One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe

Gilles Thuret*, Emilie Courrier, Sylvain Poinard, Philippe Gain, Marc Baud'Huin, Isabelle Martinache, Claus Cursiefen, Philip Maier, Jesper Hjortdal, Jacinto Sanchez Ibanez, Diego Ponzin, Stefano Ferrari, Gary Jones, Carlo Griffoni, Paul Rooney, Kyle Bennett, W John Armitage, Francisco Figueiredo, Rudy Nuijts, Mor Dickman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVES: To assess to which extent the COVID-19 pandemic affected corneal transplantation by virtue of donor selection algorithms in different European countries.

DESIGN: Survey.

SETTING: 110 eye banks in 26 European countries.

PARTICIPANTS: 64 eye banks covering 95% of European corneal transplantation activity.

INTERVENTIONS: A questionnaire listing the number of corneas procured and distributed from February to May 2018-2020 was circulated to eye banks.

MAIN OUTCOME MEASURES: The primary outcome was the number of corneal procurements. Additional outcomes were national algorithms for donor selection, classified according to their stringency (donors with COVID-19 history, suspected for COVID-19, asymptomatic, PCR testing) and the pandemic severity in each country. We calculated Spearman's correlation coefficient to determine, two by two, the relationship between the 3-month decline in eye banking activity (procurement), the stringency of donor selection algorithm and the grading of pandemic severity (cases and deaths). A partial correlation was run to determine the relationship between decline and stringency while controlling for pandemic severity.

RESULTS: Procurements decreased by 38%, 68% and 41%, respectively, in March, April and May 2020 compared with the mean of the previous 2 years, while grafts decreased, respectively, by 28%, 68% and 56% corresponding to 3866 untreated patients in 3 months. Significant disparities between countries and the decrease in activity correlated with stringency in donor selection independent of pandemic severity.

CONCLUSIONS: Our data demonstrate significant differences between countries regarding donor screening algorithms based on precautionary principles and, consequently, a decrease in the donor pool, already constrained by a long list of contraindications. Fundamental studies are needed to determine the risk of SARS-CoV-2 transmission by corneal transplantation and guide evidence-based recommendations for donor selection to justify their substantial medical and economic impact.

Original languageEnglish
Pages (from-to)312-318
Number of pages7
JournalBritish Journal of Ophthalmology
Issue number3
Early online date26 Nov 2020
Publication statusPublished - Mar 2022


  • epidemiology
  • eye (tissue) banking
  • infection
  • public health

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