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 donor cornea 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 clarity, a corneal transplant can sometimes offer a solution. Such a transplant requires eye tissue from a deceased donor, and for this,there is a waiting listin the Netherlands.
Untyped and typed corneas
By far the majority of 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, for example, necessary 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 from deceased donors available. Nevertheless, the planning of transplants sometimes has to be adjusted. This is because corneas have a limited shelf life and there are more donors in some months than in others. It can be difficult to find a donor cornea with the correct HLA typing, and therefore the waiting time for a typed cornea can be longer than for an untyped cornea.
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Discover how the tissue chain in the Netherlands is organized and which professionals work together from donor identification to transplantation.
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Emergency cases
In most cases, there is little urgency to perform the transplant. However, sometimes there is a need for haste and a corneal transplant is required as soon as possible to save the eye. 'Fortunately, there is a great system in the Netherlands 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 good cooperation 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 need surgery within 48 hours. The most common reason for an emergency corneal transplant is an impending perforation. 'That means that a hole in the cornea is threatening to form. If this happens, in almost half of the cases (47%) it is due to an infection of the cornea (infectious keratitis) that does not respond well to the usual medication, for example in the case of infections by bacteria or fungi from wearing soft contact lenses. These people do not have time to be on a waiting list and must be operated on as soon as possible to prevent perforation. With an emergency transplant, you can save a recipient from going blind in one eye,' says Rijneveld.
Storage by the eye bank
Corneas are managed centrally in the Netherlands by the two tissue banks Amnitrans EyeBank Rotterdam and ETB-BISLIFE. There, they are stored just below body temperature – between 31 and 34 degrees – in a small container with fluid containing, among other things, serum, antibiotics, and antifungal agents. The corneas swell slightly in this fluid and can be kept for 21 to 28 days. Before the corneas can be used for a transplant, they must first 'de-swell', a process that takes 2 to 3 days. For this, they are transferred to a different storage system, a so-called transport medium. The corneas are usable for about another week after they have been 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 a transplant. Rijneveld: 'That is why two emergency corneas are always available nationwide. They have already been transferred to a transport medium, so they can be used immediately for a transplant. With two of these corneas, we can actually cover all emergency requests.' Inge Uitendaal, an employee of allocation and crossover at the NTS, explains that at the NTS they keep track of which cornea, at which tissue bank, was converted and when. 'When an emergency cornea is used, we immediately inform the tissue banks that a new conversion procedure must be started. This way, we can ensure that there are always two emergency corneas available.'
Requesting a cornea online
Since 2021, a cornea allocation app developed by the NTS has been used to request donor tissue. 'Through this app, surgeons from the various hospitals can request a donor cornea. They register the recipient in the app and exactly what they want: a typed or untyped cornea, the surgical technique they want to perform, and on what date they want to operate. That date is always a bit in the future, at least a week and preferably a bit further away, so that the tissue banks have plenty of 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. Still, you can imagine that there are also disadvantages. For example, 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 planned operation 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.'
On the other hand, it also happens that a few corneas are left over if there are no emergency requests. 'It is calculated in such a way that patients with the most serious indication, an impending perforation, can always be helped so that we can avoid blindness. 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 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.'
Cornea transplants in numbers
Annually, around 40 emergency transplants are performed in the Netherlands. In 2023, 294 emergency corneas were available, of which 43 were transplanted, and in 2024, 290 were available, of which 38 were transplanted.
