Supply and Demand of Domestic Corneal Tissue and Its Implications on Export Potential—Using Australia as an Example

Abstract

Purpose: Corneal tissue importation is only possible if another country is able to export corneas without impacting its own domestic demand. Currently, there is little evidence to indicate whether export nations have such surplus capacity and in a position to export. To explore this concept, we examined our nation, Australia, which is reported to routinely decline donations because of its ability to meet domestic corneal transplant demand. Our research offers insights and opportunities for Australia and other nations to evaluate their domestic and international supply and allocation of corneal tissue in this space. Method:We collated 12 months of data on collected and noncollected donations, through participating Australian Eye Banks. The explanation of why some known donors were declined or not pursued indicated if demand was met and potential surplus-forexport levels.Results: There were 7.5% (n = 11,889) of deaths in Australia that were notified to Australian Eye Banks during our reporting period. Of those, 9.3% (n = 1106/11,889) were recovered and allocated, 15.7% (n = 1863/11,889) were known but declined, and 75% (n = 8920/11,889) were not pursued. Of those that were declined, 64.3% (n = 1197/1863) were declined because of limitations with service/manpower at the eye bank, whereas 35.7% (n = 666/1863) were declined because demand was met.Conclusions: Australia did not meet demand all the time, during our data period. There were adequate quantities of potential donors to support increasing recovery for domestic allocation and provide for exportation without hindrance to Australian demand. Further examination of domestic supply and demand cycles and the export process is required before routine exportation.

Corneal supply and the use of technology to reduce its demand: A review

“…Decisions to export and import require careful planning, consideration and checks on both sides of the exchange. For example, are the donors consented for export, 31,32 does the export nation's eye banking practice meet the import nations expectations and standards, 29,30 does the export nation's donor population pose a contraindication risk in comparison to other potential export nations or the domestic population, and can the exporter demonstrate that their action does not impact their own access 33 . Conversely, the import activity should be part of a wider capacity development program whereby the importation is one stage in a larger strategy to increase domestic access, with the ultimate aim of importation ceasing in the long‐term 26,27,29,30,34,35 .…”