Article Text

One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe
  1. Gilles Thuret1,2,
  2. Emilie Courrier1,
  3. Sylvain Poinard1,
  4. Philippe Gain1,2,
  5. Marc Baud'Huin3,
  6. Isabelle Martinache4,
  7. Claus Cursiefen5,
  8. Philip Maier6,
  9. Jesper Hjortdal7,
  10. Jacinto Sanchez Ibanez8,
  11. Diego Ponzin9,
  12. Stefano Ferrari9,
  13. Gary Jones9,10,
  14. Carlo Griffoni9,
  15. Paul Rooney11,
  16. Kyle Bennett11,
  17. W John Armitage11,
  18. Francisco Figueiredo12,
  19. Rudy Nuijts13,
  20. Mor Dickman13
  1. 1Laboratory "Biology, Engineering and Imaging of Corneal Graft", BiiGC, Faculty of Medicine, Universite Jean Monnet, Saint-Etienne, France
  2. 2Ophthalmology Department, University Hospital, Saint-Etienne, France
  3. 3Multi-Tissue Bank, University Hospital, Nantes, France
  4. 4French Biomedicine Agency, Saint-Denis, France
  5. 5Department of Ophthalmology, University of Cologne, Cologne, Germany
  6. 6University Eye Hospital Freiburg, Freiburg, Germany
  7. 7Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
  8. 8Tissue Establishment and Cryobiology Unit, A Coruna University Hospital, A Coruna, Galicia, Spain
  9. 9The Veneto Eye Bank Foundation, Venice, Veneto, Italy
  10. 10European Eye Bank Association, Venice, Italy
  11. 11Tissue and Eye Services, National Health Service Blood and Transplant (NHSBT), Liverpool, UK
  12. 12Department of Ophthalmology Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
  13. 13University Eye Clinic Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
  1. Correspondence to Professor Gilles Thuret, Laboratory "Biology, Engineering and Imaging of Corneal Graft", BiiGC, Faculty of Medicine, Universite Jean Monnet Saint-Etienne, Saint-Etienne 42100, France; gilles.thuret{at}


Objectives To assess to which extent the COVID-19 pandemic affected corneal transplantation by virtue of donor selection algorithms in different European countries.

Design Survey.

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.

  • epidemiology
  • eye (tissue) banking
  • infection
  • 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?

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data are available from the corresponding author

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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