Approval rates for corneal donation and the origin of donor tissue for transplantation at a university-based tertiary referral center with corneal subspecialization hosting a LIONS Eye Bank

Abstract

Background With the increasing demand for corneas, eye banks must optimize the tissue donation, collection, and selection process. This retrospective monocentric study analyzed the approval rates for corneal donation and the origin of and reasons for discarding donor corneas from 2010 to 2019. Methods Data included the number of deceased, approval or rejection by the family for corneal donation and contraindications. Corneal grafts were included from all deceased persons who were full-body and multi-organ donors at the Saarland University Medical Center (UKS) and from external institutions. Additional analyzed parameters included endothelial cell count (ECC), blood sample serology for infections, and conjunctival swab testing . Results A total of 1748 corneoscleral buttons were harvested from 10,265 deceased persons (17% with no contraindication) at the UKS between 2010 and 2019, with a consent rate of 23.3%. The number of keratoplasties increased from 136 in 2010 (15% of the deceased, total = 925) to 251 in 2019 (21%, total = 1214). Both the general and department-specific data showed similar percentages for corneal donation over the years, with intensive care and palliative units recently providing the most corneas. The increase in the number of corneas processed by the cornea bank over the years (368 in 2010 compared with 857 in 2019) was linked both to a better internal supply in 2010 (262, 71.2% of the total) compared with 2019 (519, 60.6%) and to an external supply by reinforcement of cooperation with external hospitals, including Luxembourg in 2010 (106, 28.8% of the total) compared with 2019 (338, 39.4%). A total of 195 of 377 corneas (52%) were discarded in 2009 compared with 260 out of 715 (36%) in 2019. The main reasons for discarding were low ECC (36% of discarded corneas in 2009; 11% in 2019), positive conjunctival swab (11% in 2009; 13% in 2019), and blood sample serology (6% in 2009 and in 2019). Conclusion Despite an increasing number of donors, the demand for corneas is still rising. Improved cooperation with internal departments and with external clinics has led to an increasing number of explanted corneas. The main reason for discarding corneas was low ECC, followed by a positive conjunctival swab for fungal or bacterial contamination and serology. Increased donation rates and continued improvements in collection and selection processes are necessary to cover the high demand for corneas.

The Impact of the First COVID-19 Lockdown Period on the Inpatient and Outpatient Volume of a University Based Tertiary Referral Center with Corneal Subspecialization in Germany

“…Thus, we decided not to interrupt our eye bank activities, since tissue was available and must not be discarded. 36 We recommended continuing the collection of all available corneas, as long as the appropriate precautions were taken. Only tissue from donors with confirmed SARS-CoV-2 infection or with a high clinical suspicion of COVID-19 should not be selected for transplantation purposes.…”

Descemet Membrane Endothelial Keratoplasty after failed penetrating keratoplasty – Case series and review of the literature

“…In eyes with a history of a herpetic disease or unclear endothelial decompensation compatible with herpetic background, additional medication with ganciclovir eye ointment (5 times a day for 6 weeks, then 2 times a day) and systemic aciclovir (400 mg 5 times a day for 6 weeks, then 2 times daily for at least a year) was prescribed. Donor tissues were collected, cultured, and provided by the LIONS eye bank Saar-Lor-Lux; Trier/Westpfalz, our on-site eye bank at the Saarland University Medical Center in Homburg/Saar [11,12].…”

Indications and Results of Emergency Penetrating Keratoplasty With Simultaneous Cataract Surgery (“Triple-PKP à Chaud”)

“…3,4 The tissue was approved for transplantation in the absence of contraindications. 5 Triple-PKP à chaud was performed under general anesthesia with controlled arterial hypotension. For intraocular lens calculation, we referred to the axial length and the corneal power of the healthy fellow eye provided that amblyopia was ruled out to avoid refractive surprises.…”