Eye donation and eye banking in India.

Corneal blindness is a priority condition under the National Programme for Control of Blindness and an important cause of avoidable blindness in India. A multipronged approach is needed to eliminate corneal blindness. Curable or treatable blindness requires a spectrum of care including medication, optical rehabilitation and corneal transplantation. Corneal transplantation is dependent on the availability of safe, donor eyes; however, there is scarcity of donor corneal tissues in India. To improve the eye banking system, the Government of India supports eye banks through recurring grants for operational costs and non-recurring grants for infrastructure costs. Strategic interventions by the government and non-governmental organizations include awareness by health promotion and education, community participation, sustainable source of donor cornea, quality medical standards, accreditation and endeavours to strengthen eye banking systems and procedures through training and research. A model eye banking system in India can be achieved only when it is linked with the targeted infrastructure proposed under 'Vision 2020: Right to Sight- India'. Considering these targets, there is a requirement of at least 20 eye bank training centres, 200 eye banks with corneal transplant facility (collection of nearly 500 corneas per year) and 2000 eye donation centres in the country. This would become a reality if the Hospital Cornea Retrieval Programme is strengthened at all private and government hospitals, uniform medical standards are made mandatory for all eye banks and eye donation centres and the process of registration and eye donation is simplified to enhance community participation.

Cost Minimization Analysis of Precut Cornea Grafts in Descemet Stripping Automated Endothelial Keratoplasty.

Descemet stripping automated endothelial keratoplasty (DSAEK) is the most common corneal transplant procedure. A key step in the procedure is preparing the donor cornea for transplantation. This can be accomplished via 1 of 3 alternatives: surgeon cuts the cornea on the day of surgery, the cornea is precut ahead of time in an offsite facility by a trained technician, or a precut cornea is purchased from an eye bank. Currently, there is little evidence on the costs and effectiveness of these 3 strategies to allow healthcare providers decide upon the preferred method to prepare grafts.The aim of this study was to compare the costs and relative effectiveness of each strategy.The Singapore National Eye Centre and Singapore Eye Bank performed both precut cornea and surgeon-cut cornea transplant services between 2009 and 2013.This study included 110 subjects who received precut cornea and 140 who received surgeon-cut cornea. Clinical outcomes and surgical duration were compared across the strategies using the propensity score matching. The cost of each strategy was estimated using the microcosting and consisted of facility costs and procedural costs including surgical duration. One-way sensitivity analysis and threshold analysis were performed.The cost for DSAEK was highest for the surgeon-cut approach ($13,965 per procedure), followed by purchasing precut corneas ($12,659) and then setting up precutting ($12,421). The higher procedural cost of the surgeon-cut approach was largely due to the longer duration of the procedure (surgeon-cut = 72.54 minutes, precut = 59.45 minutes, P < 0.001) and the higher surgeon fees. There was no evidence of differences in clinical outcomes between grafts that were precut or surgeon-cut. Threshold analysis demonstrated that if the number of cases was below 31 a year, the strategy that yielded the lowest cost was purchasing precut cornea from eye bank. If there were more than 290 cases annually, the cheapest option would be to setup precutting facility.Our findings suggest that it is more efficient for centers that are performing a large number of cornea transplants (more than 290 cases) to set up their own facility to conduct precutting.

Impact of surgeon acceptance parameters on cost and availability of corneal donor tissue for transplantation.

OBJECTIVE: To examine the effects of more restrictive donor corneal parameters on the cost and availability of transplantable tissue. METHODS: Corneal tissue data from the Midwest Eye-Banks were collected from 2008 through 2011. Endothelial cell density (ECD) and donor age were arbitrarily restricted in a statistical model based on donor tissue availability. A hypothetical baseline corneal donor tissue fee of $3000 was used for the model. RESULTS: Overall, 19,990 tissues were recovered from 10,668 donors and met Food and Drug Administration and Eye Bank Association of America donor eligibility criteria and current age and ECD criteria for surgical use for corneal transplantation. The mean corneal ECD of screened corneas was 2694 ± 338 cells per square millimeter (range, 2000-4694 cells/mm2). The average age of the recovered donor corneas eligible for surgery was 55.6 ± 14.4 years. Donors aged 51 to 75 years contributed 70.5% of the surgical tissue. In this model, a minimum ECD restriction of 2300, 2500, or 2800 cells per square millimeter would reduce the corneal tissue availability to 87.7%, 70.6%, or 36.5% of current levels, respectively. If donor age were restricted to ≤ 70, ≤ 65, or ≤ 60 years, the percentage of corneal tissue available would decrease to 89.5%, 74.3%, or 57.5% of current levels, respectively. CONCLUSIONS: Tissue criteria restrictions would affect corneal surgeons and eye banks. Restrictions on donor age and ECD would decrease the availability of surgically suitable tissue and increase the costs of cornea transplant tissue.

Costs and financing. A cost calculation of an up-to-date eye bank in Germany.

PURPOSE: To estimate the averaged cost of processing a corneal graft for keratoplasty. METHODS: We estimated the total running costs of a German corneal bank for one year. All procurement-related expenses were calculated on the basis of 300 donors per year and a disavowal percentage of 50%. RESULTS: The running costs comprise of personnel (2 physicians, 2 technicians), amortization of equipment, laboratory costs, laboratory consumables, occupancy costs and quality management. Annual expenses total 584000 EUR. This aggregation divided by 300 corneal grafts released for transplantation results in a nominal charge of 1950 EUR per corneal graft. DISCUSSION: The DRG system in Germany (in-patients at a base rate of 1.0) refunds only 850 EUR, leaving a financial gap of 1100 EUR per keratoplasty. This financial burden is currently left over to the eye bank and/or the surgeon.

Efficacy of Routine Notification and Request on reducing corneal transplantation wait times in Canada.

OBJECTIVE: To determine whether the implementation of Routine Notification and Request (RNR) has been effective in increasing the amount of donor corneal tissue available and reducing wait times for corneal transplant (CT) surgeries. DESIGN: Survey of the CT surgeons and eye banks in Canada. PARTICIPANTS: CT surgeons and representatives of the 10 eye banks in Canada. METHODS: Voluntary, anonymous questionnaires were distributed between May 1 and September 30, 2006. RESULTS: Following the implementation of RNR, 3 eye banks had an increase in the amount of corneal tissue available: Manitoba, 81% (from 42 tissues in 2004 to 76 tissues in 2006); Ontario, 25% (from 1304 tissues in 2005 to 1626 tissues in 2006); New Brunswick, 129% (from 86 tissues in 2005 to 197 tissues in 2006). British Columbia, where RNR was implemented in 1999, had a 6% increase (from 766 in 2005 to 812 in 2006). There has been a significant decrease in wait times from the time of diagnosis by CT surgeons to the time of surgery in British Columbia (from 48+/-18 weeks in 2004 to 39+/-20 weeks in 2006), Manitoba (from 82+/-56 weeks in 2004 to 32+/-23 weeks in 2006), Ontario (from 82+/-56 weeks in 2004 to 31+/-34 weeks in 2006), and Nova Scotia (from 44+/-12 weeks in 2004 to 32+/-28 weeks in 2006). CONCLUSIONS: RNR has been effective in increasing corneal tissue availability and decreasing wait times in provinces where it has been implemented. We recommend similar legislative changes to be considered in those provinces where corneal tissue shortage is delaying the availability of CT surgery.

[Financial aspects of tissue bank activities]. / Financjiski aspekti rada tkivne banke.

Nowadays, we are faced with increasing challenges in the field of tissue banking. New technologies and scientific advances have resulted in new standards designed by European Union in the form of Directives. Our ophthalmologists have also participated in this process, Professor Nikica Gabric as member of the European Eye Bank Association Committee (1999-2005) and Associate Professor Iva Dekaris as member of the same Committee (2005-2006). Since this year, Associate Professor Iva Dekaris has been appointed actual vice-president and future president of this general European organization in charge of corneal tissue banking. She will hold the position for the next three years by automatism. New regulations made to enhance tissue banking in order to provide greater amount of safety and contentment for patients necessitate increased costs. Taking eye bank as an example, we showed financial problems that each tissue bank is faced with every day. Taking care of all the costs needed for processing human corneal tissue in Croatia that will be used for transplantation, we calculated approximate costs required for this process and compared them with other countries.

[Meeting the demand for quality and safety checked corneal transplants. The role of corneal banks and health care organizations in Germany]. / Bedarfsdeckung mit qualitätsgesicherten Hornhauttransplantaten. Rolle der Hornhautbanken und der Kostenträger in Deutschland.

Only cornea banks with organ culture techniques provide the substantial length of time often required by safety and quality controls of corneal transplants. In Germany the annual need would be 4,500 transplants per year, for which 7,500 donor corneas must be primarily taken into culture. Meeting total demand should theoretically be easy as only 3,800 corneal donors are needed from a total of 860,000 deceased per year. Since consent is given in up to 50% if approached properly, shortage in donor corneas should not pose a problem. However, shortage still is the major problem because most cornea banks are still in the initial phase. This is because of the lack of direct refinancing by health care organizations. These organizations must be required to meet their legal responsibilities in this area.

Eye banking: the Minnesota experience.

We present a brief report on the activities of the Minnesota Lions Eye Bank. This eye bank receives and supplies tissue to several midwestern states. In addition, it plays a vital role in providing tissue for research and training at the University of Minnesota. In association with the Department of Ophthalmology, the eye bank is also actively involved in the research and development of various corneal preservation systems. Included below is information relative to procedures used in the eye bank for the selection and collection of donor material; the decontamination, preparation, and storage of corneas; cost of eye bank services; and staff coverage. Also included is some data on the number of eyes received and processed and the eventual uses of the tissues, during the last ten years.