Potential Corneal Donation in Patients with Out-of-hospital Cardiac Arrest: A Case-control Study

The shortage of corneal donations has been a longstanding problem in Japan. However, there are limited data on the settings in which corneal donations occur. The aim of this study was to determine the association between out-of-hospital cardiac arrest (OHCA) and corneal donation. We also investigated potential corneal donors across various death settings (OHCA, in-hospital cardiac arrest (IHCA), and home death).

This was a case-control study in Hiroshima Prefecture, Japan, from 2015 to 2023. Cases included all corneal donors based on data provided by the Hiroshima Eye Bank, while controls consisted of potential corneal donors aged ≥10 years at Hiroshima City Hiroshima Citizens Hospital. After matching cases with controls at a 1:5 ratio using age group, sex, and date of death, we employed unconditional logistic regression to analyze the association between OHCA and corneal donation.

From the combined data of the Hiroshima Eye Bank (n = 190), the hospital cohort (n = 4492), and the home cohort (n = 195), 190 were corneal donors and 3,394 were potential corneal donors. Among corneal donors, 5.3% (10/190) had OHCA, 26% (49/190) had IHCA, and 29% (55/190) died at home or in nursing homes. Among the various death settings, 72% (2,768/3,835) in the hospital cohort and 69% (134/195) in the home cohort were potential corneal donors, with OHCA patients in the hospital cohort showing the highest proportion (75%, 492/657). After adjusting for matching factors, OHCA was positively associated with corneal donation (13% [26/190] vs 15% [143/950]; odds ratio: 2.2, 95% confidence interval: 1.3-3.5, p = 0.0019).

Individuals who experienced OHCA may be more likely than individuals in other settings of death to become corneal donors. Further research is needed to confirm this study's findings and to explore strategies to address the issue of Japan's corneal donation shortage.