Postmortem procurement of donor corneas in a tropical country with death–enucleation time greater than six hours: a viable option.

Abstract

Abstract: : Background: Shortage of donor corneas for keratoplasty is an obstacle to clearing the burden of corneal blindness all over the world. In tropical countries, corneas are not harvested from cadavers if more than six hours have elapsed after death. Countries with temperate climates extend this limit to 12–40 hours. We hypothesized that procurement of corneas from donors with death enucleation time more than 6 hours is a viable option even in India if the body is kept in a cooled environment such as the mortuary. Our hospital mortuary maintains a temperature of –4 to 0⁰C for storage of cadavers. Purpose:To compare the quality of donor corneal tissue obtained in our eyebank from cadaver donors less than or equal to and more than six hours after death. Methods:Review of eyebank records from November 1998 to October 2003. Details regarding donor age, sex, cause of death, death to enucleation time, place of retrieval, bacterial culture results and utilization was noted. Data obtained for donor corneas with death enucleation time less than or equal to 6 hours (Group A) and more than 6 hours (group B) was compared. Results:A total of 2963 eyes were evaluated, 1414 were included in group A and 1549 in group B. The mean death–enucleation time was 3.25+ 1.56 hours and 10.89 + 4.56 hours respectively. The mean donor age in group B (38.94 years) was significantly less than in group A (57.58 years)(p<0.01). Medical causes of death were significantly more in group A (p<0.01) and medico–legal cases were significantly more in group B (p<0.01). 39.8% and 59.8% donor corneas in group A and group B respectively were of optical grade (p<0.01). Enucleation in group A was mainly done outside the hospital (84.4%) and for group B was done in the mortuary (79.3%). Results of bacterial cultures sent immediately after enucleation from both groups were similar. Optically clear grafts were achievable after transplantation in 86% cases overall, 87.2% in group A and 85% in group B. Conclusions:Corneal transplantation of donor tissue obtained more than six hours after death from cases preserved in the cooled environment of a mortuary can be successful in a tropical country. A high yield of transplantable tissue and successful optically clear grafts can be attained. Prolonged death enucleation time was possibly offset by younger donor age in this series.

Keywords: cornea: clinical science • anterior segment • cornea: storage