Spanish National Transplant Organisation launches National Cornea Plan to reach 5,000 donors in 2020

In partnership with the regional governments and the Scientific Societies, the ONT will launch a National Cornea Plan to reach 5,000 cornea tissue donors in 2020. The plan, work on which began in mid-2015 while measures were being formulated to improve donation, was approved at the most recent meeting of the Transplants Committee of the Inter-regional Health Council with a view to achieving self-sufficiency in covering the demand for corneas throughout the country with Spanish donors.

Experts foresee an increase in Spain over the coming years in the need for cornea tissue for this type of transplant, as has been the case recently both in Spain and in all other western countries.

The causes leading to the increased use of this therapy include an aging population and new cornea transplantation methods, such as lamellar transplantation. To this can be added the fact that the increased age of donors leads to reduced performance by the corneas. Lamellar transplantation is the implant of either of the two layers or lamellae into which the cornea can be divided, called the anterior and posterior lamellae. It is a technique that optimises viable corneas (because it enables two transplants to be performed from each cornea) but requires corneas of greater quality with high cellularity levels, which are difficult to obtain from older donors. It also requires specialists who are well-trained in obtaining the lamellae, as well as specific equipment in certain circumstances.

According to data from the ONT, the number of corneal transplants has increased by 20.6% in the last five years from 3,207 operations in 2011 to 3,870 in 2015 (an all-time high). The increase has intensified in the last year, with growth of 9% in 2015.

In this time, the number of donors has been on a par with the number of transplants; even though the launch of a National Cornea Plan has led to a substantial increase in the number of donors in the last year to a total of 3,608, an increase of 26% on 2014.

Approximately 1,300 patients are currently on the waiting list for a cornea transplant, with an average waiting time of three months.

Organisational models

The balance between supply and demand for corneas recorded in recent years in Spain led to a situation in which the organisation of this type of organ donation and transplantation mainly took place on a local level, with significant disparity between the organisational models adopted in each autonomous region of the country.

On occasions, Spain has needed to resort to using corneas from other organ banks in the European Union to cover peak demand in certain autonomous regions. In contrast, other regions that have sometimes experienced a surplus of cornea tissue have been unable to distribute this surplus to the rest of the healthcare system due to a lack of an appropriate nationwide channel for information and exchange.

To date, the ONT has been helping to resolve urgent cases by putting cornea banks and ophthalmologists from different autonomous regions in contact with one another.

Faced with the increasing demand for corneas and the foreseeable increase in this type of transplants, the ONT created a task force last year to conduct an exhaustive review of the national situation in this field and propose measures to achieve national self-sufficiency and standardise the cornea donation, processing and transplantation process throughout the country.

The Spanish solid organ donation and transplantation model, which has positioned the country as a world leader in this field for over 24 years, was used as the basis for conducting a study that revealed potential improvements to be made in the whole process - from donation to implant of the cornea tissue.

Recommendations

These aspects are reflected in the National Cornea Plan, which contains a series of recommendations that include the following:

• Although cornea donation depends on many factors, the plan recommends campaigns to foster cornea donation among the general population as well as among healthcare professionals, who are often unaware of the importance of this type of donation.
• It includes various action and management models that have demonstrated their effectiveness in detecting, obtaining and processing corneas.
• It advocates for increased training of the professionals responsible for detecting and extracting the corneas and updating the criteria for selecting the donors for this type of tissue.
• It encourages the centralisation of cornea tissue storage at one or more banks per autonomous region, given that centralisation improves the efficiency of this activity. The authors of the plan consider a cornea bank as a service provider for the hospital.
• It incorporates agreed criteria and standards for the assessment and validation of corneas by the banks.
• It recommends centralising, or at least making the Regional Coordinator aware of, the waiting list in each region.
• It defines priority criteria and recommends waiting list times for each one: emergency (72 hours); preferential (1 month); children (priority) and elective (no set time).
• It contains cornea transplantation instructions based on pathology and severity.
• It proposes creating a nationwide platform for the communication of surpluses, deficits and cornea exchange between autonomous regions.

About cornea transplantation

Cornea transplantation - the oldest form of transplant - is used to treat those diseases that damage the original cornea, making it opaque and leading to loss of eyesight (infections, trauma, burns, etc.). It is a simple procedure that can even be performed on an out-patient basis. The first cornea transplant in Spain was performed in 1940 at the Clínica Barraquer in Barcelona.

There are 180 hospitals in Spain accredited to perform this type of transplant and 112 centres authorised to obtain corneas distributed throughout all the autonomous regions.

Besides organ donation, it is also possible to donate tissue, such as corneas. Cornea donation can even be performed when death occurred outside of the ICU, as it is not necessary for the donor to be in a state of brain death. Such cases simply require a blood sample for the analyses required to avoid the transmission of diseases, a protocol and, above all, someone with expertise in obtaining the tissue. Donated corneas are processed and stored at so-called Eye Banks or Ocular Tissue Banks.

There are currently 29 banks of this nature in Spain. Per hospital, the ranking of activity since the ONT was set up is led by the Centro Oftalmológico Barraquer in Barcelona, followed by the Instituto de Microcirugía Ocular in Barcelona, the Hospital General in Alicante, the Hospital Vall de Hebrón in Barcelona and the Hospital de Cruces in Bilbao.

Since the ONT was set up, a total of 66,919 corneal transplants have been performed in Spain.