Donor cornea tissue in cases of drowning or water submersion: eye banks practice patterns and tissue outcomes
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Donor cornea tissue in cases of drowning or water submersion: eye banks practice patterns and tissue outcomes Nithya P. Vijayakumar . Purak Parikh . Shahzad I. Mian . Brad Tennant . Gregory H. Grossman . Bob Albrecht . Leslie M. Niziol . Maria A. Woodward
Received: 5 July 2017 / Accepted: 20 October 2017 / Published online: 25 October 2017 Ó Springer Science+Business Media B.V. 2017
Abstract Surgical use of donor corneal tissue from victims of water submersion (drowning or submersion secondary to death) remains controversial due to limited evidence about the quality of these tissues. To assess the safety of donor corneal tissue from victims of water submersion, an investigation of eye banks’ practice patterns and tissue outcomes was conducted. All 79 Eye Bank Association of America accredited eye banks were contacted for a phone interview of practices regarding tissue from victims of water submersion. A retrospective review of corneal tissues from 2014 to 2016 from a large eye bank network was performed to identify all donors submerged in water. Corneal epithelial integrity, endothelial cell density (ECD), rim cultures, and adverse events were analyzed for associations with water submersion characteristics. 49 eye banks (62% response) participated in the survey. 55% of these eye banks had specific, written protocol for tissue eligibility from donors N. P. Vijayakumar P. Parikh S. I. Mian L. M. Niziol M. A. Woodward (&) Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, MI 48105, USA e-mail: [email protected] B. Tennant G. H. Grossman B. Albrecht Eversight, Ann Arbor, MI, USA M. A. Woodward Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
submerged in water. With or without specific protocol, eye banks reported considering water type (84%) and length of time submerged (92%) to determine eligibility. 22% of eye banks reported medical director involvement when eligibility determination was unclear. 79 tissues from 40 donors who were submerged were identified in 2014–2016 eye bank data. No donor tissues had pre-processing corneal infiltrates, positive rim cultures, or adverse events postkeratoplasty. Corneal epithelial integrity and ECD were not associated with water type or length of time submerged. In conclusion, data from a large eye bank network showed no adverse events or outcomes, indicating these tissues may be safe. Keywords Drowning
Cornea Eye bank Transplantation
Introduction A unified policy or medical standard for donated corneal tissue from victims of drowning for corneal transplantation has not been established by the governing body, the Eye Bank Association of America (EBAA), or by corneal surgeons and eye bank specialists. Policy and protocols have not been established due to limited evidence on the safety or risks associated with using tissue for corneal transplantation from donors who drowned. Some surgeons worry that
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