Obstacles to donor eye procurement and their solutions at the University of Iowa

Shortages in transplantable corneas are common, yet little appears in the medical literature about patterns of tissue donation and factors affecting procurement. We have analyzed data on eye donations and taken measures to improve procurement rates based on our findings. Fifty consecutive Cardiovascular Intensive Care Unit (CVICU) deaths were reviewed to compare the number of transplant-eligible donors to the amount of tissue received. An anonymous survey of 250 house staff and nurses was undertaken to identify obstacles to donor eye procurement. Although 12 of 50 potential donors in the CVICU met transplant eligibility criteria, only 1 became a donor. A required request policy notwithstanding, the most common reason for nonprocurement was failure to make a request. According to the survey, the most significant impediments to making the request were (a) not thinking to ask, (b) unfamiliarity with eligibility criteria, (c) unfamiliarity with enucleation procedures, (d) feeling that someone else should make the request, and (e) reluctance to impose on a grieving family. Very few cited religious reasons or being too busy. Education based on the specific concerns listed in the survey was undertaken. During the 12 months after this initiative, the number of transplantable corneas donated from our facility doubled, as compared with the same period in 1992. Despite required request laws and regulations, failure to request tissue donation is common in our facility and may be common elsewhere. Systematic analysis of obstacles to donor eye procurement and their solutions may help to improve our country's performance in this area.