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Updated: Aug 19, 2026
A Simplified Technique for In situ Excision of Cornea and Evisceration of Retinal Tissue from Human Ocular Globe
Published on: June 12, 2012
Analysing the various obstacles to cornea postmortem procurement
M Muraine1, D Toubeau, E Menguy
1Department of Ophthalmology, Hôpital Charles Nicolle, Boulevard Gambetta, 76031 Rouen, Cedex, France. marc.muraine@chu-rouen.fr
Insights
Corneal donation shortages stem from logistical issues, not family refusal. Enhancing coordination teams is key to increasing corneal grafts and meeting patient demand.
Area of Science:
- Ophthalmology
- Transplantation Medicine
- Public Health Policy
Background:
- Corneal transplantation is vital for vision restoration.
- A significant gap exists between corneal graft demand and supply in many countries.
- Current donation rates are insufficient to address waiting lists.
Purpose of the Study:
- To identify practical changes needed to fully meet corneal graft demand.
- To analyze factors limiting effective cornea procurement.
- To determine the root causes of corneal donation shortages.
Main Methods:
- Comparative analysis of potential donor records and deceased patient data (1999).
- Investigation of parameters permitting or precluding cornea specimen collection.
- Evaluation of reasons for non-identification of potential donors.
Main Results:
- Only 40.5% of deceased patients were identified as potential donors.
- Medical contraindications excluded 55.9% of identified potential donors.
- Logistical challenges, including donor identification and reaching relatives, were primary barriers, not family refusal (5.5% of cases).
Conclusions:
- Corneal donation shortages are primarily due to logistical difficulties, not a lack of consent.
- Strengthening coordination teams with adequate staffing is essential for broader donor identification.
- Improved contact with relatives and streamlined processes are necessary to maximize corneal procurement and meet patient demand.
Aims:
In many countries the number of corneal donations is far too low to graft all patients on waiting lists within reasonable time. The aim of this study was to define specifically what practical changes are to be implemented to fully meet corneal graft demand.
Methods:
The list of potential donors drawn by the coordination team from 1 January to 31 December 1999 was compared with that of all patients who had died during the same period. In each identified record, the parameters which permitted or precluded effective collection of cornea specimens were analysed, and the reasons why other records were not identified were investigated.
Results:
Among the 1112 patients who died in 1999, coordinating nurses were able to identify 451 records (40.5 %) including 329 patients aged between 18 and 85 years (29.5%). After excluding 184 patients (55.9 %) who presented with medical contraindications, the coordinating nurses were able to meet the relatives of only 55 out of 145 patients (38%) and obtained their agreement in 39 cases (71% approval rate). Therefore, relatives' refusal was the cause for the absence of collection in only 5.5% of cases (16/290). The number of corneas procured amounted to 11.8% of identified records and 3.5% of all deceased patients.
Conclusion:
French law and regulations regarding tissue collection are based on consent presumption but it requires that verifications be made with the relatives to ensure that potential donors were not, before their death, opposed to such tissue procurement. That provision implies a high degree of organisation on the part of coordinating teams. It was demonstrated that donation shortage is no longer the result of relatives' refusal but rather because of logistical difficulties (potential donors not identified and problems in reaching relatives). It appears necessary therefore to strengthen coordinating teams with sufficient staff levels for wider donor identification. Those teams should also find ways to keep closer contact with relatives, so as to meet the maximum transparency targets required by public opinion and regulations and to graft all patients awaiting corneal transplantation.
