Van den Bogaerdt on Cornea Transplants
The impact of COVID-19 on the ETB-BISLIFE eyebank in The Netherlands
Antoon van den Bogaerdt, Head Cornea and Heart Valve Department, ETB-BISLIFE, Beverwijk, The Netherlands
Date: April 22nd, 2020 (GEUDER: Tim Pieplau)
GEUDER: The Global Alliance of Eye Bank Associations (GAEBA) and the European Eye Bank Association (EEBA) sent out precautionary measures regarding COVID-19. Please describe the situation in your country.
Antoon van den Bogaerdt: As of the middle of March, we have decided to no longer accept non-tested donors. That meant that the total donation program has collapsed to zero. Only some organ donations, where we were also able to retrieve eye bulbs, have been continuing, but not more than 3 or 4 donors from March 15th. We envisioned to only use these selected and also preserved corneas for emergency settings, like perforations or impending perforations or other operations that can have no delay. We were ready for emergency situations, but in the last one month there were only four situations that required an emergency cornea, so a lot of other corneas were again not used. But things are changing now, because in The Netherlands we have developed a new test for COVID. So we have the lysis buffer, we have the swabs, we have the retrieval teams ready to swab deceased donors and we will be able to send those swabs to Sanquin [www.sanquin.org] for testing. Next to that we have the donor screening protocol which is very well developed towards COVID signs. With these measures together in place we can start tissue donation again as of tomorrow 9 o'clock, April 23rd.
GEUDER: Does your eye bank already test donors and recipients for COVID-19?
Antoon van den Bogaerdt: We have three approaches on which we developed our donor acceptance strategy:
- Very extensive screening by our Transplant Foundation, looking at all signs and risks for COVID.
- Doing the swabs by retrieval teams and testing these for Corona virus by Sanquin.
- We have of course virus reducing steps. First, during retrieval of the eyes, on the donor Betadine Iodine is being used for disinfecting the donor in and around the eye and then, when the eyes arrive at the bank we do another step with Povidone Iodine to further disinfect the eye bulb.
With these three measures we can say that the risks on transmitting Corona virus through tissue donation are, well, neglectable.
GEUDER: Do you have sufficient numbers of tests available?
Antoon van den Bogaerdt: More and more testing is needed in the Netherlands and also more contact research around the positive donors or positive patients, so there are more and more tests available and we can join that, as the donation chain in the Netherlands. So, we are indeed starting the testing and we have enough tests available.
GEUDER: Considering the reduced volume of harvesting and transplantations. What will be the waiting times for patients in the near future for corneal transplantations?
Antoon van den Bogaerdt: We already have about 700 patients on the waiting list and I’m not sure, I cannot really answer how long the waiting time is. It is also of course based on how much tissue is available, what is the medical urgency of the transplantation amongst others, but you can easily imagine that we have a doubling of our patients on the waiting list.
GEUDER: Please describe the indications where despite the COVID-19 crisis an immediate corneal or lamellar transplantation is still necessary, in short-term.
Antoon van den Bogaerdt: We have the urgent patients that have perforations that need to be operated within 48 hours and there is a semi-urgent group of operating on a longer time scale, so the impending perforations and the bullous keratopathies. You also have the small children, which are urgent but are a very small group. We have the patients needing typed cornea's, those are of course more or less people on the waiting list for a longer time and then you have the non-typed or the random corneas and those last scheduled patients will not be involved for the coming time because there is just no possibility to electively operate on these kind of patients in any case for the coming time. They hope to, of course, but as I believe the operations by eye surgeons, also for example the cataract surgeries, in the Netherlands are all being put on the end of the priority list, so I am not sure what is going to happen in the coming months to say whether or not the eye surgeons will be able to operate.
GEUDER: Do you consider to change the cell culture medium to overcome the COVID-19 threat in the future?
Antoon van den Bogaerdt: The formal answer is that we are not planning to change the medium because there are, in my opinion, no substances that can reduce virus load inside the cells or inside the tissue in the medium, without harming the cells that we need. So if you have any knowledge concerning the use of medication or materials that reduce virus without hampering the quality of the corneas, I will be glad to hear from you.
GEUDER: Thank you very much for the interview!
(GEUDER: Tim Pieplau)