The Generative Brain

Martheswaran T et al. 2020, A contemporary risk analysis of iatrogenic transmission of CJD via corneal transplantation in the United States (Ophthalmol Ther 9:465-483)

A review with a statistical model from a Utah eye research and eye bank group that updates the US estimate of how many donated corneas may come from people carrying CJD before symptoms. It counts 10 suspected corneal graft transmissions reported worldwide and estimates that about 3.8 corneas from donors with latent CJD entered the 2018 US transplant pool, and about 47 over 1979 to 2018. These are model figures built on death statistics and an assumed 10 year latency, not observed cases. The authors think known cases are undercounted and ask that CJD deaths be checked for past corneal grafts. Later work on corneal donor rules and donor prion testing cites it. Information only, not medical advice.

Key facts

  • Published online in Ophthalmology and Therapy on 20 June 2020 (volume 9 issue 3, pages 465 to 483) after receipt on 13 May 2020; open access under CC BY-NC as PMC7406626, PMID 32564338.
  • First author Tanisha Martheswaran (Harvard) and senior author Phillip Hoopes (Hoopes Vision Research Center, Utah); co-author Majid Moshirfar is listed with the University of Utah Moran Eye Center and the Utah Lions Eye Bank. Funded by an unrestricted grant from Research to Prevent Blindness, with no conflicts declared.
  • A literature search found 10 suspected corneal graft transmissions of CJD worldwide from 1974 onward: 6 in the United States, 2 in Germany and 2 in Japan.
  • The model used CDC WONDER CJD death counts as incidence, an assumed 10 year symptom-free latency, two corneas per decedent and Eye Bank Association of America yearly transplant statistics.
  • Result: about 3.8 of 111,703 transplant-intended corneas in 2018 (donors aged 31 to 80) were estimated to come from donors with latent CJD, about 1 in 29,500, with donors aged 61 to 80 making up about 84 percent of that figure; for 1979 to 2018 the estimate was about 47 corneas, about 1 in 30,000.
  • Older donor age and repeat grafting were the main risk factors; repeat grafts made up 12.3 percent of US corneal transplants in 2018, and the estimated risk roughly doubles with a second graft.
  • The authors say routine molecular prion screening of banked corneas is not currently recommended, but suggest donor screening be studied, especially for donors over 60, and point to blood PMCA tests then in development.
  • Stated limits include a single mortality database that may undercount CJD, a fixed 10 year latency when incubation can be much longer, estimated age splits for 2018 transplants and no data for donors under 31.
  • The reference list cites the Orru 2018 mBio study of prion seeding in sCJD eyes.
  • In the EU, recipients of corneal grafts are permanently excluded from giving blood and from tissue donation under the blood and tissue directives, the policy side of the transmission route this paper models.
  • A 2024 Czech study citing this paper reported legally required prion protein testing of 8,030 corneal donors from 2007 to 2023 with no proven TSE found, and argued the test adds cost and delay.

Timeline

  1. 2020Manuscript received on 13 May 2020.
  2. 2020Published online in Ophthalmology and Therapy on 20 June 2020.
  3. 2024Czech corneal donor prion testing study citing the paper published online in Cornea.
  4. 2026Europe PMC lists 13 citing articles.
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