Donor cornea tissue in cases of drowning or water submersion: eye banks practice patterns and tissue outcomes

Abstract

Surgical use of donor corneal tissue from victims of water submersion (drowning or submersion secondary to death) remains controversial due to limited evidence about the quality of these tissues. To assess the safety of donor corneal tissue from victims of water submersion, an investigation of eye banks' practice patterns and tissue outcomes was conducted. All 79 Eye Bank Association of America accredited eye banks were contacted for a phone interview of practices regarding tissue from victims of water submersion. A retrospective review of corneal tissues from 2014 to 2016 from a large eye bank network was performed to identify all donors submerged in water. Corneal epithelial integrity, endothelial cell density (ECD), rim cultures, and adverse events were analyzed for associations with water submersion characteristics. 49 eye banks (62% response) participated in the survey. 55% of these eye banks had specific, written protocol for tissue eligibility from donors submerged in water. With or without specific protocol, eye banks reported considering water type (84%) and length of time submerged (92%) to determine eligibility. 22% of eye banks reported medical director involvement when eligibility determination was unclear. 79 tissues from 40 donors who were submerged were identified in 2014-2016 eye bank data. No donor tissues had pre-processing corneal infiltrates, positive rim cultures, or adverse events post-keratoplasty. Corneal epithelial integrity and ECD were not associated with water type or length of time submerged. In conclusion, data from a large eye bank network showed no adverse events or outcomes, indicating these tissues may be safe.

Safety and Efficacy Profile of Corneas Harvested From Donors of Drowning Victims

“…Vijaykumar et al 7 conducted a retrospective multicenter review of a network of 79 eye banks. They categorized the eligibility for tissue procurement based on victims of water submersion (drowning or submersion secondary to death) and considered the type of water and duration of submersion.…”

“…5 Despite being controversial, studies reported that corneal transplantation with tissues harvested from drowning victims has good outcomes. [7][8][9] Corneas harvested from drowning victims can contribute to the existing donor pool. The literature review highlights only a few studies on tissue characteristics, graft survival, and corneal outcomes in corneal tissues collected from drowning victims.…”

“…5 Despite being controversial, studies reported that corneal transplantation with tissues harvested from drowning victims has good outcomes. 7–9…”