Emergency corneal transplant: a unique system in the Netherlands
Sometimes an eye can only be saved by an emergency corneal transplant. Fortunately, in the Netherlands, it is possible to receive a cornea from a donor within 24 hours. But how does that work?
28 april 2026
Annemiek Rijneveld (former ophthalmologist and medical advisor at tissue bank ETB-BISLIFE) and Inge Uitendaal (allocation and crossover employee at the NTS) explain.
When the cornea is deformed or loses its clarity, a corneal transplant can sometimes offer a solution. Such a transplant requires eye tissue from a deceased donor and for thisthere is a waiting listin the Netherlands.
Untyped and typed corneas
By far the most patients do not need a specific type of donor cornea and are placed on the 'regular' waiting list for a so-called untyped cornea. In addition, there is a waiting list for patients who do need a specific type of cornea (about 3% of all corneal transplants). These are corneas with a specific identity card for the cells in your body (human leukocyte antigen (HLA) typing). Such a typed donor cornea is necessary, for example, for patients who have blood vessels in their cornea. That is rare, because normally there are no blood vessels in the cornea. It is also possible that the ophthalmologist wants to use a typed donor cornea after previous rejection.
The ophthalmologist determines, in consultation with the patient, the moment a cornea is needed and requests it. In the Netherlands, there are usually enough corneas available from deceased donors. Even so, the scheduling of transplants sometimes needs to be adjusted. This is because corneas have a limited shelf life and some months have more donors than others. However, it can be difficult to find a donor cornea with the right HLA typing, and as a result, the waiting time for a typed cornea can be longer than for an untyped cornea.
Tissue chain: donation and transplantation
Discover how the tissue chain is organized in the Netherlands and which professionals work together from donor identification to transplantation.
More about the tissue chain
Emergencies
In most cases, there is little urgency to perform the transplant. However, sometimes there is haste and a corneal transplant is needed as quickly as possible to save the eye. 'Fortunately, the Netherlands has a wonderful system that allows an emergency transplant to take place very quickly,' says Annemiek Rijneveld, former ophthalmologist and medical advisor at tissue bank ETB-BISLIFE in Haarlem. 'This is possible thanks to a close collaboration between the NTS, the tissue banks in the Netherlands, and transplanting ophthalmologists.'
A donor cornea used for an emergency transplant is also called an emergency cornea. These emergency corneas are used for Dutch patients who require surgery within 48 hours. The most common reason for an emergency corneal transplant is an impending perforation. 'This means that a hole in the cornea is threatening to develop. When this happens, in almost half of the cases (47%) it is caused by a corneal infection (infectious keratitis) that does not respond well to the usual medication, for example in infections by bacteria or fungi when wearing soft contact lenses. These people do not have time to wait on the waiting list and must be operated on as soon as possible to prevent perforation. With an emergency transplant, you can prevent a recipient from going blind in one eye,' says Rijneveld.
Storage by the eye bank
Corneas are centrally managed in the Netherlands by the two tissue banks Amnitrans EyeBank Rotterdam and ETB-BISLIFE. There, they are stored at just under body temperature – between 31 and 34 degrees – in a vial of fluid containing, among other things, serum, antibiotics, and antifungal agents. The corneas swell slightly in this fluid and can be kept this way for 21 to 28 days. Before the corneas can be used for a transplantation, they must first 'de-swell', a process that takes 2 to 3 days. To this end, they are transferred to another storage system, a so-called transport medium. The corneas can be used for about a week after being transferred to a transport medium.
But what happens if a cornea is needed urgently? After all, there is no time to wait two to three days for transplantation in that case. Rijneveld: 'That is why there are always two emergency corneas available nationwide. These have already been transferred to a transport medium so that they can be used immediately for a transplantation. With two of these corneas, we can actually cover all emergency requests.' Inge Uitendaal, allocation and cross-over employee at the NTS, explains that the NTS keeps track of which cornea was converted at which tissue bank and when. 'When an emergency cornea is used, we immediately inform the tissue banks that a new conversion procedure must be started. This is how we ensure that there are always two emergency corneas available.'
Requesting a cornea online
Since 2021, requesting donor tissue has been done using a cornea allocation app developed by the NTS. 'Through this app, surgeons from the various hospitals can request a donor cornea. They register the recipient in the app and what they precisely want: a typed or untyped cornea, the surgical technique they wish to perform, and on which date they want to operate. That date is always a bit in the future, at least a week and preferably a bit further out, so that the tissue banks have ample time to make an offer. They can also send requests for emergency corneas via this app. The application then immediately shows which emergency cornea is available,' says Uitendaal.
Ethical dilemma
The procedure for emergency corneas works very well. Yet you can imagine that there are also disadvantages. For instance, it could happen that at a certain moment more than two patients urgently need a cornea. What happens to that third patient then? 'Then an untyped cornea can be used that was actually intended for another patient,' says Rijneveld. 'A scheduled surgery would then have to be postponed for a few days. That is not a desirable situation, because someone who has prepared for that cannot be operated on immediately, but fortunately this has not happened in recent years.'
Conversely, it also happens that a few corneas are left over when there are no emergency requests. 'It has been calculated in such a way that patients with the most severe indication, an impending perforation, can always be helped so that blindness can be avoided. As far as I am concerned, saving an eye far outweighs having a cornea left over,' says Rijneveld. 'For patients, their loved ones, and the surviving relatives of donors, it is especially very important to know that everything is being done in the Netherlands to give every cornea a good destination.'
Corneal transplantations in numbers
Every year in the Netherlands around 40 emergency transplantations are performed. In 2023, there were 294 emergency corneas available, of which 43 were transplanted, and in 2024 there were 290 available, of which 38 were transplanted.
