An Operational Burden Issue: Deciding on a Corneal Recipient From the Corneal Transplant Wait List for Elective Corneal Transplant

Abstract

The cornea is the outermost tissue of the eye and must be transparent to maintain good visual function. Diseases with loss of corneal transparency (ie, corneal blindness) account for 10% of blindness worldwide. The treatment of this condition is only possible with corneal transplant from corneal tissue obtained from deceased donors. More than 10 million people worldwide have corneal blindness, but the annual number of available corneal transplants is only 185 000. Accordingly, it is obvious that the quantity of available donor tissue does not meet the need, with nearly 70 candidates on the wait list for each available corneal transplant. Rapid identification of appropriate recipients has become a crucial element in the field of corneal transplantation. There is a similar urgency (and scarcity) in other solid-organ donation programs, most of which have an established set of selection parameters (such as blood enzyme levels) that are easily defined and measurable. However, in the case of corneal transplant, there is presently no worldwide consensus on such selection criteria. The corneal transplant wait lists are long. The selection of appropriate recipients from these wait list candidates is managed by a designated authority (the authorized recipient selection operator) informed by the literature and the characteristics of the recipient within a framework of generally accepted, but variable, guidelines. The decision process is encumbered to a degree proportionate to the length of the wait list. In this review, we focus on solutions documented in the literature for selection of appropriate corneal recipients from transplant wait lists.