1 Crisis becomes the norm: how a non-profit network withstands the pandemic

SARS-CoV-2 (corona virus) presents the world with new kinds of challenges. The crisis mode that persisted in many countries also put a strain on the German health system: on the one hand, through the treatment of patients infected with corona, and on the other hand through the cancellation and postponement of elective operations. This had a corresponding impact on tissue donation and transplantation. The effects of the pandemic-related restrictions can be reflected by the rate of corneal donation in the DGFG network: With the beginning of the first closure in Germany, donation and transplant numbers decreased by almost 25% from March to April 2020. After a recovery during summer, the activities were again restricted from October onwards due to increasing infection numbers. Subsequently in 2021 there was a similar trend.The already careful screening of potential tissue donors was expanded in accordance with the guidelines of the Paul-Ehrlich-Institute. However, this important measure led to an increase in discontinued donations due to medical contraindications from 44% in 2019 to 52% in 2020 and 55% in 2021 (Status Nov 2021). Nevertheless, the donation and transplantation result from 2019 was exceeded and DGFG was able to maintain patient care in Germany on stable level compared to other European countries. This positive result is partly due to an increased consent rate of 41% in 2020 and 42% in 2021 due to a higher sensitivity in the population to health issues during the pandemic. In 2021, the situation stabilised again, although the number of donations that could not be realised due to corona detection in the deceased continued to increase with the waves of infections that occurred.Low losses in donation and thus in the supply of transplants for patients seem to be due to the fact that a nationwide network such as the DGFG can respond flexibly to changing requirements. For example, if the number of COVID-19 infections varies between regions, it is possible to react to the local conditions to continue donation and processing where possible and allow allocation to regions where transplantation can take place.In summary it has been shown that efficient donation programs, resilient network structures, awareness of population for tissue donation and effective precautionary measures ensure a safe patient care with corneal transplants also in pandemic times.