Comparative study on the utilization rates and infective adverse events from corneas recovered pre- and post-autopsy at the mortuary from four eye banks

Dear Editor, We would like to report our research study titled “Comparative Study on the Utilization Rates and Infective Adverse Events from Corneas Recovered Pre- and Post-Autopsy at the Mortuary from Four Eye Banks.” The eye banks retrieve donor corneas through voluntary home calls and hospital/mortuary cornea recovery programs.[1,2] The major source of the donor corneas at an eye bank varies depending on the local conditions and situations that are more favorable for cornea retrieval in the geographical location of the eye banks. Some eye banks heavily rely on hospital/mortuary-based cornea recovery programs, whereas others depend on voluntary calls. A study conducted in Andhra Pradesh showed that there was significant growth of multi-drug resistant organisms from various sites within the mortuary.[3] In the mortuary, the donor corneas are recovered either before autopsy or after the autopsy. This practice is governed by donor’s medicolegal issues and the protocols at each forensic unit. Due to variability in time and handling of the body during post-mortem, including exposure of viscera, there is a concern that the corneas collected after autopsy might be associated with an increased risk of infection. To mitigate the spread of infection in mortuary-based recovery, practices, such as instilling antibiotics and closure of eye lids at the time of autopsy, have been adopted. However, the feasibility and rigor of these preventive measures during autopsy may vary and cannot be always quantified/audited. To address the concern if corneas retrieved after autopsy could be potentially at a higher risk for donor-related infections, we conducted a retrospective study between March 2021 and March 2024 (3 years) from four eye banks. We retrieved the data on collection, utilization of corneas, and donor-related adverse events with the utilized corneas that were retrieved before and after autopsy. The data were collected either from eye bank software or manual records. Overall, during the study period, 46,498 corneas were collected across the four eye banks, of which 24,300 (52.2%) were utilized for keratoplasty [Table 1]. The total number of corneas retrieved at the mortuary was 27,048 (58.17% of total collection). The total numbers retrieved at mortuary that were utilized for transplants was 20,600 (84.7% of the overall utilization). The overall utilization rate of corneas retrieved at the mortuary was 76%.Table 1: Cornea collection and utilization data from four eye banks between March 2021 and March 2024Amongst the 20,600 corneas utilized from the mortuary source, 5,988 (29.06%) corneas were utilized from corneas recovered post-autopsy and 14,612 (70.93%) were recovered before autopsy [Table 2]. The overall utilization rate of corneas retrieved from all four eye banks at the mortuary post- and pre-autopsy was 83.6% versus 73.2% (P value < 0.001, two-sample tests of proportion), respectively. On excluding one eye bank, where donor corneas were exclusively procured only after the autopsy, from the analysis, the overall utilization rate of corneas was comparable (73.52% vs. 73.47%, P value = 0.99).Table 2: Comparison of utilization of corneas retrieved after autopsy versus before autopsyDuring this time frame of the study, the overall rate of infectious adverse events after keratoplasty using donor corneas from mortuary was 0.0007% (15/20600). The infective adverse events between post-autopsy and pre-autopsy donors were 8 versus 7 eyes (0.0013% vs. 0.0004%, P value = 0.199), with two pairs of donor corneas in each. The mean donor age in post-autopsy recovered corneas was 37.5 (1–87) years versus 39 (2–89) years in pre-autopsy recovered corneas, and the mean endothelial cell density (ECD) was 2887 (1227–4739) cells/mm2 in post autopsy and 2835 (883–5677) cells/mm2 in pre-autopsy donors. Both age and ECD were statistically insignificant between the two groups. There was statistically significant difference in the proportion of donor corneas utilized for PK and DSEK in pre-autopsy versus the post autopsy donors, whereas there was no significant difference in other surgeries (DMEK, ALK, TPK, and K Pro) [Table 2]. Based on the data presented here, the utilization rate of corneas from mortuary sources was favorable, averaging around 76% (range 62–87). The utilization rates of corneas retrieved post-autopsy were comparable to the corneas recovered pre-autopsy. Overall, the risk of infectious adverse events was 0.0007% from the mortuary-recovered corneas. There was a slightly higher risk (~3 times more) of infectious adverse events in post-autopsy (0.0013%) versus pre-autopsy procured donor corneas (0.0004%), although the difference was not statistically significant. In conclusion, the study shows good utilization rates from donor corneas retrieved from mortuaries, and no significant difference in the utilization rates for pre- and post-autopsy recovered donor corneas. The association of infective adverse events in corneas recovered after autopsy was low, validating the protocols followed in donor recoveries after autopsy. Nevertheless, retrieval of donor corneas before autopsy would be a desirable practice in eye banking to avoid the inconsistencies and inadvertent breaches in protocols that may occur either during or post-autopsy. One limitation in extrapolating the results of this study is the maintenance status of individual mortuaries, which may differ amongst various hospitals. Awareness on the importance of consistent maintenance of recommended cold storage and the cleanliness in the mortuary setting for donor cornea recovery should be created Financial support and sponsorship: Hyderabad Eye Research Foundation, India. Conflicts of interest: There are no conflicts of interest.