Compensating for a shortage of corneal donors after Brexit

Our blog features many success stories highlighting the importance of eye donations to help those affected by sight loss.  This week an article was featured in The Lancet, highlighting the shortage of eyes donations in the UK, the challenges this presents and what problems Brexit could present to the UK. The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest, most prestigious and best known general medical journals.     

This is a copy of the wording that was featured in the article. 

The Lancet. Published online July 5, 2019

Corneal transplantation is one of the most common and successful  The LancetThe Lancettransplant procedures worldwide.¹ Although it is predominantly done to improve or preserve sight, the procedure can also be done to preserve the eye or for pain relief to improve a patient’s quality of life.

Because fewer eyes are donated than are needed for transplantation, the UK has an estimated shortage of 1500 corneas per year.¹ The number
of corneas retrieved and transplanted per population in the UK is less than in the USA and in other European countries, such as Germany and Italy (table). This trend is not only observed for corneas; the consent rate for all types of organ donation in the UK is one of the lowest in Europe.² Consequently, corneal tissue needs to be imported to the UK to compensate for this deficit. Corneas imported from countries within
the EU can be directly imported to a transplant centre. By contrast, corneas from non-EU countries first need to be imported to an eye bank  that is licensed by the Human Tissue Authority before they can be taken to a transplant centre.

No clear explanation has been found for the low donor rates and number of corneal transplants done in the UK as compared with in Italy, Germany, and the USA. An opt-out system of organ donation is due to be introduced in England in April, 2020, which might help to reduce the shortage of donors. However, the effectiveness of an opt-out system that was introduced in Wales in 2015 is not yet clear.

The shortage of eye donors is likely to be exacerbated by Brexit, because leaving the EU could affect the importation of donor tissue from outside the UK. In addition, if a no-deal Brexit becomes a reality, the EU Organ Donation Directives and EU Tissue and Cells Directives would no longer apply in the UK, and the deficit in corneal graft availability could increase further.

 

Number of eyes donated and transplanted in 4 countries

 

Vito Romano, Michelle Dinsdale, Stephen Kaye

  1. Gaum L, Reynolds I, Jones MN, Clarkson AJ, Gillian HL, Kaye SB. Tissue and corneal donation and transplantation in the UK.
    Br J Anaesth 2012; 108: 43–47.
  2. NHS Blood and Transplant. Organ donation and transplantation: activity report 2016/17. Watford: NHS Blood and Transplant, 2017.
  3. Flockerzi E, Maier P, Bohringer D, et al.
    Trends in corneal transplantation from 2001to 2016 in Germany: a report of the DOG-section cornea and its keratoplasty registry. Am J Ophthalmol 2018; 188: 91–98.
  4. Eye Bank Association of America. 2016 eye banking statistical report. Washington, DC: Eye Bank Association of America, 2016.
  5. Eurocet. Data: Tissue donation and transplant activity. http://old.iss.it/ecet/index.php?lang=2&id=92&tipo=12 (accessed April 26, 2019).
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