8 The donor of tomorrow: challenges posed by the pandemic, demographic change, and increased transplant requirements

In the Corona pandemic, the importance of donor health for the supply of patients with high-quality transplants has once again become particularly apparent in the field of cornea donation.And there are further challenges ahead: Due to new operation methods such as lamellar techniques an earlier stage of disease can be treated hence patients are being operated at younger ages. At the same time, with demographic change, potential donors are getting older.Therefore, the demand for a high-quality transplant without pre-operations seems to be difficult to fulfil in the future. This is particularly important in the highly developed industrialised countries, where the indications for corneal transplantation are different and the expected quality characteristics are therefore other than in emerging or developing countries, for example. At the same time, the new surgical methods present the tissue banks with new tasks to meet the surgeons' demands.In the DGFG network, the average age of corneal donors is currently 69.7 years while the requests for transplants with a high endothelial cell density (ECD) increase. The ECD continues to be one of the main criteria for a high-quality cornea and is more likely to be found in younger donors. As mentioned at the beginning, however, the average life expectancy in Germany is already currently around 80 years.It seems that it is impossible to find the perfect donor of tomorrow. With the increase in the need for high-quality transplants, the question must be asked whether donor shortage is a home-grown problem in industrialised countries. What developments need to be initiated to counter the trend towards donor shortage? Could greater flexibility at the medical and/or regulatory level be a solution? The presentation aims to shed light on these and other questions and would like to discuss this with the experts.