# A nurse is preparing to care for a 60-year-old patient who has consented to corneal donation after death. Which action by the nurse demonstrates proper understanding of eye tissue donation protocols?

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> subject: Adult Health

## 문제

A nurse is preparing to care for a 60-year-old patient who has consented to corneal donation after death. Which action by the nurse demonstrates proper understanding of eye tissue donation protocols?

## 보기

1. Close the patient's eyelids and place ice packs directly on the eyes immediately after death
2. Wait 8-12 hours after death before notifying the eye bank to allow for proper family grieving time
3. Remove contact lenses immediately after death and irrigate the eyes with normal saline
4. Keep the patient's head elevated and eyes closed with moist gauze pads after death **✔ 정답**

**정답: 4**

## 해설

Proper eye tissue donation requires keeping the patient's head elevated and eyes closed with moist gauze pads after death to maintain tissue viability. Other options involve incorrect timing, inappropriate cooling, or potential damage.

## 심화 해설

Understanding Corneal Donation After Death

When a patient consents to corneal donation, the nurse's immediate actions after death are critical to preserve the viability of the tissue. Unlike solid organs, corneas do not require a continuous blood supply and can be recovered several hours after death, but they are extremely sensitive to environmental conditions. The primary goal is to protect the delicate endothelial cells from dehydration and damage.

Analysis of Correct and Incorrect Actions

The correct protocol focuses on maintaining a moist, protected environment for the eyes while keeping the head elevated to reduce postmortem edema and intraocular pressure, which can damage the corneal endothelium.

*   Correct Action (Option 4): Keeping the patient's head elevated and eyes closed with moist gauze pads. Elevating the head to approximately 30 degrees minimizes facial and conjunctival edema. Closing the eyelids and placing saline-moistened gauze pads over them prevents the corneal epithelium from drying out and creates a physical barrier against trauma. This action is a standard, evidence-based step in donor eye care as part of the broader management of a potential tissue donor .

*   Incorrect Action (Option 1): Closing the eyelids and placing ice packs directly on the eyes. While closing the eyes is correct, applying ice directly to the globe can cause thermal injury to the corneal endothelial cells, rendering the tissue unsuitable for transplantation. The goal is cooling, but it must be done gently and indirectly if at all, and never with direct ice application.

*   Incorrect Action (Option 2): Waiting 8-12 hours after death before notifying the eye bank. Timely notification is a cornerstone of the donation process. The eye bank must be contacted immediately or within a very short, pre-specified timeframe (usually within 1 hour) after death to determine suitability and coordinate recovery. Delaying notification by several hours can lead to tissue degradation and may exceed the permissible time for recovery, disrespecting the patient's gift and the family's wishes .

*   Incorrect Action (Option 3): Removing contact lenses immediately after death and irrigating the eyes with normal saline. If the patient was wearing contact lenses, they should be removed. However, irrigation of the eyes is not a standard protocol step and could introduce contaminants or cause mechanical damage to the corneal surface. The correct action after lens removal is to close the eyes and apply the moist gauze as described in the correct option.

Pathophysiology and Clinical Rationale

The corneal endothelium is a single layer of cells on the inner surface of the cornea that functions as a pump to maintain stromal deturgescence, which is essential for corneal transparency. After death, this pump mechanism ceases, and the cornea begins to swell. If the epithelium also dries out due to exposure, it becomes cloudy and sloughs off. These changes can rapidly degrade the quality of the tissue, making it unsuitable for transplantation. The simple interventions of elevating the head and applying moist gauze work to counteract these processes by reducing hydrostatic pressure and preventing desiccation, thereby preserving the precious tissue for a recipient. The management of a potential donor, even for tissues, is a critical care continuum that extends into the immediate post-death period .

## 임상 시나리오

Eye Tissue Donation: Immediate Postmortem Nursing Protocol

When a patient has consented to corneal donation, the nurse's actions in the first moments after death directly determine tissue viability. Corneas are avascular and survive by aqueous humor and tear film diffusion, making them uniquely vulnerable to environmental insult.

Step 1: Notify the Eye Bank

Contact the local eye bank immediately after death is pronounced. Provide the patient's identification, time of death, and medical history. Do not delay this call for family grieving; eye bank coordinators work alongside the family support process.

Step 2: Position the Patient

Elevate the head of the bed to a **30-degree angle**. This reduces postmortem facial and conjunctival edema, which can cloud the cornea and damage endothelial cells. Maintain this position until the recovery team arrives.

Step 3: Protect the Corneas

- **Close the eyelids gently.** Do not force closure if rigor mortis has begun; instead, proceed to the next step.

- **Apply sterile saline-moistened gauze pads** over the closed eyes. Ensure the gauze is damp but not dripping. This creates a moist chamber that prevents epithelial drying and mechanical trauma.

- **Do not remove contact lenses.** Leave them in place to act as a protective barrier. Removal risks corneal abrasion and introduces contaminants.

Critical Prohibitions

**Never apply ice directly to the eyes or globes.** Thermal injury from freezing destroys the delicate endothelial cell layer, which is non-regenerative and essential for corneal transparency. Cooling is achieved through ambient room temperature management, not direct application.

**Do not irrigate the eyes.** Irrigation with saline or any solution disrupts the natural tear film, introduces potential pathogens, and can cause mechanical sloughing of epithelial cells.

Step 4: Document and Communicate

Record the time of death, head elevation, eye care measures taken, and time of eye bank notification in the medical record. Communicate the donor status clearly to all staff during handoff to ensure continued protection of the tissue until recovery.

**Reference:** Eye Bank Association of America (EBAA) Medical Standards; AORN Guidelines for Perioperative Practice, Tissue Banking section.

## 핵심 개념

- **Corneal Endothelium** — The innermost single layer of cells on the cornea responsible for maintaining stromal deturgescence; highly sensitive to hypoxia and mechanical trauma.
- **Postmortem Edema** — Swelling of tissues after death due to fluid shifts and loss of cell membrane integrity; elevating the head reduces facial and conjunctival edema.
- **Moist Chamber Technique** — A method of eye preservation involving closing the eyelids and covering them with saline-moistened gauze to prevent epithelial drying.
- **Eye Bank** — An organization responsible for recovering, evaluating, processing, and distributing donor eye tissue for transplantation.
- **Thermal Injury** — Tissue damage caused by extreme temperatures; direct ice application can freeze and destroy delicate corneal endothelial cells.

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