Could the Corneal Transplant Pool Increase?

With any transplant procedure comes risk, but ophthalmologists may be too cautious, according to Gilles Thuret MD, PhD.

Demand for corneal transplantations is rising exponentially across the globe, yet remains largely unmet—due, in part, to the high number of medical contraindications.

The six most common of these contraindications, Dr Thuret said, are neurodegenerative disease, malignant haematological disease, melanoma, neoplastic meningitis, lymphangitic carcinomatosis, and tumours of the central nervous system.

Based on his previous research into the issue, Dr Thuret believes “many contraindications regarding corneal donation and allocation need to be reviewed and modified—or discarded altogether.” If achieved, he argues the corneal donor pool could increase by up to 70%.

To start this process, Dr Thuret polled surgeons regarding their perception of the risks associated with corneal transplantations and the ways they convey such risks to their patients. Sixty-six of the 110 surgeons who perform keratoplasty in France submitted responses.

The poll asked, “How often do you explain the risk of the transmission of general disease during transplantation to patients?” Of the respondents, 35% said they never did, while 36% only did so sometimes.

When asked why, 65% of these respondents said it was their belief “the risk [of disease transmission] was lower than that of other risks,” which Dr Thuret described as a “good approach.”

The surgeons were then asked which of the six contraindications they believed could be eliminated. The results were as follows: neurodegenerative disease, 59%; malignant haematological disease, 45%; melanoma, 48%; neoplastic meningitis, 41%; lymphangitic carcinomatosis, 41%; and tumours of the central nervous system, 64%.

“Approximately 50% of surgeons think it’s okay for [there to be] a revision of the contraindication list, while the other 50% remain unsure,” Dr Thuret said. “There were two kinds of responses of ‘no’, the first being that the ‘risk is likely or proven’ [15% of surgeons polled], which can be addressed with educational activities.”

The second group—constituting the majority of those who responded ‘no’ (and 35% of the total number of doctors polled)—said they did so because “the precautionary principle must be applied.” Dr Thuret described this reaction as “unfortunate, as it is much less accessible to scientific reasoning.”

Dr Thuret said “taking refuge behind the precautionary principle” serves as a major brake on progress in this particular field. However, with the majority either willing to withdraw the contraindications or remaining open to change their minds based on evidence, he said he plans to launch a clinical trial to demonstrate the safety of these previously ineligible donors, who “would increase the donor pool by more than 70%.”

Dr Thuret presented at the 2025 EuCornea congress in Prague.

Gilles Thuret MD, PhD, IUF is a clinical professor at Jean Monnet University in Saint-Étienne, France. gilles.thuret@univ-st-etienne.fr