By Madelyn Beck for WyoFile and Rae Ellen Bichell for KFF Health News.
Broadcast version by Kathleen Shannon for Wyoming News Service reporting for the KFF Health News-Public News Service Collaboration

William Lopez remembers clearly the day in June 2017 when he says he was asked to call the spouse of a college friend who had just died and ask for her eyes.

The spouse hadn’t responded to calls from other employees at the Rocky Mountain Lions Eye Bank, he said. As Lopez recalled, his supervisor thought a friend’s personal number would have more success.

Lopez refused. “I went for a walk,” he said.

Even without Lopez’s help, the eye bank that procures corneas from deceased donors in Wyoming and Colorado eventually collected his friend’s corneas, Lopez said. Lopez, who had entered the field to help people, became increasingly disillusioned during his three years working with the eye bank, despite rising from a technician to the distribution manager, and ultimately quit.

Checking the “donor” box on a driver’s license application, people may picture their heart, kidneys, or other organs saving another person’s life should the worst happen.

They are less likely to consider that tissues — corneas, tendons, bone marrow, skin, bone — are also covered by that checked box. In fact, donated tissues are collected much more frequently than organs, and corneas are the most commonly transplanted body part in the U.S., with nearly 51,000 transplants last year, according to the Eye Bank Association of America.

Organ and tissue donations are guided by different rules, with less transparency and what critics identify as more self-policing in the tissue donation industry. In Wyoming and Colorado, where the Rocky Mountain Lions Eye Bank estimates it collects eye tissue from about 2,500 deceased donors a year, that has contributed to a tense work environment resulting in damaged or wasted tissues due to accidents, four former eye bank employees say.

“I think there’s an urgent need for stricter oversight of the donation process in general, particularly for eye and tissue banks,” said Janell Lewis, who worked at the Rocky Mountain Lions Eye Bank for 12 years, managing public relations and overseeing fundraising before she quit in February 2023.

John Lohmeier, executive director of the Rocky Mountain Lions Eye Bank, declined to be interviewed for this article. In a prepared statement, he said he couldn’t comment on personnel matters or specific incidents raised by the former employees.

But generally, he wrote, “there are internal procedures that have been in place and continue to be followed to investigate and/or report any incident that would impact health and safety concerns.”

Lewis, Lopez, and two other former eye bank employees recalled one or more of the following problems during their time at Rocky Mountain Lions Eye Bank:

• Removal of eye tissue from the wrong body


• Damage or destruction of corneas due to improper removal


• Removal of corneas from a donor with a high-risk family history that could endanger a transplant recipient


• Lack of transparency about whether errors were being reported to federal agencies


• Pressuring and bullying of technicians


• High turnover and brief training of low-paid and inexperienced technicians

The Windshield of the Eye


The cornea is considered the windshield of the eye. It is a clear dome that protects the eye from contaminants, maintains fluid balance, and filters light. Recipients of cornea donations typically need transplants because of trauma, infection, or other conditions that cause blindness or blurred or cloudy vision.


The Rocky Mountain Lions Eye Bank is one of about 60 eye banks operating in the U.S., which leads the world in corneal transplants. New technicians often arrive at the eye bank untrained, sometimes with only a high school diploma, to perform the grim job of removing corneas from recently deceased corpses for about the same wages many fast-food workers earn.


But what eye bank technicians may lack in education and training, they generally make up for with a strong belief in the mission, according to the former employees. They said they joined the Rocky Mountain Lions Eye Bank because they wanted to help restore people’s sight.


The nonprofit employs about 70 people across Colorado and Wyoming, according to a tax filing submitted in 2023. Those records also show a net income of less than $1 million and more than $16 million in assets. Lohmeier was paid about $142,000.


Organs vs. Tissue


Organ donations fall under the purview of the Health Resources and Services Administration, and public data details performance and financial transaction records of organ procurement groups. Tissue donation is regulated by the Food and Drug Administration, as well as national industry groups, and tissue bank transactions, performance, and outcomes are not available to the public.


There’s no reason tissues and organs should be treated differently, said Robert Dickson, medical director for the Washtenaw County Tuberculosis Clinic in Michigan. A patient in his county died from a bone graft contaminated with tuberculosis just a couple of years after a contaminated bone graft killed eight other patients.


He compared the tissue regulatory environment to the Wild West and called it a major public health concern.


“It’s fundamentally no different from an organ transplant. You’re taking tissue from one deceased patient and putting it into a living recipient. But it is not regulated and not tested as rigorously,” he said.

Marc Pearce, president and CEO of the American Association of Tissue Banks, said such cases are very rare.


“We don’t believe that we’ve proven ourselves to be not capable of regulating ourselves,” he said.


FDA officials disagree that the tissue industry is largely self-regulated, pointing to federal rules that require certain organizations to register with the agency and provide a list of human cells or tissues they recover, store, or distribute.


The rules set donor eligibility requirements, and the agency inspects tissue establishments, including eye banks, said spokesperson Carly Pflaum.


“The FDA has implemented a tiered risk-based approach for the regulation of human cell, tissue and cellular and tissue-based products,” Pflaum wrote.


KFF Health News and WyoFile months ago requested reports of adverse events associated with the Rocky Mountain Lions Eye Bank, but the FDA has yet to provide them. FDA dashboards show the eye bank has not issued a recall since 2017, and inspections since at least 2009 have not resulted in any official action.


The tissue industry is largely self-monitored and the performance of eye banks is tracked internally, whereas the federal government publishes annual performance reports for organ procurement groups. Health care providers are not required to report to the FDA adverse events resulting from tissue transplants.


Organ transplant providers are required to report safety events in recipients within 72 hours to the Organ Procurement and Transplantation Network, which operates under contract with the U.S. Department of Health and Human Services. That includes an organ going unused because it was delivered to the wrong location. They have 24 hours if, for example, the recipient gets an infection or disease that may have been from the new organ.


Other countries have public registries detailing the outcomes of corneal transplants, including Australia, the United Kingdom, and Sweden. A similar registry in the U.S. could help monitor outcomes for patients and identify adverse events from transplant procedures, eye doctors and researchers wrote in the journal Ophthalmology Science.


Tissue bank industry groups are responsible for much of the oversight of their dues-paying members. Transplanting surgeons may report adverse reactions to the tissue bank, which generally then conducts a review and submits a report to the FDA and the Eye Bank Association of America or the American Association of Tissue Banks.


Nearly all eye banks in the U.S. are members of the Eye Bank Association of America, which inspects member banks at least every three years as part of its accreditation process, but such inspection reports aren’t publicly available. Safety is paramount, association president Kevin Corcoran said, and the association’s medical standards require eye banks to request patient outcome information from transplanting surgeons a few months after surgery.


“We want to make sure we don’t have an eye bank that is slipping in their performance or failing to recover tissue,” he said. He declined to comment on any individual eye bank’s performance or release quality or transplantation data, complaints filed, or investigations undertaken.


No investigations have resulted in corrective action, he said, in the 13 years he has been at the association. The Rocky Mountain Lions Eye Bank is an accredited member of the association.


Balancing Mission and Stress


Several of the former employees were hesitant to speak about the Rocky Mountain Lions Eye Bank because they didn’t want to sully the reputation of an industry they believe is essential for improving people’s lives and honoring the wishes of the dead.


But they described a high-pressure environment that they said led to many of their colleagues leaving and errors that reduced the number of successful retrievals.

Mackenzie Urban started recovering corneas as a technician for the eye bank in 2019 after finishing her bachelor’s degree. She saw it as a temporary job as she applied for medical school. But within a year of recovering her first cornea, she said, enough employees had left that she became the senior recovery technician and was training others.


She used limes for the training, guiding her students on how to use a scalpel to remove the peel without nicking the fruit beneath. Success meant lifting the peel off the lime without any juice spilling out.


“If you’re stressed, you’re going to shake,” Urban said.


Outside factors can compound the challenges of performing the delicate procedure. Maybe the coroner had drawn fluid from beneath the cornea, making collection much trickier, she said. After a person has been dead for about 24 hours, the eyes tend to deflate to the point of uselessness, adding time pressure to collecting donations, Urban said.


Sometimes, Urban said, another technician would be working on a body simultaneously, so that the entire body was moving around while she was trying to do the delicate procedure.


Interactions with grieving families could be intense, too. Sometimes, families would hug her, thankful that something good would come of their loss. Other times, they were hostile, such as the time one relative of a potential donor told her to “Cut your own f****** eyes out, you b****,” she recalled.


Urban appreciates the work the eye bank performs and doesn’t regret her time there. She said she respected that “they had a real commitment to serving the community and keeping prices low.” (It’s illegal to sell human body parts for transplant, but companies get reimbursed varying amounts for the expenses of harvesting, preparing, and shipping tissues.)


But the workplace culture made it untenable for her, she said. For example, Urban said, she was reprimanded and told that she needed to “buck up or get out” because she declined to harvest corneas from a person who died from an unknown cause. The body was purple from the neck down, covered in oozing blisters and with opaque flecks in the eyes, Urban said.


When Irish Eyes Are Smiling


The Rocky Mountain Lions Eye Bank has international contracts and ships corneas to Japan and the U.K., among other destinations. It became the exclusive eye tissue provider for Ireland when that country stopped collecting corneas over fears of transmitting mad cow disease. That means anyone who has received a cornea transplant in Ireland in the past two decades likely now sees thanks to a person who died in Colorado or Wyoming, according to the Irish Blood Transfusion Service.


Lohmeier, the eye bank CEO, said local needs are prioritized for donations, while international shipments help fulfill the eye bank’s mission and “ensure that all viable corneas are transplanted, giving the gift of restored sight.”


The U.S. is one of the few nations with a cornea surplus. FDA inspection reports confirmed that the Rocky Mountain Lions Eye Bank procures more tissue than its geographic area can use.

The demand for international orders contributed to the high-pressure environment, Lopez said.


Employee turnover and the stress of the job resulted in the collection of corneas of poor quality, Lewis said. Local hospitals inquired about why so many corneas weren’t being transplanted, she added.


The leading reason was recovery errors that damaged the tissue, Lewis said.


Lohmeier disagreed that there was a significant decline in corneas being placed. “We do not believe this description accurately reflects the state of corneal recovery and transplants,” he said.


Internal records showed that about half of recovered corneas in November 2022 had moderate to heavy stress. The Eye Bank Association of America does not have comparable national data. The closest figure it tracks is the proportion, among tissues that were prepared but not transplanted, that were unable to be transplanted because of damage during processing; in 2022, it was a quarter.


Ashi Moore, who used to lead the Rocky Mountain Lions Eye Bank’s quality assurance department, said she once filed a report to the FDA after a donor’s eye tissues were removed despite a family history indicating a high risk of Creutzfeldt-Jakob disease. The disease, which should have been disqualifying for donation purposes, is a fatal brain disorder that can be transmitted through infected tissue.


The issue was caught before the corneas could be placed in someone else’s eyes, but it should never have gotten to the point that the corneas were removed from the body, Moore said.


At least once, a technician retrieved corneas from the wrong body, according to Moore and other former employees. (The FDA was unable to provide records to confirm that report by publication.) Moore said she should have been told about the case of mistaken identity immediately but said she wasn’t made aware of it until after the eye bank’s leaders handled the situation themselves.


She said she couldn’t find evidence that the eye bank had reported the error to the FDA. It was one of the major reasons she decided to leave the organization, though she had derived a strong sense of purpose from working at the eye bank, she said.


When Lewis resigned, officials at the nonprofit eye bank offered her $5,000 to sign a severance agreement with a nondisparagement provision. She declined.


Lewis said she would like to see states hold tissue recovery agencies to the same standards as other organizations that handle corpses, such as hospitals, coroners, and funeral homes. And if they fail to meet those standards, they need to be held accountable to build public trust, she said.


Lewis’ and Lopez’s negative experiences with the eye bank had another consequence. Each decided they no longer wanted to be an organ or tissue donor.


“After witnessing and experiencing so many issues, I no longer feel comfortable with the potential of my family having to go through that when the time comes,” Lewis said.




Madelyn Beck and Rae Ellen Bichell wrote this story for KFF Health News.


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Holiday travel is in full swing and for many, so is the stress. The American Heart Association of Missouri has health tips for anyone with heart disease or other chronic health conditions.

Medical professionals emphasized holiday travel requires planning. They suggested starting with a checklist: Consult your doctor, stock up on medications and prepare any medical equipment.

Dr. Georges Chahoud, cardiologist with SSM Health and board president for the American Heart Association-Metro St. Louis, offered advice for travelers with pacemakers and similar devices.

"If they are traveling, especially on an airplane, they have to make sure that they have enough time because they have to go through a special security check, since they have those devices," Chahoud explained. "It's recommended that they don't go through the metal detector; they can be 'wanded.'"

The American Heart Association also noted flights over four hours increase blood clot risk, so wearing compression socks is recommended. Research shows 6% to 7% of travelers deal with some kind of illness during or after their trips.

In a Heart Association survey, 69% of respondents said they struggle with eating healthily during the holiday season.

Chahoud, who is regional director of the Heart Failure Clinical program at SSM Health-St. Louis and Southern Illinois, and director of Cardiology Services at SSM Health-St. Joseph Hospital in Lake St. Louis, emphasized the problem can be exacerbated if you are traveling.

"They may indulge more in alcohol use, which can induce some heart problems, especially with irregular heart rhythm and A-fib," Chahoud pointed out. "Diet is quite important for patients with heart failure, especially as it pertains to those patients that don't watch the salt in their food."

He stressed the importance of seeking immediate medical attention if you experience symptoms of heart issues, such as chest pain or shortness of breath. Check for medical facilities available at your destination and know your health insurance coverage.

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Maryland is facing a significant shortage of behavioral health professionals and a new report from the Maryland Health Care Commission offered some suggestions to fix the problem.

All but two counties in Maryland are labeled as a partial or complete mental health shortage area. Years of underinvestment and high rates of burnout for behavioral health specialists has caught up with the state. The report found a 50% shortage in the number of professionals needed to adequately care for Maryland's population.

Tiara Fennell, assistant clinical professor and clinic director of the Center for Healthy Families at the University of Maryland-College Park, said behavioral health professionals have long been undervalued, which can lead to burnout. The COVID-19 pandemic, she added, is also partly to blame.

"A lot of it has nothing to do with their intent or their desire to help people," Fennell explained. "It's because of their desire to want to be able to take care of themselves. One of the major things that is a deterrent is people not getting paid enough."

The report showed 45% of behavioral health professionals currently working in Maryland are expected to either retire, leave the state or exit the profession in the next five years.

To tackle the shortage, the Maryland General Assembly passed a Behavioral Health Workforce Investment Fund in 2023 and commissioned a report on how to spend the money. The report recommended focusing on investments in behavioral health. It suggested implementing more "earn while you learn" programs, with paid apprenticeships, fellowships and stipends to lessen the costs of college. More flexible schedules and mentorship programs were also recommended to address the nonfinancial issues of burnout.

Fennell pointed out many behavioral health internships are unpaid and she believes efforts to increase pay and reduce work loads for these professionals will boost recruitment and retention.

"That would make a huge difference getting people interested in this type of work," Fennell contended. "Also, maintaining that workforce -- and having people want to be there long-term, and spend the majority of their employment history -- however long that will be, working in this space."

The Behavioral Health Workforce Investment Fund will allocate more than $148 million over the next five years.


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The excitement of the holiday season is celebrated with family get-togethers. But for Alzheimer's patients, large groups can produce fear and confusion. The disease causes brain cell deterioration and the ability to rapidly process information diminishes daily.

Macie P. Smith, a licensed social worker and gerontologist, advised paying attention to nonverbal cues when a patient appears agitated.

"If you're going to have a small, intimate gathering, I also recommend doing name tags," Smith suggested. "Go ahead and put the person's name and the relationship to the person on the shirt, so that way they won't have to guess and wonder and try to figure out who this person is. It just helps with the ease of engagement."

Reminiscing over the family photo album is a traditional holiday favorite. Despite the best intentions, Smith explained, asking an Alzheimer's patient to identify a relative can be frustrating. The questions cause them to use brain cells that are severely impacted and could produce combativeness and aggression. She recommended singing or playing music as better choices.

The Alzheimer's Association Illinois chapter reported 311,000 caregivers cook meals, assist with basic hygiene and monitor medication intake. The needs of patients are unpredictable, leaving them with sporadic break times.

Additional stress from gift shopping and work obligations underlines the importance for a caregiver to routinely nurture their physical and mental well-being. Smith advised using a calendar for scheduling enjoyable activities.

"I've asked caregivers, 'So, what do you like to do?' They don't know, or they don't remember, because they have been so engulfed with caring for someone else and depleting everything that they've had, they've lost a sense of self," Smith observed.

For unmanageable situations, Smith recommends contacting a professional respite care service through your local department on aging. The agencies offer vouchers to pay a certified person to sit with your loved one. Another choice is asking for help from a church member, trusted neighbor or a Medicare or Medicaid-funded adult day service.


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