Ethics in Eye Banking: Understanding Professional Attitudes Toward Industry Changes

Abstract

Purpose: To describe the ethical attitudes of corneal surgeons and eye bank leadership toward for-profit entities in corneal donation, processing, and distribution. Methods: Fifty postfellowship corneal surgeons practicing in the United States and 25 eye bank leaders (eg, eye bank directors, CEOs, or presidents) for the Eye Bank Association of America–accredited eye banks completed a 22-question interview, focusing on corneal donation industry changes, including the entry of for-profit institutions. Results: Most participants in both study groups agreed that they have concerns with the entry of for-profit businesses into eye banking (62% corneal surgeons, 68% eye bank leadership), although physicians partnered with a for-profit corneal processor were significantly more likely to have no concerns with the entry of for-profits into eye banking than corneal surgeons partnered with a nonprofit processor (P = 0.04). The most frequently identified concerns with the entry of for-profit businesses into corneal banking were the hypothetical loss of donor trust (56% corneal surgeons, 64% eye bank leadership, P = 0.04) and the potential exploitation of donor generosity (72% corneal surgeons, 60% eye bank leadership). Qualitative theme analysis suggests that both study groups may view increased research/innovation as a potential benefit (64% corneal surgeons, 66% eye bank leadership) of for-profits in eye banking. Conclusions: Key stakeholders in eye banking do hold relevant ethical beliefs toward recent industry changes, and these attitudes should be considered in the future creation of the ethical corneal donation policy. Further research is needed to assess the attitudes of potential donors and donor families.

Do Eye Bank Models and Competitive Practice Affect International Cornea Allocation?

“…5 All but one EB organization in the world functions as a nonprofit organization 6 ; however, since for-profit emergence in 2016, 6 such profit models have been, and remain, widely contested in the eye tissue and eye care space. 7–9 In addition, we also note that third-party distributors (brokers) and transplant facilities may or may not be for-profit.…”

Corneal supply and the use of technology to reduce its demand: A review

“…Profiteering from end‐of‐life donations is widely condemned, 18,20 and illegal in many jurisdictions 21 . Therefore, eye banks are universally non‐profit‐organisations.…”

“…However, this paradigm changed when a USA eye bank split their model in 2016 into a non‐profit recovery arm that subsequently transferred the donation to their spin‐off ‘for‐profit partner’ 22 with profits transferred to shareholders 9,17 . Since inception, this model has been globally condemned in the eye tissue and eye care field 20,23–25 . Its emergence is at odds with the wider eye tissue and eye care sector, and does not meet the recommendations outlined in The Barcelona Principles, 26 the GAEBA Commercialisation Statement 27 and the ICO Statement of 2017 28 .…”

Empirical and Normative Research in Ethics in Eye Banking

“…10 The entry of for-profit entities into eye banking in the United States is a complex issue with ethical implications. Empirical ethics research, such as that by Ahmad et al (2020), helps to identify current perceptions of this contentious issue. However, determining the ethics of for-profit entities in eye banking requires normative ethics research.…”

“…Ahmad et al 1 reported the results of a well-conducted survey of practicing cornea specialists and nonphysician eye bank leaders regarding the entrance of for-profit entities into eye banking in the United States. They identified several concerns that are held by corneal surgeons and eye bank leaders and provided interesting findings regarding differences in beliefs and attitudes between and within each group.…”