One of our recipients actually got choked up talking about it, because he felt so grateful that somebody was able to help him. It was quite moving.'
Mr Rabbetts is enthusiastic about the project's future. 'We've already had a lot of positive responses from staff', he says. 'They are starting to get behind us and once we've got their support, there's nothing stopping this scheme becoming the absolute success it deserves to be.'
Cornea retrieval and transplant - the facts
- In the UK between 1 April 2004 and 31 March 2005 2,375 people had their sight restored through a cornea transplant - the highest number for eight years
- 90 per cent of transplants use corneas stored in eye banks in Bristol and Manchester
- Corneas are sent from other eye banks and hospitals throughout the UK for storage and subsequent distribution to more than 150 cornea transplant units
- The eye banks use special techniques to store corneas for up to four weeks
- Between 1 January and 31 March 2005 261 requests were made to access the Organ Donation Register: 27 per cent of all cornea donors were found to have registered their wishes on the ODR
- Patients who are precluded from donation include patients with HIV, hepatitis B, hepatitis C and syphilis, and those suffering from confusion, which may indicate diseases such as CJD or Parkinson's.