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Citation: Röck T, Bramkamp M, Bartz-Schmidt KU, Röck D. Organ
transplantation scandal influencing corneal donation rate. Int J Ophthalmol
2017;10(6):1001-1003
Organ transplantation scandal influencing corneal
donation rate
Tobias Röck1, Matthias Bramkamp2,
Karl Ulrich Bartz-Schmidt1, Daniel Röck1
1Department
of Ophthalmology, Eberhard-Karls University Tübingen, Tübingen 72076, Germany
2Department of General Medicine,
Ruhr-University Bochum, Bochum 44801, Germany
Correspondence to: Tobias
Röck. Department
of Ophthalmology, Eberhard-Karls University Tübingen, Elfriede-Aulhorn-Street 7, Tübingen 72076, Germany.
Tobias.Roeck@med.uni-tuebingen.de
Received: 2016-03-24
Accepted: 2017-01-03
Abstract
In the majority of countries, there
is a shortage of donor corneas for corneal transplantations. This study
investigated the impact of organ transplantation scandals on corneal donation
rate at the University Hospital Tübingen. Each deceased patient was considered
as a potential corneal donor. An ophthalmic
resident handled with stable methods of
procedures the corneal
donor procurement from 2009 to 2015. The rates of corneal donation were
examined and analyzed. Among the 5712 hospital deaths, consent for corneal
donation was obtained in 711 cases. The mean annual corneal donation rate was
12.4%. Since 2009, the donation rate per year could be increased with exception
of 2013 and 2015. In the end of 2012 and 2014 two huge organ donation scandals
were known in Germany. In the following years 2013 and 2015 corneal donation
rate decreased significantly (P=0.0181 and P=0.0006). We
concluded that transplantation scandals have a significant impact on corneal
donation rate. Improving professional's performance through full transparency
and honesty is very important to earn trust of potential donors and their
families.
KEYWORDS: cornea; corneal donation; tissue
procurement; transplantation scandal; public trust
DOI:10.18240/ijo.2017.06.25
Citation: Röck T, Bramkamp M, Bartz-Schmidt KU, Röck D. Organ
transplantation scandal influencing corneal donation rate. Int J Ophthalmol
2017;10(6):1001-1003
INTRODUCTION
The first
visually successful human corneal transplant was performed 111 years ago, in
1905, by Dr. Eduard Zirm[1]. Corneal transplant is the most successful among all
organ transplant procedures. Corneal diseases are a major cause of blindness
worldwide. In most of these cases keratoplasty can help to restore or improve
the vision. However the number of corneal transplants done is far less than
required due to the enormous lack of corneal donation[2].
The acquisition of donor corneas is based on
sufficient staff levels of the eye bank team[3], interaction
between intensivists and the
staff of the responsible eye bank[4] and the
previous informed
consent from the donor according to German law. If the previous informed consent is missing, a
relative or partner may give consent, but may not contradict any known wishes
of the donor[5].
In recent
years, there have been publications[6, 7,
8, 9, 10, 11,
12] about two vast German transplantation scandals
which have reduced public support for organ and tissue donation. Several
centers with wait-list manipulations have been uncovered in the end of 2012.
The criteria for organ allocation have been incorrect reported to
Eurotransplant, the central office that creates
waiting lists, in order of receiving an organ faster for their patients on the
waiting list[10, 11]. In the
end of 2014 at the German Heart Center in Berlin a cardiologist has been accused of
giving preference to some heart transplant patients. Some were given extra
doses of drugs to change their status on the transplantation list. This further transplant scandal shocked Germany again[12]. These two German transplant scandals have resulted in a mistrust of
transplantation. Confronted with a perceived decline of
corneal donors we
determined to evaluate
the impact of transplant scandals on corneal donation rate at the University
Hospital Tübingen.
METHODS
From January 2009 to December 2015 medical records from every deceased
patient at the University Hospital Tübingen with approximately 1559 beds were
analysed retrospectively. During the whole study period an ophthalmic resident handled on a full-time basis the donor
acquisition without changing the
procedures. For more details on the donor screening and acquisition see Röck et
al[2]. The
annual corneal donation rate per 100 deaths were calculated and analyzed.
This study adhered to the tenets of the Declaration of Helsinki.
Statistical Analysis Statistical
analysis of the results was performed using the t-test. Statistical
analysis of the data was conducted using the Statistical Packages for the
Social Science (SPSS 18.0). Quantitative variables were expressed as mean±standard deviation (SD). P<0.05
was considered to be statistically significant.
RESULTS AND DISCUSSION
This investigation included 5712 deaths on the wards at the University Hospital
Tübingen. Consent for corneal donation has been given in 711
cases. The female-male ratio was 39:61. The mean donor age of cornea donors was
70y (SD 14y, range 16-93y). Three-quarters of donors were 60y of age and older.
The mean
annual corneal donation rate was 12.4% (range: 8.7%-17.8%). The number of
cornea donors developed from 64 of 738 deceased in 2009 to 79 of 783 deceased
in 2010 to 93 of 779 deceased in 2011 to 124 of 829 deceased in 2012 to 96 of
856 in 2013 to 150 of 844 deceased in 2014 to 105 of 883 deceased in 2015,
respectively. The corneal donation rate was 8.7% in 2009, 10.1% in 2010, 11.9%
in 2011, 15.0% in 2012, 11.2% in 2013, 17.8% in 2014 and 11.9% in 2015,
respectively.
The maximal
corneal donation rate was reached in 2014 (17.8%), compared with
the lowest in 2009 (8.7%). Since 2009, the donation rate per year could be
increased with exception of 2013 and 2015. In the end of 2012 and 2014 two huge
transplantation scandals were known in Germany. In the following years 2013 and
2015 corneal donation rate decreased significantly (P=0.0181 and P=0.0006).
In earlier reports we
described different factors which lead to an imbalance between the supply and
the demand for donor corneas. One of the
leading factors include the refusal to
donate[2]. The
main reasons for refusal by the potential donor’s next of kin include fear of
face mutilation during eye removal, religious beliefs, lack of confidence in
the health care system and the deceased patient wishes for nondonation. Our
study group showed another important factor limiting corneal donation: failures
of identification and notification regarding potential cornea donors, which is mostly due to an insufficient
number of staffs in the eye bank team[3].
This investigation illustrates the impact of
transplantation scandals on corneal donation rate in 5712 consecutive hospital
deceased at a German University Hospital. In the end of 2012 and 2014 two vast
German transplantation scandals have reduced trust for organ and tissue
donation[6, 7, 8, 9, 10, 11, 12].
Especially at this time mass media, like newspapers, radio, television and
internet reported repeatedly on the scandal. In the following years 2013 and
2015 the corneal donation rate decreased significantly at the University
Hospital Tübingen (P=0.0181 and P=0.0006). Already Schrem and
Kaltenborn[13] showed a significant decline of
organ donations in Germany attributable to transplant scandals. The number of
tissue donors in Germany decreased by 11% from 5697 in 2012 to 5093 in 2013[14]. This percentage reflects our experience with cornea
donors. The number of cornea donors at the University Hospital Tübingen
decreased by 23% from 124 in 2012 to 96 in 2013 and by 30% from 150 in 2014 to
105 in 2015. The situation was similar to that in organ donors. After the huge
German transplantation scandal in the end of 2012 the number of organ donors at
the University Hospital Tübingen decreased by 33% from 12 in 2012 to 8 in 2013,
the number of organ donors in Baden-Württemberg decreased by 18% from 119 in
2012 to 98 in 2013 and the number of organ donors in Germany decreased by 16%
from 1046 in 2012 to 876 in 2013[15]. In Germany
in 2011, 6976 corneas were placed in tissue culture, 8024 in 2012 and 7920 in
2013, respectively[15, 16].
These numbers correspond to an increase of 15% from 2011 to 2012 and a decline
of 1% from 2012 to 2013. Although the corneal donation rate at the University
Hospital Tübingen decreased significantly to 11.2% in 2013, it increased to
17.8% in 2014. This was because different promotion campaigns were done to encourage public trust and
awareness about organ donation and transplantation inside and outside the
University Hospital.
Because of
not changing the setting of corneal donor procurement and without changing processes in the whole study period we
assume that the significant decline had been caused by organ donation scandals. The
decrease may has been a protest against wrongful distribution and has showed a
loss of trust by potential donors and their families.
In summary,
our investigation illustrates that organ donation scandals have a significant
impact on corneal donation rate. It seems that increasing professional's
performance is very important to earn public trust and improve corneal donation
rate. Furthermore the knowledge and awareness of people about corneal donation
through educational and enlightenment work is necessary to meet the scarcity.
ACKNOWLEDGEMENTS
Conflicts
of Interest: Röck T, None; Bramkamp M, None; Bartz-Schmidt KU, None; Röck
D, None.
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