Effects of Eye Bank Donor Age Expansion on Corneal Endothelial Cell Density and Surgeon Tissue Acceptance

Abstract

Purpose: To investigate the effects of expansion in eye bank donor age from 75 to 80 years on corneal endothelial cell density (ECD) and surgeon acceptance rate of donated tissues. Methods: Conducted as a single-site retrospective analysis, the study examined 25,969 donor corneas from 2018 to 2022. After the increase in the donor age limit in August 2022, the sample included donors aged 2 to 75 years (n = 25,558) and 76 to 80 years (n = 411). Donor characteristics, corneal ECD, and tissue acceptance rates were compared across age groups stratified by 5-year intervals. Results: Increasing the donor age upper limit produced 411 more corneal donations, which resulted in 208 more surgeries. The average corneal ECD in donors between the ages of 71 and 75 years was 2349 cells/mm2 (95% CI, 2332–2367), and in donors between the ages of 76 and 80 years, the average corneal ECD was 2227 cells/mm2 (95% CI, 2159–2296). Our results demonstrated a lower average corneal ECD in the 76- to 80-year-old group in comparison with the 71- to 75-year-old group by 122 cells/mm2 (95% CI, 51–193, P < 0.001). Tissue from donors aged 71 to 75 years had a 48% surgeon acceptance rate, whereas tissue from those aged 76 to 80 years had a significantly lower 38% acceptance rate (P = 0.003). Conclusions: Corneas from donors of older ages are viable and suitable for use in transplant surgery but are significantly less likely to be selected by surgeons. Age bias by surgeons against older corneas is a possible reason for this finding and warrants further exploration.