Trends and Determinants of Corneal Tissue Utilization and Discard: 14 Years of Data From United States Eye Banks

To characterize national trends in corneal tissue recovery, release, utilization, and discard across the United States, quantify seasonality and the COVID-19 shock, and identify associations between donor features and tissue discard.

We conducted a retrospective analysis of Eye Bank Association of America data from 2011 to 2024. Temporal trends in tissue recovery, release, utilization, and discard (defined as prerelease or postrelease) were modeled with regression-based analyses. Seasonality was assessed with decomposition and month-of-year models. Multivariable regressions were used to investigate associations between donor characteristics and tissue discard.

Although national recovery volumes increased from 2011 to 2024, the likelihood of utilization declined. The proportion of corneas discarded prerelease fell, but postrelease discard rose, indicating a shift of attrition downstream. Monthly activity showed consistent troughs in December and a pronounced dip during March-May 2020. Among reasons for prerelease discard, shares attributed to tissue quality, failed testing, serologic findings, and medical record/autopsy findings increased between 2011 and 2024. Postrelease discard because of tissue damage during processing and handling increased, whereas discard because of surgeon or recipient issues and expiration decreased. In multivariable models, older donor age and causes of death including cancer, trauma, and cardiac disease were associated with higher probabilities of prerelease discard.

Corneal graft attrition has shifted downstream, with rising discard after tissue release despite improved prerelease yield. These data may shape strategies to maximize the efficiency of corneal transplantation. Further research is needed to determine whether shifts in tissue utilization have corresponded with improved patient outcomes.