Corneal Donor Profile and Evolution of Corneal Donation in a Brazilian State Where the Number of Individuals on the Waiting List Reached Zero But Increased Again.

BACKGROUND: In most countries, the amount of corneal graft tissue available for transplantation is insufficient to meet demand. In 2010, there were 459 patients on the waiting list for corneal transplantation (WLCT) in Espirito Santo (ES), a Brazilian state with 3,885,000 inhabitants. Several strategies were implemented to reduce the number of individuals on the WLCT, which reached zero in 2011. Studies on the evolution of corneal donation contribute to reducing the WLCT worldwide. The aim of this study was to describe the evolution of corneal donation in ES and the profile of corneal donors from 2010 to 2013. METHODS: This was a retrospective study. The data were collected from records referring to donations of corneas and from the archives of the Center for Organ Procurement and Distribution of ES. Statistical software was used to perform descriptive analysis of the data. RESULTS: The sample consisted of 1359 donors, aged 46.82 ± 17.32 (mean ± standard deviation), 70.1% of whom were male. Most of the consent forms for donation were signed by the sons of the donors. In 2011, there was a major increase (105%) in the number of corneal transplants compared with 2010; consequently, the number of patients on the WLCT reached zero, but increased again, reaching 139 patients in 2013. CONCLUSION: This study shows that strategies to increase corneal donations should be continued even after reduction or elimination waiting time on the WLCT.

Main causes of nonfulfillment of corneal donation in five hospitals of a Brazilian state.

The waiting list for corneal transplantation in Brazil had 6684 patients in June 2012, with great variations in the number of patients among different states. The mean waiting time for a corneal transplant also differs substantially across the states: it is 2 years in State of Espirito Santo (ES) at the time of this study. The aim of the study was to determine the main reasons for nonfulfillment of corneal donation in five ES hospitals. The data collection was performed from March to August 2010. The data were collected using forms completed daily by the Intrahospital Commissions of Organ and Tissues Donation for Transplantation. The total number of deaths was 1347. The main causes of nonfulfillment of donations were medical contraindications (67.86%), logistical/structural problems (27.84%), and family refusal (2.15%). The main medical contraindications were age outside the required range (24.49%), the presence of infectious disease (11.36%), or age outside the range plus infection (15.66%). In 2010, there were 459 people on the waiting list for corneas in ES. Considering the average of failures in these five hospitals multiplied by the number of hospitals in the ES, it seems clear that the solutions to these problems might eliminate the waiting list of the State. In fact, the number of individuals on the waiting list in ES did reach zero in August 2011, after the inauguration of a new Eye Bank that trains employees to interview and perform procurements, in addition to keeping them available in the most important hospitals. Additionally, the maximal age for donation in ES was increased.

Reasons for noneffectiveness of organ donation programs in five hospitals in the state of Espírito Santo, Brazil.

Although, in absolute numbers, more organ transplantations are performed in Brazil than in many other countries, the donation rate (the number of donors per million individuals) remains quite low. The aim of this study was to determine the reasons for nonfulfillment of organ donations in five hospitals in the State of Espirito Santo, Brazil. This knowledge could help to identify strategies and implement changes to improve the organ donation process and to increase the rate in Brazil and other countries that face similar challenges. This prospective study collected data including the numbers of patients with suspected brain death (both confirmed and nonconfirmed), effective, and of nonfulfilled donations. Data were collected using forms completed daily by the Intra-Hospital Commission for Organ and Tissue Donation of the hospitals during the period from March to August 2010. There were 1386 deaths. The protocol for brain death diagnosis was initiated in 2.8% of them, but only 28.21% of confirmed brain death patients became effective donors. The causes of nondonation differed among the hospitals surveyed, suggesting that different strategies should be implemented to combat the specific weaknesses of each service, which must be continuously evaluated to increase the efficiency of the organ donation process.