Objectives To assess to which extent the COVID-19 pandemic affected corneal transplantation by virtue of donor selection algorithms in different European countries.
Setting 110 eye banks in 26 European countries.
Participants 64 eye banks covering 95% of European corneal transplantation activity.
Interventions A questionnaire listing the number of corneas procured and distributed from February to May 2018–2020 was circulated to eye banks.
Main outcome measures The primary outcome was the number of corneal procurements. Additional outcomes were national algorithms for donor selection, classified according to their stringency (donors with COVID-19 history, suspected for COVID-19, asymptomatic, PCR testing) and the pandemic severity in each country. We calculated Spearman’s correlation coefficient to determine, two by two, the relationship between the 3-month decline in eye banking activity (procurement), the stringency of donor selection algorithm and the grading of pandemic severity (cases and deaths). A partial correlation was run to determine the relationship between decline and stringency while controlling for pandemic severity.
Results Procurements decreased by 38%, 68% and 41%, respectively, in March, April and May 2020 compared with the mean of the previous 2 years, while grafts decreased, respectively, by 28%, 68% and 56% corresponding to 3866 untreated patients in 3 months. Significant disparities between countries and the decrease in activity correlated with stringency in donor selection independent of pandemic severity.
Conclusions Our data demonstrate significant differences between countries regarding donor screening algorithms based on precautionary principles and, consequently, a decrease in the donor pool, already constrained by a long list of contraindications. Fundamental studies are needed to determine the risk of SARS-CoV-2 transmission by corneal transplantation and guide evidence-based recommendations for donor selection to justify their substantial medical and economic impact.
- eye (tissue) banking
- public health
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Contributors GT, PG, MB, IM, CC, PM, JH, JSI, DP, SF, GJ, PR, KB, JA, FF, RN and MD were responsible for the conception and design of the study. GT and MD are the executive coordinators of the project. GT, DP, SF and GJ are responsible for the coordination of data acquisition. GT, EC and SP were in charge of statistical analyses and table and figure design. All remaining authors contributed to data acquisition and interpretation. The first draft was written by GT, EC, SP, CC, PM, JH, JSI, DP, GJ, PR, KB, JA, FF and MD. All authors contributed to data interpretation, critically reviewed the first draft and approved the final version and agreed to be accountable for the work.
Funding Supported by a grant from the Agence Nationale pour la Recherche call for proposal RA-COVID, CorDon Project: Corneal procurement during and after the SARS-Cov-2 pandemic What microbiological tests should be performed? What are the risks?
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Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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