Enhancing Corneal Donation Through Hospital Collaborations in Germany: A 21-Year Perspective

Keratoplasty is the most common transplantation worldwide, yet donor tissue shortages persist. This study evaluates how external hospital collaborations affect corneal donation rates, donor demographics, and tissue quality and identifies operational barriers to optimizing procurement.

A retrospective analysis of corneal donation records from the LIONS Eye Bank Baden-Württemberg (2004-2024) was performed, including donors from the University Medical Center Freiburg (internal) and 14 collaborating hospitals (external). Donation rates, donor characteristics, death-to-retrieval times, and endothelial cell density were compared. Logistic regression analysis was used to assess factors influencing transplantation likelihood. Separately, a structured 6-item questionnaire evaluated collaboration quality, operational efficiency, and key challenges among cornea bank staff.

Of 7054 donors (14,038 corneas), 64.7% were internal and 35.3% external. Median donor age was 73 years. Over time, external donations rose steadily, exceeding 100 annually since 2012, with hospitals within 20-km driving distance of the eye bank contributing most external donors. Recent donation rates were higher internally (15.8%) than externally (5.4%). Analysis of 11,059 corneas showed shorter death-to-retrieval times for external donors (22.8 vs. 25.1 h) but lower endothelial cell density (2190 vs. 2263 cells/mm2). Pseudophakia, older donor age, and longer death-to-retrieval times significantly reduced transplantation likelihood. Staff reported good collaboration (88.9%), but assessing external donors took at least twice as long.

External collaborations substantially increased donor numbers over 2 decades, but donation rates remain lower than internal sites. Overcoming logistical barriers could unlock the full potential of external networks, strengthen local tissue supply, and reduce reliance on imported grafts.