Eye donation potential at a UK tertiary general hospital

Abstract

Purpose: the United Kingdom faces a significant shortage of ocular tissue for corneal transplantation. About 6,000 patients in the UK are waiting for corneal transplants. Eye donation rates have been decreasing for several years, and there is uncertainty about the potential and barriers to eye donation in NHS hospital settings. It is unclear whether changes to donor opt-in legislation have affected eye donation. The aim of this study was to assess the potential and barriers to eye donations at a UK tertiary general hospital.

Methods: a retrospective review was conducted on 100 random adult deaths at the University Hospital of Southampton (UHS) 2023 (~1400 inpatient beds). Two Specialist Nurses in Organ Donation examined each case against current eye donation criteria and the UK donor register to assess their suitability for eye donation.

Results: there were 2391 deaths at UHS; a comparison of the random sample (n=100) showed no statistical differences in age, gender, or ethnicity between the sampled cohort and the total death cohort. In the 100 sampled deceased cohort, 22 deceased patients had opted in for eye donations, 15 of whom were eligible, but only one was referred. Overall, 62 cases were suitable for eye donation. Only three were referred for potential eye donation. Two cases involved discussions with the next of kin regarding eye donation, and only two ended up becoming donors. Malignancies and neurodegenerative disorders (17% each) were common contraindications. Highest proportion of eligible donors were in ITUs (11/15=73%), emergency department (4/5=80%), Acute Medical Unit (6/7=86%), and medical wards (21/28=75%). The return of eye donation in 2023 showed that among the 2,391 deceased, 30 (1.25%) were eye donors, 25 of whom were ITU multi-organ donors. Extrapolating our findings to total annual deaths, we estimate that there is a potential of over 359 donors per year, enough to supply 570 corneas, equating to 10% of the annual current demand for corneal transplants in the UK.

Conclusion: this study suggests that UK NHS tertiary hospitals are a rich source for eye donations. Many patients‘ registered donation wishes are not fulfilled due to a lack of timely donor identification and referral. Systemic changes are needed to integrate eye donations into end-of-life clinical practices in hospitals. The study indicates that focusing efforts in these environments offers a sustainable solution to meet the current and future demands for corneal transplant surgery.

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ORCID for Parwez Hossain: orcid.org/0000-0002-3131-2395

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