Abstract
Background Corneal graft (keratoplasty) is the most common allograft in the world, but the imbalance between the number of donors and the number of patients waiting for transplants is abysmal on a global scale and varies enormously from one country to another. The risk of transmission of systemic diseases from donor to recipient is particularly low, since in 50 years and probably 2.5 million transplants, only 8 cases of rabies, 2 cases of hepatitis B and 2 cases of Creuzfeldt-Jakob disease (CJD) have been well documented. Conversely, other cases of rabies, HIV, hep C, hep B and CJD have not been transmitted via keratoplasty. The list of medical contraindications (MCI) to corneal donation also includes diseases for which no risk has been identified, in particular neurodegenerative diseases, haematological malignancies, melanomas, tumours of the central nervous system and carcinomatous meningitis and lymphangitis. However, the precise weight of these CIs is not known.
Methods Analysis of 45 months of exhaustive data from the hospital coordination for organ and tissue procurement at St-Etienne University Hospital (2020-2023). All stages of donor selection were analysed.
Results Out of 5248 consecutive deaths, the coordination team was able to analyse 2349 (45%) files (the others were excluded due to logistical problems). 1346 (57%) had an MCI to donation. The identification of a neurodegenerative disease was the most frequent, accounting for 16% of the files examined and 29% of MCIs. Of these, 75% were related to cognitive disorders. The 5 diseases or families of diseases that we are targeting concerned 712 donors, corresponding to 30% of the files examined and 53% of all MCIs. Of the 1003 deceased without MCI, 738 families (74%) were contacted. No objection to donation was received in 52% of cases, enabling 385 procurements to be carried out (i.e. 7% of deaths). Eliminating these 5 MCIs would have increased the number of donors by 71% (658 instead of 385).
Conclusions Eliminating 5 categories of contraindications to corneal donation that are not based on any medical or scientific rationale would have a major effect on reducing the shortage of donors and combating corneal blindness. We propose that this elimination should be accompanied by a prospective evaluation process, by allocating the corneas of these donors to patients aged 75 and over, and by monitoring them for a minimum of 5 years.
