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Invited Commentary
September 24, 2020

Using Data to Rethink the Ban on Cornea Donation From Men Who Have Sex With Men

Author Affiliations
  • 1Kellogg Eye Center, University of Michigan, Ann Arbor
  • 2Department of Ophthalmology and Visual Science, University of Kentucky, Lexington
JAMA Ophthalmol. 2020;138(11):1150. doi:10.1001/jamaophthalmol.2020.3629

Puente et al1 have raised an important question for eye banking and corneal transplant. Should we reassess the current US Food and Drug Administration (FDA) guidance and Eye Bank Association of America medical standards that place restrictions on transplant of corneas from men who have sex with men (MSM)?

From their survey of North American eye banks, Puente et al1 estimate that about 3200 corneas may have been excluded from consideration for transplant in 2018 on the basis of sexual activity within 5 years by MSM in the United States or within 12 months by MSM in Canada. These data are collected by eye banks based on donor risk assessment interviews of family members of deceased potential corneal donors. Although this number represents less than 2.5% of the donor pool in the United States and Canada,1 those corneas are a precious resource for patients who are blind because of corneal disease, particularly in most of the world where donor supply is severely limited. These data likely underestimate the prevalence of MSM among the potential donor pool because family members may not be aware of sexual practices or may choose to answer questions inaccurately because of the persistence of associated stigma. In contrast, the actual implications for the donor supply may be smaller because some of these potential donor corneas (approximately 20% in the general population2) may not be transplantable for other reasons, such as donor quality or medical conditions.

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