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

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.

A Qualitative Study Using Semi-Structured Interviews: Comparing the Views of Palliative Care Unit Patients and Clinicians on Corneal Donation Discussions

Background: Blindness from corneal opacity accounts for 12% of cases of blindness worldwide. There is a severe shortage of corneas for donation worldwide for transplantation and research purposes. One group of individuals who could potentially be donors are those who die within the inpatient palliative care unit. The aims of the study were to 1. determine the frequency of corneal donation discussion; 2. determine whether inpatient palliative care unit patients and clinicians were aware of the potential for corneal donation discussions and 3. explore the attitudes and beliefs of inpatient palliative care unit patients and clinicians about corneal donation. Methods: An exploratory qualitative study was designed where inpatient palliative care unit patients and clinicians were invited to a semi-structured interview. A total of 46 face to face interviews were undertaken involving inpatient palliative care unit patients (20) and clinicians (26) in three major inpatient palliative care units in South Australia. Results: Very few patient participants were asked about corneal donations during their time in palliative care. Most inpatient palliative care unit clinicians did not bring up the topic as they felt other areas of care took precedence. Inpatient palliative care unit patients thought if inpatient palliative care unit clinicians did not raise the topic, then it was not important. Conclusions: Findings suggest that patients are receptive to discussing corneal donations, but few discussions are occurring. There were some differences between patient and clinician views, such as preference about who raises the possibility of donation and when the discussion might occur.

Canadian demand and access to corneal transplantation: a provincial comparison

To gather information from stakeholders involved in corneal donation and transplantation to inform discussion at the “National Consensus Forum on Improving Cornea Donation and Transplantation Access in Canada” held in February 2020, survey questions were posed to eye banks, transplanting ophthalmologists and organ donation organizations across Canada to learn more about demand, wait times, and access to tissue for transplant. The survey response rate was one hundred percent (100%) for eye banks and organ donation organizations while 64 percent (64%) of transplant ophthalmologists provided feedback. A number of opportunities for improvement were identified including: demand forecasting; infrastructure and strategies to align supply with demand; data collection and benchmarking of wait times for assessment and transplant to support consistency, equitability and transparency in access; and national collaboration in the development of a data strategy to accurately measure demand and access to cornea transplants in a consistent manner across all provinces to facilitate equity in access nationally.

Knowledge, Attitude and Awareness towards Corneal Donation in Aseer Region, Saudi Arabia

Background: Corneal transplantation is the mainstay procedure performed for sight restoration in patients with corneal blindness, which can be caused by infection, corneal dystrophy, degenerative disorders such as keratoconus or traumatic causes. Most corneal transplants in Saudi Arabia are performed using imported corneas. Aims: To determine the level of knowledge and awareness and the factors affecting corneal donation in Aseer region, Saudi Arabia. Subjects and Methods: A descriptive cross-sectional approach was used targeting the population of Aseer region aged 18 years and above. The data were collected using electronic self-administered questionnaire. The tool covered the participants’ biodemographic data, knowledge related questions and willingness of corneal donation and factors affecting such attitudes. Results: Of the 641 participants, 66.1% were males, 47.6% were in the age group 20 – 30 years and 19.2% claimed to have enough knowledge about corneal donation. The mean knowledge score (SD) was 2.13 (1.757) out of 8. Regarding participants’ attitude, 26.7% were willing to donate their own cornea. The willingness was significantly associated with good level of knowledge (p = 0.008). Females were more inclined to donate their corneas than males (30.9% vs 24.5%, p = 0.025). Conclusion: The study revealed a low level of knowledge of corneal donation in Aseer region, Saudi Arabia. Approximately one quarter of the participants reported willingness of corneal donation. Lack of knowledge was the main barrier, as it was reported by almost two thirds. Key words: Cornea, Donation, Awareness, Penetrating Keratoplasty, Saudi Arabia

Willingness of corneal donation and its associated factors among adult patients attending Gondar University Comprehensive and Specialized Hospital

Introduction Corneal transplantation is the only treatment option for corneal blindness to restore sight. However, there is a disproportionate imbalance between the demand and supply of corneal tissue in Ethiopia. This is because accessing corneal tissue is reliant on people who are willing to donate corneas after death. Objective This study aimed to assess the proportion of willingness to donate cornea and associated factors among adult patients attending at University of Gondar comprehensive and specialized hospital. Method Institutional based cross-sectional study was conducted from July 13 to July 28, 2020, through a face-to-face interview. A total of 451 samples were selected using systematic random sampling. The data were entered into Epidemiological information version 7 and exported to statistical package for social science version 20 for formal analysis. Variables with a P-value of < 0.20 in a bi-variable logistic regression were entered into the multivariable logistic regression and those variables with a p-value of < 0.05 were taken as statistically significant. The strength of association was shown using the odds ratio with a 95% confidence interval. Result A total of 408 adults participated in this study with a response rate of 90% and the proportion of willingness to donate cornea was 179(43.90%). Participants who had a religious belief in Christianity (AOR = 3.23 (95% CI: 1.09–9.57)) and good knowledge about corneal donation (AOR = 5.45(95%CI: 2.69–11.18)) were positively associated with the willingness of corneal donation. On the other side, the age group above 43 years (AOR = 0.31(95% CI: 0.11–0.89) was negatively associated with the willingness of corneal donation. Conclusion The proportion of willingness to donate cornea 43.9% among participants attending Gondar University Comprehensive and Specialized Hospital. Age group greater than 43 years, religion of Christianity and good knowledge were associated with the willingness of corneal donation.