Abstract
Abstract Objective: The aim of this study is to identify the causes for discarding corneas at the Eye Bank of the Federal District in Brasilia, Brazil, and describe the social and demographic variables and Causa Mortis of cornea donors from 2014 to 2017. Methods: We conducted an exploratory and social-epidemiologic descriptive study regarding cornea donation. The data base information was obtained from the corneal donor's medical records analysis. All of the potential donors' records (cause of death, cause of cornea discard, month of donation, age, gender, and time of death, corneal enucleation and preservation), from 2014 to 2017 were included in the study. Results: We looked at 1,574 corneal donor notifications. Demographic characteristics displayed significant differences in gender distribution (male, 74.8% and female, 25.2%), and the average donor age was 40 ± 15.9 years. 25% of the causes of death were from cardiovascular disease followed by 19.6% from sharp or blunt instrument injury, 14.2% resulted from multiple traumas. We described 3,074 donated corneas from the DF Eye Bank, where 2.6% has not been uptaken. Of those 3,074 corneal tissues, nearly 60% (n=1,836) have been transplanted and 40% (n=1,238) were discarded. Regarding the causes of discard, 68% (n=841) were due to positive or indeterminate serological blood tests and 39% (n=486) because of matureness (expired medium guaranteed period of corneal preservation). Conclusions: Specific issues such as violent causes of death, gender disproportion and total time of corneal processing can be better managed to reduce procurement times, and availability, of corneal tissue for transplantation.
Highlights
It is estimated that 36 million people are considered legally blind and another 216.6 million people are classified as vision impaired worldwide.[1, 2] The main causes for these impairments are uncorrected refractive errors, representing 43%, and cataracts with 33% of the cases
From 2010 to 2017, 113,219 corneal transplants were performed in Brazil, which is significantly higher than other solid organs transplantation such as kidney (43.224) and liver (12.038). [9,10] Beyond the increasing numbers of corneal transplantations, the procurement process has increased when compared to transplantation per capita rate.[3,11] Until December of 2017, 9, 266 patients were on the general waiting list for corneal transplants in Brazil and 2.14% (199/9,266) of those are from the Federal District (DF).(10) From 2009 to 2016, the number of potential donors grew 36.10%, but the proportion of effective and potential donations increased only 3.8%, so the challenge of improving the donor selection process is still important.[12, 13]
The National Agency for Health Surveillance (ANVISA) in Brazil regulates the Eye Banks work through the “Resolução da Diretoria Colegiada’’ (RDC) n° 55/2015, [15] available on the institution website.This legal rule standardizes the potential donor selection process using the family interview, medical records analysis, the deceased body evaluation and the tissue quality itself. [14, 15] The total cost of family interview, harvesting and processing the corneas by the eye banks is paid by the public health system
Summary
It is estimated that 36 million people are considered legally blind and another 216.6 million people are classified as vision impaired worldwide.[1, 2] The main causes for these impairments are uncorrected refractive errors, representing 43%, and cataracts with 33% of the cases. Keratoconus and Fuchs’ dystrophy are the most important pathologies to use corneal transplant as treatment strategy.[2,7] Corneal transplants have been performed all over the world and in 2012 alone almost 184.576 were done in 116 countries.[3] Of those, 8% (nearly 15.000) were performed in Brazil, which, is a leader in tissue and solid organ transplantation worldwide by the public health system (SUS).(3,4,8). The National Agency for Health Surveillance (ANVISA) in Brazil regulates the Eye Banks work through the “Resolução da Diretoria Colegiada’’ (RDC) n° 55/2015, [15] available on the institution website.This legal rule standardizes the potential donor selection process using the family interview, medical records analysis, the deceased body evaluation and the tissue quality itself. Because of the infectious and transmissible diseases risks, the RDC n° 55/2015 establishes the tissue contraindication parameters, such as the donor serological tests for tissue approval for transplantation.[16]
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