ABSTRACT
Understanding patients' wishes regarding organ and tissue donation is an important aspect of advance care planning (ACP). Many patients with life-limiting illnesses are still eligible to be corneal donors. A quality improvement (QI) approach has promoted a positive change in culture at an inpatient hospice, making the discussion of patients' wishes on corneal donation the norm. This cultural change led to a sustained high rate of such discussions, despite the multitude of challenges presented by the COVID-19 pandemic.Copyright © Royal College of Physicians 2023. All rights reserved.
ABSTRACT
Purpose:The purpose of this study was to assess the impact of ongoing waves of the COVID-19 pandemic and resulting guidelines on the corneal donor pool with resumption of clinical operations.Methods:A retrospective analysis of donors deemed eligible for corneal transplantation at an eye bank from July 1, 2020, through December 31, 2021. Donors ineligible due to meeting Eye Bank Association of America (EBAA) COVID-19 guidelines or a positive postmortem COVID-19 testing were examined. The correlation between COVID-19 rule outs and state COVID positivity was calculated. The number of scheduled surgeries, suitable corneas, imports, and international exports was compared with a pre-COVID period. Postmortem testing was reduced for the final 5 months of the study, and numbers were compared before and after the policy change.Results:2.85% of referrals to the eye bank were ruled out because of EBAA guidelines. 3.2% of postmortem tests were positive or indeterminate resulting in an ineligible tissue donor (0.42% of referrals). Over the 18-month period, there was a 4.30% shortage of suitable corneas compared with transplantation procedures. There was a significant correlation between postmortem testing and state COVID-19 positivity (r = 0.37, P <0.01), but not with EBAA guidelines (r = 0.19, P = 0.07). When postmortem testing was reduced, significantly more corneas were exported internationally.Conclusions:Although corneal transplant procedures were back to normal levels, there was a shortage of suitable corneal tissue. The discontinuation of postmortem testing was associated with a significant increase in international exports of corneal donor tissue. © 2023 Lippincott Williams and Wilkins. All rights reserved.
ABSTRACT
Purpose : To evaluate the impact of the covid-19 pandemic and the safety of the corneal donation process in an Eye Bank in Southern Brazil. Methods : This is a cross-sectional, observational, retrospective study involving 771 potential corneal donors and their respective RT-PCR COVID-19 results. The tests were performed by collecting secretions from the oropharynx and nasopharynx and processed in a laboratory at the University Hospital of Londrina-PR, from March 2020 to November 2021. The individuals were submitted to a complementary check list to the traditional one for clinical and epidemiological screening of potential corneal donors against coronavirus (SARS-Cov2). Patients not tested for COVID-19 in this first step were excluded using the main clinical screening criteria already routinely used. The criteria used for further validation of potential donors were: donor who had COVID-19 with complete remission of symptoms for more than 28 days, donor with no clinical suspicion, and no suspected or confirmed contact of COVID-19. Donors diagnosed with COVID-19, donor with COVID-19 suspected by clinical and epidemiological evaluation, contacts of suspected or confirmed COVID-19 less than 14 days ago, and donor with clinical suspicion less than 28 days ago but negative molecular test were discarded in this evaluation. Results : Among the 771 potential corneal donors, 710 individuals performed the RT-PCR test. A total of 689 (97.04%) individuals tested negative for COVID-19. The average age of suitable donors was 52.52 ± 18.10 years, 289 (41.9%) were female and 400 (58.1%) were male. However, 21 (2.96%) individuals tested positive for COVID-19 and were discarded, even after the complementary screening implemented due to the coronavirus pandemic. Among the positives, 9 (1.2%) cases were female and 12 (1.6%) were male;the average age was 55.10 ± 23.10. Conclusions : Despite the complementary exclusion criteria for potential organ and tissue donors in the pandemic, the use of RT-PCR for COVID-19 proved to be essential to maintain safety in the corneal donation process.