Bootcongres

Introduction: In the Netherlands 644 patients (Dec. 2013) are on the national cornea waitlist. The Dutch Transplant Foundation is assigned by law to register all cornea donors reported by medical doctors in the Netherlands, to check medical suitability, to organize procurement, and to allocate corneas to Dutch recipients. Purpose: To develop strategies to dissolve shortage of corneas and to realize equal allocation. Methods: Data about cornea donation, waitlist and allocation stratified by type of cornea and transplant center, during the years 2010-2012 were evaluated. A waitlist model was created to simulate several alternative strategies of allocation.

Results: The number of cornea donors increased from 1358 in 2010 to 1635 in 2012, due to an increase of the donor acceptance age limit from 75 to 85 years in October 2010. This resulted in an increase of corneas allocated to Dutch transplant centers from 1165 (57 HLA-typed, 474 untyped and 634 untyped lamellar corneas) in 2010 to 1385 (52 HLA-typed, 453 untyped and 880 untyped lamellar corneas) in 2012. The national waitlist did not decrease concordantly due to increasing demand of untyped lamellair corneas. Waiting times for untyped (lamellar) corneas differed considerably between centers. Allocation of untyped (lammelar) corneas was complicated by different cornea bank preferences, planning of operation rooms, and waitlist management by the transplant centers. The waiting time for untyped (lamellar) corneas is expected to decrease with current policy from 175 days to 128 (95%CI 120-137) days on average approximated by the model after 7 years. In our model a 5% increase of cornea donations could in 7 years halve the waiting time for untyped (lamellar) corneas compared to no increase, and could considerable decrease the number of cancelled operations. No preference of cornea bank and flexible planning of operation rooms by transplant centers significantly decreased the number of expired corneas.

Conclusion: Allocation of corneas in the Netherlands is complicated by different policies of the transplant centers. Waitlist modeling showed that the mean waiting time for a cornea transplant will slightly decrease with the current policy. A small increase in the number of cornea donors will already significantly decrease the waiting time. A more short term operation planning for corneas already available for transplantation and acceptance of corneas from both cornea banks must minimize the number of expired corneas.