Summary of Corneal Transplant Activity: Eye Bank Association of America

Each year, the Eye Bank Association of America (EBAA) reports statistics on the corneal transplant activity in the United States. Eighty member eye banks in the U.S. reported statistics for the year 2000 to the EBAA. Herein, we provide to the readership of Cornea a small selection of material from the annual EBAA statistical report that will profile the corneal donation and transplant activity in North America and will highlight some of the current challenges facing the U.S. eye banking system. Statistics from the past decade indicate that there were fewer corneal transplants performed in the U.S. in 2000 (33,260) than in 1990 (36,037). During this decade, the distribution of corneas for transplant to international sites increased steadily, which more than accounts for the difference. In 1990, 2,726 corneas were exported (7% of the total). Ten years later, the figure exported was reported at 13,689 (29% of the total). Thus, in the year 2000, growing international demand contributed to an increase in the total amount of tissue provided for transplant: 46,949 compared with 38,762, in 1990 (Fig. 1). Seventy-seven eye banks reported recipient diagnoses for the year. The total number of cases with specific recipient diagnoses reported remained approximately the same–31,532 in 2000, compared with 32,394 in 1999. This represents 67% of the corneas distributed by the 80 U.S. eye banks reporting for the year 2000 (Fig. 2) The decrease in the number of corneal transplants performed in the U.S. today, compared with 10 years ago, invites the question of what factors are affecting the demand. Has the need (or clinical indications for) corneal transplantation decreased, or are other factors influencing access to corneal surgery? One possible consideration is the continued transition to newer, less traumatic techniques of phacoemulsification with a resultant decline in the prevalence of pseudophakic corneal edema. In the U.S. today, any patient who is an appropriate candidate for corneal transplantation can be assured of the availability of a cornea suitable for transplant. Tissue is always available for an emergency, and eye banks are providing an adequate number of corneas for elective transplant within the US. Significant attention has been paid by the government to the number of patients on the waiting list to receive organs for transplant. The “waiting list” for corneas is not comparable to waiting lists for organ donation and does not have the same meaning. The corneal transplant waiting list of 1,125 patients represents patients who are candidates waiting for keratoplasty, but whose procedures have been delayed because of elective factors such as a temporary postponement by the surgeon, the patient, or both. Some surgeons defer surgery until their personal criteria for tissue characteristics are met. The majority of these “criteria” relate to donor age. The National Eye Institute, the Castroviejo Cornea Society, and the Eye Bank Association of America have partnered in the sponsorship of the Cornea Donor Study (CDS), a 5-year prospective masked trial designed to determine the safety and efficacy of using older donor tissue for keratoplasty. If the hypothesis of the CDS, that older donor tissue is equally as safe and efficacious as younger tissue, is validated, the potential donor pool will be greatly expanded nationally and internationally, and there will be little rationale for the refusal of tissue on age criteria alone.