Corneal donation in the accident and emergency department: observational studyBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7271.1263 (Published 18 November 2000) Cite this as: BMJ 2000;321:1263
- J Long (), specialist registrar in accident and emergencya,
- D Walsh, transplant coordinatorb,
- D A W Ritchie, consultant in accident and emergencyc,
- F Russell, consultant in accident and emergencyd
- a Monklands Hospital, Airdrie, Scotland ML6 0JS,
- b Renal Unit, Western Infirmary, Glasgow G11 6NT,
- c Victoria Infirmary, Glasgow G42 9TY,
- d Royal Alexandra Hospital, Paisley PA2 9PN
- Correspondence to: J Long
- Accepted 22 May 2000
Corneal grafting restores sight to individuals with corneal damage. Corneal donations have decreased recently from 4419 in 1996 to 3346 in 1998.1 Patients pronounced dead in accident and emergency departments are potential donors of corneas for 24 hours, but this resource is underused.2 In the year before the study only one pair of corneas (1 of 106 deaths (0.9%)) was donated in our department.
The study consisted of developing a policy to request consent for corneal donation and to determine whether the rate of corneal donation was affected. In addition, a simple questionnaire assessed relatives' attitudes to corneal donation.
Methods and results
All patients pronounced dead in the accident and emergency department from April to July 1999 were considered for the study. Exclusion criteria were suspicious deaths, patients <16 years old, contraindication to corneal donation (scarring or deterioration of tissue, infectious disease in the eye tissue, rare invasive brain tumour, Alzheimer's disease or other disease of unknown aetiology), or no relatives present within six hours of death.
All relatives were asked whether the patient carried a donor card or had expressed a wish to donate organs, including corneas. Once consent was granted, we then checked whether there were any contraindications. The transplant coordinator was contacted and the relatives of patients in the study were asked two simple questions in a questionnaire: whether they thought it was appropriate to be approached about corneal donation in accident and emergency; and whether they were offended or distressed by the request.
During the four month study period 47 deaths occurred in the department. Eleven patients were excluded, comprising six suspicious deaths, three with no next of kin, and two with known contraindications. In addition, 11 patients were missed by the study. Of the remaining 25 patients, consent was given for nine and nine pairs of corneas were retrieved for storage.
One questionnaire was incorrectly completed, leaving 24 for analysis. Twenty one relatives thought it was appropriate to be approached regarding corneal donation; 23 were not distressed by the request.
Only four out of 24 patients carried a donor card or had expressed a wish to their relatives to donate their organs and in each case this included corneas. These data may add to the political debate on the validity of donor cards and the need for an opt out policy. Of the nine patients who donated corneas, three carried a donor card.
The study shows that an active policy for corneal donation in accident and emergency departments can have a dramatic effect on retrieval rates of corneas. The retrieval rate of 36% (25% if the 11 missed patients are included) compares favourably with rates found in previous studies.3–5 The rate is also a significant increase from the 1% of the previous year (95% confidence difference 24% (10% to 38%); P=0.001).
Many factors may be responsible for the 11 patients missed by the study. Despite training, staff may have felt it was inappropriate to approach relatives at this time of grief, or the department may have been busy, causing concern that the procedure would be time consuming. Exclusion criteria may have been known but not documented in the case notes at the time of death.
More work is needed to educate the public and staff about corneal donation. In January 1999 the Manchester Eye Bank was unable to issue any corneas for grafting because of a shortage. In 1998, 28 pairs of corneas were retrieved in the west of Scotland. Projecting our results for one year, we would expect to double the number of corneas donated in the west of Scotland simply by implementing this policy in one accident and emergency department. Accident and emergency is clearly a specialty that could help resolve the national shortage of donor corneal tissue.
We thank all the medical and nursing staff in the Accident and Emergency Department, Victoria Infirmary, Glasgow, for their help and support during this study.
Contributors: JL had the original idea for the study, coordinating it, participating in data collection and interpretation, and writing the paper. He is also the guarantor. DW participated in the design of the study and data collection. DAWR participated in the design of the study. FR participated in the design of the study, data collection and interpretation, and writing the paper.
Competing interests None declared.