CLINICAL SCIENCE
Do Donated Corneas Become Transplanted Corneas? The
Causes of Discard in Southern Brazil
Rosane Almeida de Freitas, PhD,* Cátia Millene Dell’Agnolo, PhD,† Willian Augusto de Melo, PhD,‡
Luciano de Andrade, PhD,‡§ Rafael Rodrigo Pimentel, Bel,¶ Sandra Marisa Pelloso, PhD,‡ and
Maria Dalva de Barros Carvalho, PhD‡
Purpose: To analyze the number of discarded donated corneas and
the causes associated with discard in southern Brazil.
Methods: This retrospective, cross-sectional, and analytic study of
donor corneal discards and their associated factors and geospatial
distribution was based on a macroregional strategy conducted from
2011 to 2015 in Paraná, southern Brazil. The dataset included all
cornea donations from patients who died of cardiac arrest at ages
between 3 and 70 years.
Results: A total of 9290 donor corneas were identified from 4645
donor patients; of these corneas, 4235 (45.6%) were discarded and
5055 (54.4%) transplanted. Mean age of the donors was 51.13 6
14.30 years. The main causes of discard were positive serology
(49.6%), corneal viability (19.8%), corneal tissue quality (8.5%), and
others (16.0%). The discard rate was higher in the 50 to 64 year
age group.
Conclusions: The corneal discard rate was high in all macro-
regions studied, with positive serology, viability, and quality of the
donated corneas being the main causes of discard. Discards were
more prevalent in older age groups (50–64 years and 65 or above age
groups). Considering the presented results, the assessment process of
potential cornea donors should be changed to reduce losses
and costs.
Key Words: cornea donation, Brazil, corneal transplantation,
epidemiology
(Cornea 2019;38:419–425)
Received for publication June 11, 2018; accepted November 28, 2018.
Published online ahead of print January 23, 2019.
From the *Health Sciences Department, University Hospital of Maringá, State
University of Maringá, Maringá, Paraná, Brazil; †Women’s Health
Research Group, University Hospital of Maringá, State University of
Maringá, Paraná, Brazil; ‡Health Sciences Department, State University of
Paraná, Paranavaí, Paraná, Brazil; §DGHI Global Injury Collaboration,
Duke University, Durham, NC; and ¶Nursing Management Residence,
State University of Londrina, Paraná, Brazil.
The authors have no funding or conflicts of interest to disclose.
Correspondence: Rosane Almeida de Freitas, Health Sciences Department,
University Hospital of Maringá, State University of Maringá, Colombo
Ave, 5790, Maringá, Paraná, Brazil 87020-900 Health Sciences Program
126 block (e-mail: rosane3.2@hotmail.com).
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Cornea  Volume 38, Number 4, April 2019
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
A pproximately 253 million people worldwide are visually
impaired. Of these individuals, 36 million are blind and
217 million have moderate to severe vision impairment.
Developing countries account for 80% of all cases.1,2 The
number of people with disabilities is estimated to triple over
the coming decades, from 38.5 million in 2020 to 115 million
in 2050, because of population growth and aging.2 The major
causes of impaired vision include cataracts and uncorrected
refractive errors. Approximately 80% of cases can be
prevented or cured.1
In 2017, Brazil had a total of 208.1 million inhabitants,
with an overall rate of 16.6 actual organ donors per million
population (pmp).3 According to the 2010 Brazilian Institute
of Geography and Statistics, 35,774,392 Brazilians are visually
impaired; of these individuals, 506,377 are blind and 6,056,533
are severely visually impaired.4 When specific cornea recovery
treatments are not plausible or do not achieve the expected
results, performing a corneal transplant is possible, represent-
ing the only way to recover vision in these cases.5
In 2017, 15,242 corneal transplants (74 pmp) were
performed in Brazil, which is below the estimated need for
18,547 transplants.3 In the first trimester of 2018, 8722 people
were on the waiting list for corneal transplants in Brazil.6
Brazil is one of the few countries in the world in which
the cost of transplantation is covered almost entirely by the
public health system. Keeping donations that cannot be used
to improve the quality of a population’s vision serves only to
leverage statistics, resulting in unnecessary financial costs in
an area with already significant expenditures, thus affecting
the overall health of the country.
Paraná is a state in southern Brazil with approximately
11,321,000 inhabitants, making it the second largest state in
this region in terms of population size. The 3 states that make
up the Southern region together contain 30 million inhab-
itants, which is approximately 15% of the total Brazilian
population. Of the 5 regions in Brazil, the Southern region
ranks first in terms of actual organ donors (34.1 pmp)3 and
contains the locations with the first (Paraná—44.2 pmp) and
second (Santa Catarina—33.7) highest actual multiple-organ
donations pmp.6 In regard to corneal transplants, the Southern
region ranks third, with 73.3 pmp. In 2017, Paraná state was
ranked eighth in the country, with 79.1 corneal transplants
pmp.3
In our country, a growing concern exists regarding the
actual use of donated corneas because Brazil aims to increase
donations without necessarily worrying about the viability of
www.corneajrnl.com | 419
Almeida de Freitas et al
these corneas. Thus, identifying the distribution and causes of
cornea discard will allow for directed action to optimize
donations and reduce losses and costs, which in turn has
a greater ethical aspect that pertains to the population and
financial budget of Brazil. Accordingly, this research analyz-
ing the number of donated corneas discarded and the causes
of discard and geospatial distribution in southern Brazil via
a macroregional analysis is justified.
MATERIALS AND METHODS
Data Collection Protocol
This cross-sectional, retrospective, and analytic study
was conducted to investigate donated cornea discards and
their associated factors, evolution, and geospatial distribution
across macroregions from 2011 to 2015 in Paraná, southern
Brazil. All cornea donations from individuals aged 3 to 70
years who died of cardiac arrest that occurred during the study
period were included, whereas individuals who died because
of brain death were excluded. Sclera donations were also
excluded because they were few in number (22 cases) and did
not fulfill the objectives of this research.
Reports from the State Transplant Center (CET) of
Paraná (PR), the Organ Procurement Organization, and the
headquarters of Maringá and Londrina were used as data
sources. These reports included all notifications and donations
from the macroregions of Paraná that were sent monthly to
the CET/PR, which provided the data in Excel spreadsheets,
including the destination of the organs donated, collected,
transplanted, or discarded. Incomplete data were comple-
mented by analyzing the medical records available at the
CET/PR headquarters.
The dependent variable was the discard status of the
donated corneas (yes/no). The independent variables included
year, age (categorized as age groups, according to the
Brazilian Registry of the Brazilian Association of Organ
Transplantation7), gender (male/female), macroregion (East/
West/North/Northwest), and notifying category (death verifi-
cation service and hospital). An analysis of the distribution
and percentage of independent variables was used to
generally describe the data, considering the total number of
donated corneas (N = 9290), and to evaluate the discards,
distributed across 4645 donor patients (the number used to
analyze the associated factors).
Among the causes of discard, those standardized by the
CET/PR were used as a reason for disposal: positive serology
(for contagious diseases, including hepatitis, acquired immu-
nodeficiency syndrome, and human lymphotropic T virus),
corneal viability (ie, expiration of the transplant period
according to the preservation solution used, which corre-
sponds to 14 days in Paraná8), tissue quality (ocular lesion/
low endothelial cell count, which is considered adequate
when more than 2000 cells per mm2),8 or clinical contrain-
dication (sepsis with active infection, neurologic diseases of
undetermined diagnosis, or malignant disease, except for
primary basal cell carcinoma, cervical carcinoma in situ, and
some primary tumors of the central nervous system; in cases
of eye tissue donation, patients with malignancies can be
420 | www.corneajrnl.com
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Cornea  Volume 38, Number 4, April 2019
considered, except for those with retinoblastoma, hematologic
malignancies, and malignant anterior segment tumors).8
Donor selection and exclusion criteria included an evaluation
of donor history, behavior, drug use, and the cause of death;
physical evaluation; and laboratory screening.8
The corneas were evaluated under a slit lamp at
a minimum magnification of 40X. The state’s eye banks
followed the technical standards of the National Health
Surveillance Agency, which specifies operating and technical
standards for the harvesting, storage, evaluation, and distri-
bution of corneas.8 In 2018, Paraná had 25 corneal transplant
centers and 5 eye tissue banks.9
Statistical Analysis
The data analysis was conducted over 3 phases. The
first phase considered the total number of cornea donors and
discards from the donation, categorized as yes/no (N = 9290).
The second phase considered only the cases discarded for
donation (n = 4235). A bivariate analysis was performed.
Pearson x2 test or Fisher exact test was used when the
frequency was less than or equal to 5, and measures of
association between variables were estimated via an adjusted
odds ratio. In the third phase, the Kolmogorov–Smirnov test
with Lilliefors and Shapiro–Wilks corrections was used to test
for a non-normal distribution of the dependent variable (age).
Subsequently, the nonparametric Kruskal–Wallis test was
used for analyses of variance, which are represented graphi-
cally by box plots.
The data collected were organized using Microsoft
Excel spreadsheets, and the historical series are represented as
polygon and frequency interaction graphs. For all analyses,
confidence intervals of 95% were considered, and a level of
significance of 5% was used for descriptive levels of the
respective statistical tests (P , 0.05). All data were analyzed
using R (R Core Team, 2014) and Epi Info 7.2.1.
Ethical Issues
All ethical concerns were addressed. The research was
evaluated and approved by the Research Ethics Committee at
the State University of Maringá (approval number 1470684).
RESULTS
A total of 9290 donor corneas were recorded from 4645
donor patients; of these corneas, 4235 (45.6%) were dis-
carded and 5055 (54.4%) transplanted. Mean age of the
donors was 51.13 6 14.30 years (range, 3–70 years, which
was the recommended age range for cornea donation in the
state at the time of this research).
Donations from adolescents, young adults, and the
elderly were associated with discard among all state dona-
tions. The distribution of donated, transplanted, and discarded
corneas is shown in Table 1, and the percentage of discarded
corneas by the cause in Paraná is shown in Table 2.
The distribution of the causes of cornea discard by
gender and age is shown in Figure 1. Mean age of patients
associated with discard was higher at hospital intake than at
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Cornea  Volume 38, Number 4, April 2019 Do Donated Corneas Become Transplanted Corneas

TABLE 1. Distribution of Donated Corneas (Transplanted and Discarded) in Paraná, Southern Brazil, From 2011 to 2015
Donated Corneas Discarded Corneas Transplanted Corneas Odds 95% Confidence
(N = 9290) (n = 4235), n (%) (n = 5055), n (%) Ratio Intervals P
Age group (yr)
#5 4 (30.7) 9 (69.3) 0.53 0.11–1.90 0.426*
6–10 8 (36.4) 14 (63.6) 0.68 0.28–1.62 0.384
11–17 33 (19.3) 138 (80.7) 0.27 0.19–0.40 ,0.001
18–34 642 (25.2) 1.909 (74.8) 0.29 0.26–0.32 ,0.001
35–49 901 (43.7) 1.161 (56.3) 0.90 0.821–1.00 0.050
50–64 1.842 (56.1) 1.441 (43.9) 1.93 1.77–2.10 ,0.001
$65 805 (67.7) 383 (32.3) 2.86 2.51–3.26 ,0.001
Gender
Female 1.350 (50.2) 1.340 (49.8) 1.29 1.18–1.41 ,0.001
Male 2.885 (43.7) 3.715 (56.3) 0.77 0.70–0.84 ,0.001
Macroregion
East 1.510 (33.8) 2.959 (66.2) 0.39 0.36–0.42 ,0.001
North 925 (60.6) 601 (39.4) 2.07 1.85–2.31 ,0.001
Northwest 627 (64.5) 345 (35.5) 2.37 2.06–2.72 ,0.001
West 1.173 (50.5) 1.150 (49.5) 1.30 1.18–1.42 ,0.001
Total 4.235 (45.6) 5.055 (54.4)
*Fisher exact test.

death verification centers, and the maximum age was similar,
excluding outliers. Figure 2 presents Kruskal–Wallis test box
plots for the variables notifying category and the cause of
discard by age.
DISCUSSION
In the present study, approximately 4235 corneas
(45.6%) were discarded, which is almost half of the corneas
donated (N = 9,290). The absolute number of transplants
performed in Brazil is impressive compared with other
countries.10 Brazil has an excellent public health service for
the transplantation of organs and tissues and is in fact
considered one of the best countries in the world in this
TABLE 2. Percentage of Discarded Corneas by the Cause in
Paraná, Southern Brazil, From 2011 to 2015
Cause of Discard
Positive serology
Corneal viability
Other causes
Corneal tissue quality
Clinical contraindication
Non-withdrawn corneas
Contamination of ocular tissue
Insufficient or hemodiluted/hemolysis of blood sample
Corneal injury during removal
Unknown cause of death*
Total
*Patients who were admitted in death in the hospital and were sent to death
verification service to determine the cause.
regard,11 with public funding for most of the procedures
performed. This service invests heavily in campaigns and
team building, and also in other factors that have contributed
to its success.10 When analyzed in relation to the needs of the
population, however, the number of transplants remains
insufficient. In 2017, 15,242 corneal transplants (74 pmp)
were performed in Brazil, which is less than the estimated
need for 18,547 transplants.3
Brazil maintains reliable statistics on notifications and
donations; however, the results of the country’s transplant
program are unknown.10 Data on transplants performed in the
country are available from the Brazilian Association of Organ
Transplantation and have increased substantially in recent
years. However, a gap regarding the difference between the
number of donations and transplants, that is, the number of
discards, exists, and the causes of discard, has only recently
started being studied. Simply increasing the number of
donations is insufficient if the donated organs do not end
up being used in a transplant.
n (%) Thus, the objective of transplant result evaluations
2.097 (49.6) should include not only the number of notifications and
841 (19.8) donations but also the actual effectiveness of these transplants
673 (16.0) in terms of the quality of life and health costs. The data should
362 (8.5) show ethical transparency and grounds for new political and
74 (1.7) public decisions in this area.
72 (1.6) In Brazil, 10,923 people awaited corneal transplants in
47 (1.1) 2016.5 This number tends to increase with the age of the
36 (0.9) population; in fact, the risk of deficiencies in vision because
30 (0.7) of the occurrence of chronic diseases2 will increase the need
3 (0.1) for new transplants.
4.235 (100) The cornea is the most transplanted tissue in the world,
with approximately 100,000 corneal transplants performed per
year.12 However, researchers have shown that a shortage of
corneal tissue exists internationally,13,14 with only one cornea

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.corneajrnl.com | 421

Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Almeida de Freitas et al Cornea  Volume 38, Number 4, April 2019

FIGURE 1. Distribution of the causes of discarded corneas by gender and age range in Paraná, southern Brazil. The data collected were
organized using Microsoft Excel (Microsoft Inc, Redmond, WA) spreadsheets, and the historical series are represented as polygon and
frequency interaction graphs.

422 | www.corneajrnl.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Cornea  Volume 38, Number 4, April 2019 Do Donated Corneas Become Transplanted Corneas

FIGURE 2. Box plots with Kruskal–Wallis tests for the variables (A) notifying category and (B) the cause of corneal discard by age
range in Paraná, southern Brazil. (A) The box plot shows the difference between the dispersions of the notification groups in the
hospital and death verification centers. (B) The box plot shows the dispersions of groups of causes of corneal discarding by age.
The asterisks (*) represent outliers. A level of significance of 5% was used for descriptive levels of the respective statistical tests (P ,
0.05). All data were analyzed using R (R Core Team, 2014) and Epi Info 7.2.1.

available for transplant for every 70 needed.13 The increased age
range of cornea donation, collection at death verification centers,
and other activities represent some of the actions recently
initiated in our country to increase the number of donations.
Brazil has a high percentage of discarded corneas,
totaling 29.5% between 2011 and 2015. The discard rates of
donated corneas found in some eye banks in Brazil range
from 10% to 16.3%.15 In northeastern Brazil, an eye bank
analysis revealed a 21.9% corneal discard rate over 15
months,16 a rate much lower than that described in the
present study. In southern Brazil, the corneal discard rate was
44%.17
An analysis of age-related discards found that approx-
imately 62.5% of discards occurred in people older than 50
years (a statistically significant association), followed by
young adults (aged 18–34 years, 15.2%) and adults (aged
35–49 years, 21.3%), giving a total of 36.5%. Corneas from
donors aged 65 years or older are approximately 3 times more
likely to be discarded.
As the population ages, the number of young donors
tends to decrease. Previous study authors in the United States
have shown that donors older than 65 years have increased in
number, with approximately half of all American cornea
donors being above 60 years. However, some institutions
have arbitrarily set an age limit of 65 years for cornea
donation, contrary to previous studies, which have not
confirmed that donor age is relevant for the success of
transplant.14
Similarly, a previous study stated that being 80 years
old (or younger) is not a barrier to donating corneas.18 Some
authors have also confirmed that donor age does not clearly
affect corneal viability with regard to transplantation/graft
survival; thus, this topic remains controversial among Amer-
ican surgeons.14 Although some authors have reported
a similar 5-year (86%) transplant success rate between donors
aged 12 to 65 years and those aged 66 to 75 years with regard
to age at corneal transplant outcome,14 the present study
found that a greater discard rate was associated with donors of
more advanced ages. According to the World Health
Organization, approximately 80% of people who are blind
or visually impaired worldwide are aged 50 years or above,1
which, in Brazil, may be related to the higher discard rate in
the older age groups, because many families are unaware of
patient vision problems or may not have access to health care
services for their detection.
Regarding the discard rate by gender, men constituted
the largest group of cornea donors in this study. This was
similar to the results described by other authors.19
Measures to reduce the number of discards in Brazil
should be based on the main causes of discard. In Paraná,
a positive serology for infectious diseases was responsible for
49.6% of all discards, which is much higher than the rate
described in another study (21.7%).16 This value might be
associated with the sexually active age group of donors,
which exposes them to a greater risk of contracting diseases,
including emerging and reemerging infectious diseases in
the country. However, one measure that might contribute to
the reduction in discard for this cause would be more
rigorous screening during interviews with donor relatives.
In addition, modifying the dynamics of the donation
process, with serology collected before cornea collection
(a strategy not yet performed in any state in Brazil), would
avoid any unnecessary public health costs associated with
the transplants.
The viability of the corneas in our study was 19.8%,
which is similar to that observed at an eye bank in

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.corneajrnl.com | 423

Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Almeida de Freitas et al
northeastern Brazil (18.3%).16 The age range with the highest
prevalence of discard resulting from viability in our study was
50 years or older, regardless of gender. This result might be
related to the nonacceptance of transplantation services
because of the greater risk of loss caused by declining quality
at more advanced ages. Another problem is the nonuse of
organs meant for other patients, which harms both patients
and the public system10; this effect might reduce the number
of discards resulting from viability.
Much controversy exists regarding the decline in
quality related to age. Some authors have described a slightly
greater transplant success rate with younger donors, with
lower endothelial cell loss at 5 years.14
A loss in tissue quality was found in 8.5% of all
discarded cases, which is lower than the rates reported by
studies conducted in other localities in Brazil (ie, 14.2% by
Freire et al16 and 31.1% by Freire et al19). The differences
found among these studies might be related to the qualifica-
tions of the health professionals involved in the donation/
transplant process performed in Paraná. Improving the use of
donations and reducing the number of discards because of
preventable causes are essential.16
Cornea quality might be related to exposure because of
lack of protection/occlusion of the patients’ eyes, which
causes epithelial ulcers15 and renders the cornea unviable for
transplantation purposes. Clinical contraindications (1.7%),
an unknown cause of death (0.1%), and non-withdrawn
corneas (1.6%) were associated with lower rates of discard,
but they deserve attention because they comprise causes that
can be ascertained before uptake.
Blood sample–related problems were reported in other
studies in other regions of Brazil, with a percentage of 8.3%
found at an eye bank in northeastern Brazil,16 a value much
higher than that in the present study (0.9%); however, similar
data were obtained in a state in the southeast region of Brazil
(0.53%).15 The increased age range for cornea donation and
the funding for death verification services and other activities
represent some of the actions recently initiated in Brazil to
increase the number of cornea donations.
Corneas can be collected in hospital settings or via
death verification services in cases of death resulting from
external causes. In this study, an association was found
between age and notifying category. Mean age of patients
associated with discards was higher for corneas collected at
hospital intake than for those collected at death verification
services, although the maximum age was similar, excluding
outliers. Death resulting from external causes is more
prevalent in young patients in Paraná, which may explain
this result.20
An association was found between age group and
cause of discard. Mean age was above 40 years in most
causes of discard, except for an unknown cause of death,
excluding outliers.
The lowest discard rate was found in the East macro-
region (34%). This macroregion has the largest population21;
it is also the capital of the state and is considered to be the
headquarters of the State Transplant Center, responsible for
donations and transplants throughout the state. Analyzing the
possible causes of the low discard rate in this region is
424 | www.corneajrnl.com
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Cornea  Volume 38, Number 4, April 2019
essential for extending the donation process of this macro-
region to other regions of the state via the development of
training programs and campaigns that can contribute to the
reduction in discard rates.
The rate of corneal discard was high for all macro-
regions studied. The main causes of discard were positive
serology, viability, and the quality of the donated corneas.
Discards were more prevalent among older age group donors.
One limitation of this study is the data source, which
reports other causes of discard as associated with multiple
causes. Therefore, identifying the causes separately was
not possible.
Progress is needed in this area to ensure that all
candidates for the transplant waiting list have access to the
data obtained in this research, which can serve as a basis for
new policy decisions in Brazil. Strategic changes are needed
to reduce corneal discards, improve transplantation effective-
ness, reduce public costs related to the financial budget of
Brazil, and increase ethical respect for the population.
REFERENCES
1. World Health Organization. Programmes. Blindness and Visual Impair-
ment Prevention. 2017: World sight day. 2017. Available at: http://www.
Who.int/blindness/world_sight_day/2017/en/. Acessed November 18,
2017.
2. World Health Organization. Media centre. Vision Impairment and
Blindness. Factsheet. 2017. Available at: http://www.Who.int/
mediacentre/factsheets/fs282/en/. Acessed November 18, 2017.
3. Brasil. Associação Brasileira de Transplante de Órgãos. Registro
Brasileiro de Transplantes. Dimensionamento dos Transplantes no
Brasil e em cada estado (2010-2017). 2017. Available at: http://www.
abto.org.br/abtov03/Upload/file/RBT/2017/rbt-imprensa-leitura-compressed.
pdf. Acessed: July 30, 2018.
4. Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto
Brasileiro de Geografia e Estatística. Censo demográfico 2010. Car-
acterísticas gerais da população, religião e pessoas com deficiência:
2010. Available at: https://biblioteca.ibge.gov.br/visualizacao/periodicos/
94/cd_2010_religiao_deficiencia.pdf. Accessed November 19, 2017.
5. Brazil. Health Portal. Professional and Manager. Corneal Transplan-
tation: 2016. Available at: http://portalsaude.saude.gov.br/index.php/o-
ministerio/principal/secretarias/366-sas-raiz/dahu-raiz/transplantes-raiz/
transplantes/21683-transplante-de-cornea. Accessed November 19, 2017.
6. Brasil. Associação Brasileira de Transplante de Órgãos. Registro
Brasileiro de Transplantes. Dados numéricos de doação de órgãos e
transplantes realizados por estado e instituição no periodo de jan-mar -
2018, 2018. Available at: http://www.abto.org.br/abtov03/Upload/file/
RBT/2018/rbt2018-leitura.pdf. Accessed July 30, 2018.
7. Brazil. Brazilian Organ Transplantation Society. Brazilian Transplan-
tation Registry. Organ Transplantation in Brazil (2008-2015). 2015.
Available at: http://www.abto.org.br/abtov03/Upload/file/RBT/2015/
RBT2015-INGLES.pdf. Accessed July 30, 2018.
8. Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária.
Resolução da Diretoria Colegiada – RDC 55, de 11 de dezembro de
2015. Dispõe sobre as boas práticas em tecidos humanos para uso
terapêutico. Available from: http://www.cevs.rs.gov.br/upload/arquivos/
201705/18112318-rdc-55-2015-boas-praticas-em-tecidos-14-12-2015.pdf.
Accessed July 30, 2018.
9. Secretaria de Estado da Saúde do Estado do Paraná. Sistema Estadual de
Transplantes do Paraná. Dados de Doações e Transplantes—Compa-
rativos de Janeiro a Junho (2011 a 2018), 2018. Available at: http://
www.saude.pr.gov.br/arquivos/File/Comparativos_Transplantes_
JUNHO_2018.pdf. Accessed July 30, 2018.
10. Castro CR. Associação Brasileira de Transplante de Órgãos. Home.
Biblioteca. A ABTO e o transplante de órgãos e tecidos no Brasil. Uma
visão pessoal 2017. Available at: http://www.abto.org.br/abtov03/
default.aspx?mn=512&c=958&s=0&friendly=a-abto-e-o-transplante-de-
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Cornea  Volume 38, Number 4, April 2019
orgaose-tecidos-no-brasil-uma-visao-pessoal. Accessed February 5,
2018.
11. Brazilian Organ Transplantation Society. Brazilian Transplantation
Registry. 2008-2015. Available at: http://www.abto.org.br/abtov03/
Upload/file/RBT/2015/RBT2015-INGLES.pdf. Accessed November 19,
2017.
12. Lamm V, Hara H, Mammen A, et al. Corneal blindness and xenotrans-
plantation. Xenotransplantation. 2014;21:99–114.
13. Gain P, Jullienne R, He Z, et al. Global survey of corneal transplantation
and eye banking. JAMA Ophthalmol. 2016;134:167–173.
14. Gal RL, Dontchev M, Beck RW, et al. The effect of donor age on corneal
transplantation outcome results of the cornea donor study. Ophthalmol-
ogy. 2008;115:620–626.
15. Santos CG, Pacini KM, Adán CBD, et al. Discarding causes of cornea
collected by eye bank of São Paulo hospital in two years. Rev Bras
Oftalmol. 2010;69:18–22.
16. Freire ILS, Araujo RO, Vasconcelos QLDAQ, et al. Causes for the
discards of corneas collected by the ocular tissues bank from Rio Grande
do Norte. Rev Pesqui Cuid Fundam. 2015;7:1867–1874.
17. Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária.
Relatório de Avaliação dos dados de produção dos bancos de tecidos,
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Do Donated Corneas Become Transplanted Corneas
2016. Brasília. 2017. Available at: http://portal.anvisa.gov.br/documents/
33840/2818486/Relatório+de+Avaliação+dos+Dados+de+Produção+dos+
Bancos+de+Tecidos+–+2016/dd27517b-f3fe-4531-8f46-38a24586100c.
Accessed November 19, 2017.
18. Organ donation—Know more about organ donation (what is corneal
transplantation?). Hong Kong SAR: Department of Health; 2013.
Available at: https://www.organdonation.gov.hk/eng/introduction_
cornea.html. Accessed November 15, 2017.
19. Freire ILS, Silva MF, Gomes ATL, et al. Harnessing of corneas captured
and processed for transplantation in an ocular tissue bank of North-
eastern Brazil. Rev Gaucha Enferm. 2014;35:14–20.
20. Brasil. Ministério da Saúde. DATASUS. Tecnologia da Informação
a serviço do SUS. Informações de Saúde. Óbitos por causas externas.
Paraná, 2011-2015. 2018. Available at: http://tabnet.datasus.gov.br/cgi/
tabcgi.exe?sim/cnv/ext10pr.def. Accessed November 12, 2017.
21. Brasil. Ministério da Saúde. DATASUS. Tecnologia da Informação
a serviço do SUS. População residente. Paraná. Informações de Saúde.
Demográficas e Socioeconômicas. População residente por Faixa Etária
detalhada segundo Macrorregião de Saúde. 2012. Available at: http://
tabnet.datasus.gov.br/cgi/tabcgi.exe?ibge/cnv/poppr.def. Accessed
November 10, 2017.
www.corneajrnl.com | 425