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.