Determining the willingness of Australians to export their corneas on death

Abstract

Background 12.7 million people await a corneal transplant, but 53% are without access to corneal tissue. Sharing corneal tissue across nations can provide some access, however the willingness of export populations, like Australians, to export their donation on death, has never been evaluated. Our research samples the Australian population, determining their willingness to export. Materials and method We conducted e-surveys. N = 1044 Australians participated. The sample represented the Australian population, based on population demographics. Chi-Square and bivariate correlation coefficients examined associations between categorical variables, with a sample size of N = 1044, power of 0.80, and alpha of p = 0.05. Outcome measures were based on population sampling, by exploring willingness export, through the e-survey method. Results 38% (n = 397) of respondents said yes to exportation, 23.8% (n = 248) said no, and 38.2% (n = 399) were undecided. We found no relationship between willingness to export and general demographics, though those registered on the Donatelife Register (p = < .001), and those already willing to donate their eyes (p = < .001) were significantly more willing to export. Discussion More Australians are willing to export their corneas than not, though a significant portion remain undecided. The Donatelife Register, and donation awareness, are key components of respondent decision making. Therefore, the provision of information about exportation prior to, and at the point-of-donation, is essential for assisting Australian’s to decide to export or not. Further examination and development of consent-for-export systems are necessary before routine exportation is undertaken.

Examining Corneal Tissue Exportation Fee and Its Impact on Equitable Allocation

“…Further work is needed in this area particularly to ascertain the impact of current fee methods and their continuation, cessation, or adaptation by both export and import nations and how they may or may not affect service sustainability, corneal access, recovery, allocation, recipient wait times, and donor willingness to support. 7–11…”

“…Further work is needed in this area particularly to ascertain the impact of current fee methods and their continuation, cessation, or adaptation by both export and import nations and how they may or may not affect service sustainability, corneal access, recovery, allocation, recipient wait times, and donor willingness to support. [7][8][9][10][11] Although factors such as currency exchange rates or freight and logistics will change (depending on the physical distance between the exporter and importer and the fees charged by the freight companies for those routes), all other costs incurred by the individual eye bank were determined by that individual eye bank (eg, what storage method they used and the cost points on their consumables). This is influenced by the jurisdiction the eye bank is located (eg, wages will be affected by the cost of living and wage laws in that jurisdiction) and the impact of inflation.…”

Corneal supply and the use of technology to reduce its demand: A review

“…It is not as simple as improving access to other surgical services, for example, cataract surgery. This reflects that the supply of corneas is influenced by a population's willingness to donate on their death 32 . This is also compounded by services and resources available to the eye bank and/or partner transplant coordination agencies to develop and sustain donation awareness campaigns, conduct the consent process at the point of death with the next‐of‐kin and perform the recovery, processing and allocation steps (e.g., transportation for the cornea).…”

“…Decisions to export and import require careful planning, consideration and checks on both sides of the exchange. For example, are the donors consented for export, 31,32 does the export nation's eye banking practice meet the import nations expectations and standards, 29,30 does the export nation's donor population pose a contraindication risk in comparison to other potential export nations or the domestic population, and can the exporter demonstrate that their action does not impact their own access 33 . Conversely, the import activity should be part of a wider capacity development program whereby the importation is one stage in a larger strategy to increase domestic access, with the ultimate aim of importation ceasing in the long‐term 26,27,29,30,34,35 .…”

Do Corneal Tissue Providers Inform Their Community That They Export Corneas? An Audit of Publicly Available Sector Websites

“…Nor is there any indication at the national level that donors are uniformly informed or consented-for-export at the point of their donation. 11,12 There has been no research published to indicate if and how exporting eye banks and distributors currently provide information to their donors or the public about their organization's export participation. 10 Finally, there is no understanding of the current degree of transparency by export organizations about their activities nor the gaps in existing publicly available information that requires address.…”