The EBAI CME 2013 - 21st and 22nd of September 2013, Golden Valley Resort, Ghodbunder Road, Thane West, Mumbai.

1. Donor Screening and
Selection
Dr. Pooja Bandivadekar
Senior Resident
National Eye Bank
Rajendra Prasad Center for Ophthalmic Sciences
All India Institute of Medical Sciences
New Delhi, India

2. Aim
• Prevention of transmission of
diseases from donor to patient
• Provision of optimal quality of
corneal tissue for
transplantation

3. Overview
Contraindications For Eye
Retrieval/ Use
Donor Screening- Serological
Tests

4. Contraindications For Eye-call / Retrieval
Systemic Causes Local Causes
Malignancies
Systemic
Infections
Miscellaneous
Ocular
Infections
Ocular
Malignancies
Neurological
Diseases

5. Systemic Infections- Contraindications
• HIV
• Hepatitis B
• Hepatitis C
• Syphilis
• Rabies
• Tetanus
• Active Malaria
• Miliary Tuberculosis
• Viral Diseases like Dengue
• Active viral hepatitis
• Active viral encephalitis
• Active meningitis

6. Systemic Infections- Contraindications
• Septicemia
▫ Total leucocyte count > 14,000 cells/ml
▫ Fever
▫ Positive Blood Culture
• Treatment with antibiotics
• Resolution of pyrexia
• Normalization of Leucocyte count

7. Systemic Infections- History Taking
• Cause of death
• Hospitalization
• Intravenous medications and
fluids
• Blood/ Blood component
transfusion
• Ventilator Support
• High risk behavior
• Recreational drugs abuse
• Tattooing
• Body piercing
Supplemented with
examination !!!!
Supplemented with
Documentation !!!!

8. Case Scenario
21 year old
male donor-
Cause of
Death- CRA
Cardio-
respiratory
arrest is only
a terminal
event
What was the
preceding
event before
CRA ?
Infection?
Trauma?
Malignancy?
Unknown
etiology?
Dialogue with
treating
physician and
relatives
Proper
documen-
tation

9. Systemic Malignancies-Contraindications
• Hodgkin's Disease/ Lymphoma
• Leukaemia
• Lymphosarcoma
• Multiple Myeloma
• Myeloproliferative Disease
Not All Malignancies Are Contraindications !

10. Neurological Diseases
• Alzheimer's Disease
• Dementia of unknown cause
• Multiple Sclerosis
• Parkinson’s Disease
• Creutzfeld -Jacob Disease
• Unknown neurological diseases

11. Neurological Diseases- History Taking
• Transmission of prion diseases-
Small but real risk
• No serological test for detection
• Onset and progression of neurological
disease
• Travel to/ treatment in European countries

12. Ocular Pathologies
• Conjunctivitis
• Corneal ulcer
• Corneal ectatic disorders
• Previous corneal surgery
• Corneal Scars
Not Every Ocular Surgery Is A
Contraindication !

13. Ocular Malignancies
• Retinoblastoma
• Malignant melanoma
• Ocular surface squamous neoplasia
• Metastatic tumour in the eye

14. Contraindications- Other causes
• Death due to unknown cause
• Patients on ventilators > 72 Hours
• Cyanide poisoning
• Death- preservation time > 24 hours

15. Donor Screening
Serological tests
HIV 1&2 HbSAg
HCV
antibody
Syphilis

16. Processing Of Blood Sample

17. Processing Of Blood Sample

18. What If Any Test Is Positive ?
• Label the cornea as Biohazard
• Unsuitable for transplant
• Unsuitable for research purpose
• Discard through the hospital waste disposal
system

19. Take Home Message
• Careful, sympathetic and appropriate elicitation
of history
• Careful documentation of cause of death
• Serological evaluation in every single donor