Obtaining corneal tissue for keratoplasty | Archivos de la Sociedad Española de Oftalmología (English Edition)

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(A) 360° neovascularization with thin and uneven epithelium covering the corneal surface in the upper temporal quadrant and conjunctivalization of the rest of the surface. (B) Late fluorescein staining." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Mataix, A. Alcántara, M. Caro, J. Montero, B. Ponte, E. Rodríguez de la Rúa" "autores" => array:6 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Mataix" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Alcántara" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Caro" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Montero" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Ponte" ] 5 => array:2 [ "nombre" => "E." 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Navarro Martínez-Cantullera, M. Calatayud Pinuaga" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Navarro Martínez-Cantullera" "email" => array:1 [ 0 => "anavarro@bst.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." 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The difference between cornea donation and transplant is very important, although some difficulties have to be taken into account at the global level.<a class="elsevierStyleCrossRef" href="#bib0135">1</a> the United States has the highest number of transplants per million people (199 pmp); developed countries with a quality health system carry out between 55 and 75 transplants pmp; Spain,<a class="elsevierStyleCrossRef" href="#bib0140">2</a> with 60 cornea transplants pmp, is within the European average.The first published cornea transplant was performed by Zirm in 1905. In Spain, Arruga and Barraquer performed in 1940 the first operations in humans. In 1960, corneal transplants became widespread in Spain, and in 1962 professor Barraquer established the Eye Bank in Barcelona. At present, there are 25 cornea banks throughout the country. With the advent of new lamellar implant techniques, tissue banks and health professionals have implemented new processing protocols for distributing the most adequate graft to each receptor. In addition, new cell therapy techniques have been developed in recent years, including tissue engineering with the aim of creating an artificial corneae from stem cells.<a class="elsevierStyleCrossRef" href="#bib0145">3</a>DonationIntroductionAt present, a cornea transplant requires a donor who must voluntarily agree to donate his or her eyes to altruistically help other people. Without this altruistic gesture, transplants would not be possible.Donation is a complex process involving many health professionals: the treating physician, nurses, social workers, transplant coordinators and many other professionals that participate in the process to enable receptors the definitive reception of the transplant.In general, organ donation is better known by the population and health professionals, although the number of tissue donors and transplants is much higher. Specifically, the cornea is one of the most transplanted tissues in Spain. An example of the lack of knowledge about tissue transplant among health professionals and general society is the refusal by the relatives of deceased patients, which amounts to 18% for organ donation and approximately 40% for tissue donation.In 2013, 2861 cornea donations took place in Spain, representing 61 donors pmp, yielding 5162 corneae and 3465 transplants. Comparing these data with organ donation, in 2013 the pmp donation rate was of 36 and overall organ transplants amounted to 4281.Organ and tissue donation are similar (organs and some tissue save lives) but also have differences (organs are transplanted within hours but tissue can be stored for years) which may allow us to better understand the process.Tissue donation in the worldDifferences in organ and tissue donation and transplant in the world are huge. According to the Global Observatory on Donation and Transplantation (<a id="intr0025" class="elsevierStyleInterRef" href="http://www.transplant-observatory.org/">http://www.transplant-observatory.org</a>), all over the world more than 100,000 patients receive a transplanted organ that saves their lives or improves their quality of life, although only 10% of transplant requirements are being covered. In some countries like Spain, Croatia and Malta<a class="elsevierStyleCrossRef" href="#bib0150">4</a> organ donations of deceased people reaches 30 donors pmp and the process is regulated after death. On the contrary, in other countries such as Japan, Russia and Ecuador, organ and tissue donation of dead people is nearly nonexistent (5 pmp) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In what concerns cornea transplants worldwide, the needs of only 53% of the population are being met and there is one cornea available for transplant for every 70 that are needed.<a class="elsevierStyleCrossRef" href="#bib0135">1</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Said differences give rise to long waiting lists and avoidable deaths due to the lack of organs. For this reason, during the 2011 assembly of the World Health Organization, the World Health Assembly (WHA) approved resolution WHA 63.22 calling on member states to reinforce national or multinational authorities or organizations to coordinate, organize and supervise organ and tissue donation and transplant activities, with special emphasis on optimizing cadaver donations to protect the welfare and life of donors jointly with adequate health services in the long-term.<a class="elsevierStyleCrossRef" href="#bib0155">5</a> Said resolution also established the guidelines for transplants within an ethical and regulated framework.Tissue donation in SpainSpain is the leader in organ donation and transplants.<a class="elsevierStyleCrossRef" href="#bib0140">2</a> The so-called “Spanish donation model” consists in a number of actions during the donation process that has made donation a standard and accepted procedure in the health system and among the general population. The main characteristics of the Spanish donation model are:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Systematically organizing the donation process at the national, regional and hospital level</li><li class="elsevierStyleListItem" id="lsti0010">-the transplant coordinator as a key professional figure for the success of the program</li><li class="elsevierStyleListItem" id="lsti0015">-quality program for the donation of deceased donors</li><li class="elsevierStyleListItem" id="lsti0020">-training of personnel involved in the process and all health professionals</li><li class="elsevierStyleListItem" id="lsti0025">-transparent communication of the process and ongoing availability for the public.</li></ul>Types of tissue donorsCornea donations can only be obtained from deceased donors. A cornea donor is a person who is in brain death or asystole and who has not previously expressed opposition to said donation and altruistically donates tissues and cells for transplant to other human beings.<a class="elsevierStyleCrossRef" href="#bib0160">6</a>The most frequent tissue donations involve:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">-Cornea donors, who only donate corneae. These donations are produced in the largest numbers because oncological disease<a class="elsevierStyleCrossRef" href="#bib0165">7</a> and active infections are accepted in medical records, which are not accepted for the rest of tissue (excepting malignity in blood, lymph or melanoma, which are a contraindication for any donation). In addition, for many years no age limits were established for cornea donors as the effect of age on corneal tissue is limited.<a class="elsevierStyleCrossRefs" href="#bib0170">8,9</a></li><li class="elsevierStyleListItem" id="lsti0035">-Multi-tissue donors, who donate at least 2 types of tissue. These donations are less frequent because exclusion criteria are higher (for example, up to 55 years of age for donating arteries) and a history or knowledge about neoplasia or active infection at the time of the demise are not accepted.</li><li class="elsevierStyleListItem" id="lsti0040">-Organ and tissue donors who, in addition to donating organs also donate one or more types of tissue.</li></ul>Tissue donation modelsVery frequently, tissue donation takes place at the same time as organ donation so that, when transplant coordinators offer the possibility of donating organs they also mention the need for tissue, leaving the decision up to the relatives. Potential cornea donors are detected not only in hospitals, as is the case of organ donors, but also in funeral parlors, forensic institutes or even at the home of the deceased. The evaluation of donors is always exhaustive, regardless of donor location. Extraction is carried out by a trained professional in an authorized center.Evaluation of potential cornea donorsMedical–social recordsThe selection of potential donors involves a comprehensive review of a number of parameters required for successful transplants. This process is positive for the receptor and does not involve any problem or drawback that did not exist prior to the transplant.Initially, information must be obtained to identify any contraindication for the donation and to assess any risk of transmission of diseases, or identifying risks of failure of the transplanted organ. To this end, standardized working protocols must be established to ensure that the entire process is systematically carried out with full control so that transplanted tissue will remain safe and perform as efficiently as possible.Cause of demiseThe cause of death is crucial information to identify any contraindication for donation and to prevent the transmission of the disease that caused the death through the cornea transplant. If the cause of death is not known at the time of extraction, adequate actions must be carried out after donation in order to obtain relevant information, such as anatomopathological analyses of organs or tissues or autopsy to determine the cause of death.Current clinical records and medical antecedentsThe clinical history of potential donors prior to death is a very important source of information, which comprises the reason for hospital admission, clinic evolution, treatment medication and clinical history annotations. In addition, analyses must be checked together with all the lab and imaging tests which may have been carried out during the hospital stay. Received blood transfusions must also be checked to assess the blood to be subsequently submitted to serological tests. Finally, it is recommended to interview the treating physician to understand the antecedents and current medical history. When the demise of a patient has taken place outside a hospital, medical records must be obtained through the primary care physician or requesting information from the police or he forensic examiners, when applicable.Absolute contraindications for donation in medical recordsInfectionsActive systemic infectionsWhen, at the time of death, the potential donor had an uncontrolled systemic active infection (bacterian or viral, fungal or parasitic), donation is contraindicated due to the risk of transmitting said infection to the receptor.<a class="elsevierStyleCrossRefs" href="#bib0180">10,11</a> Donors with bacterian septicemia (excepting encephalitis and meningitis) can be assessed and considered for cornea donation but only when these are preserved in a culture enabling aerobic, anaerobic and fungal microbiological tests prior to the implant. Donors colonized with multi-resistant bacteria must always be excluded.Chronic infectionsPersistent chronic infections must also be taken into account, above all those caused by protozoa that could give rise to chronic infections (tuberculosis, brucellosis, leprosy, amyloidosis, Q fever, chlamydiosis, salmonellosis and tularemia) and arthropods (brucellosis, bartonelosis, rickettsial, trypanosomiasis, leishmaniasis, babesiosis and ehrlichiosis). In addition, the possibility that a bearer could transmit an infection through the cornea transplant must be assessed. It is very useful to perform a risk analysis taking into account the germ, the treatment received by the patient and the tissue being transplanted.Malign diseaseIn accordance with the European directive on tissues and cells,<a class="elsevierStyleCrossRef" href="#bib0190">12</a> antecedents or presence of neoplasia can be considered an absolute exclusion criteria for tissue donation, with the exception of primary basal cell carcinoma, in situ uterus carcinoma and primary central nervous system carcinoma, which must be assessed as established by the WHO. In contrast with the rest of tissue, cornea donations can be made even when the donors suffered a malign disease, excepting antecedents or presence of retinoblastoma, hematological neoplasia (leukemia, lymphoma, multiple myeloma) and anterior segment malign tumors, which are also contraindication criteria for cornea donation.Any cornea donation for human application that is not limited to the non-vascularized portion of the cornea (for instance, limbus or limbar cell transplant) cannot be considered in the case of cancer history.Risk of transmitting disease caused by prionsThe Creutzfeldt-Jakob disease or family history of this disease of non-iatrogenic cause, or suspected rapid progressive dementia diagnostic, is an absolute contraindication for ocular tissue donation. History of dementia can only be accepted in a donor if the primary cause is known and non-transmissible, such as dementia of vascular origin. In addition, it is necessary to discard the existence of demyelinization disease or central nervous system disease without a clear cause. Donation must also be excluded if the donor was treated with human pituitary gland derivate or has received dura, cornea or sclera transplant.Receptor of an organ or xenotransplantationIn the case of xenotransplantation, receptors must be excluded if the xenotransplantation they received included live cells.Recent vaccination recordsAttenuated virus or bacteria. Donations must be excluded if the donor received a vaccination one month earlier (according to blood donation criteria).Intoxication due to toxic substancesExposure to cyanide, mercury, gold or toxic substances due to accident or type of work must be excluded as said intoxication can be transmitted through tissue.Exclusion for blood donationIf the cause is unknown, the exclusion involves tissue donation. In addition, donors who have received transfusions in the United Kingdom are also excluded.Additional relevant information to be taken into account in assessments which may contraindicate donationMedication: high dose immunosuppression treatments could weaken the immune system and produce unreliable serology results. Overdose of any medicaments must be assessed.Transfusions: it is necessary to know if the potential donor was a patient who chronically received blood transfusions or products, or if at the time of obtaining blood samples a hemodilution exceeding 50% was present. In these cases, it is necessary to find blood prior to said transfusion to carry out serology or contraindicate the donor. Generally, if the potential donor was admitted in hospital, previous blood samples can be found at the hospital lab.Previous surgery: antecedents related to surgery must be analyzed to assess any contraindication for tissue donation (for example, cornea surgeries could damage tissue).Self-immune diseases: self-immune diseases can contraindicate cornea donation if treated with high doses of immunosuppressants or if the immune disease of the potential donor could have damaged the cornea.Genetic diseases: potential donors with non-iatrogenic CJD disease must be excluded due to genetic predisposition.Extended hospital stay: it is necessary to analyze the possibility that the potential donor may have acquired an infectious hospital disease if admitted for a long period of time or has spent many days with assisted ventilation. Each case must be assessed on the basis of infection type, received treatment and patient condition at the time of death.Social history. Evaluation of risk attitudesSocial history must always be requested from the relative who is able to fill in the questionnaire. If nobody can do this, cornea donation must not be accepted. Said questionnaire aims at identifying donor attitudes and actions that could involve higher risk of acquiring transmissible diseases. It includes questions related to:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045">-The use of intravenous or nasal drugs: this could be an absolute contraindication, because it is very difficult to determine that the potential donor did not consume said drugs in the past few months.</li><li class="elsevierStyleListItem" id="lsti0050">-Tattoos, piercings or acupuncture 4 months prior to death, if it cannot be determined that only sterile single use materials were used and that tattoo ink was changed between clients.</li><li class="elsevierStyleListItem" id="lsti0055">-Prison stay within the last 12 months.</li><li class="elsevierStyleListItem" id="lsti0060">-Living with someone with VHB or VHC</li><li class="elsevierStyleListItem" id="lsti0065">-Risk of acquiring sexually transmitted diseases in the last 12 months. The presence of venereal diseases must be assessed as it could indicate risk practices and could be an absolute contraindication in case of doubt. Potential donors who engaged in sexual practices for money or drugs are definitely excluded. In addition, donors who were sexually promiscuous, occasional partners or maintained intercourse with virus bearers (HIV or HTLVI/II) must be assessed for risk.</li></ul>Social history, residency and travelsRisks due to travels or living in high-risk countries where they could have contracted emerging infectious diseases such as dengue, yellow fever, Chagas disease, tuberculosis, West Nile virus, Q fever, CJD, malaria and HIV-1 group O.<a class="elsevierStyleCrossRef" href="#bib0195">13</a>Specific contraindications for cornea donationsThe age of a cornea donor is not per se a contraindication because the tissue is exhaustively analyzed as its quality determines feasibility.<a class="elsevierStyleCrossRef" href="#bib0200">14</a> Every tissue bank can establish the maximum and minimum age criteria, taking into account that the lower age limit produces corneae with greater plasticity. Contraindications for specific cornea donation<a class="elsevierStyleCrossRef" href="#bib0205">15</a> are:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0070">•Previous surgery: radial keratotomy, lamellar and obviously penetrating keratoplasty, corneal or intraocular refractive surgery and photorefractive keratectomy (PRK), any intraocular surgery which could have compromised endothelial count. All the above refers to cornea donations for penetrating keratoplasty. The past decade has seen a shift in corneal transplants, the current trend being to perform lamellar keratoplasty whenever possible.<a class="elsevierStyleCrossRef" href="#bib0210">16</a> This procedure consists mainly in transplanting only the deficient part of the cornea, i.e., the endothelium (DMEK: Descemet's membrane endothelial keratoplasty) or the endothelium and a thin sheet of stroma (DEAEK: Descemet's stripping automated endothelial keratoplasty), or the stroma, leaving donor endothelium untouched (DALK: deep/descemetic anterior lamellar keratoplasty). There are different criteria in these cases so that a cornea with anterior leukoma or with previous corneal refractive surgery and an endothelium in good shape could be utilized for endothelial transplant and vice versa, i.e., a cornea with deficient endothelium that is not apt for penetrating keratoplasty could be utilized in anterior lamellar transplants because the endothelium is discarded during surgery. At present, corneal surgeons request the tissue, specifying the procedure to be carried out in each patient. This has produced an increase in the amount of tissue available for transplant as a single cornea can be used for 2 patients, implanting the endothelium in one and the stroma and epithelium in another.<a class="elsevierStyleCrossRef" href="#bib0215">17</a></li><li class="elsevierStyleListItem" id="lsti0075">•Anterior pole diseases: Central opacity, scars, pterygium.</li><li class="elsevierStyleListItem" id="lsti0080">•Congenital or acquired disease: keratocone, keratoglobe or leukomae affecting the central area of the cornea.</li><li class="elsevierStyleListItem" id="lsti0085">•Ocular inflammation (even when caused by systemic diseases such as rheumatoid arthritis or sarcoidosis).</li><li class="elsevierStyleListItem" id="lsti0090">•Active ocular infections, including ocular herpes history.</li><li class="elsevierStyleListItem" id="lsti0095">•Malign eye tumors.</li></ul>After removing the tissue, slitlamp must be used to assess its feasibility and carry out an endothelial count, which is essential in the posterior (endothelial) penetrating and lamellar keratoplasty. Donor age, careless tissue extraction from the donor and glaucoma are considered risk factors for late endothelial failure (occurring in the long-term due to progressive cellular deterioration). A loss of up to 10%<a class="elsevierStyleCrossRef" href="#bib0220">18</a> of endothelial cell population has been reported during collection, transport, storage and implant. Mirror microscopy provides adequate information about pleomorphism (changes in cell hexagonality), polymegatism (variations in cell area) and cell density, and enables the diagnosis of cornea guttata.<a class="elsevierStyleCrossRef" href="#bib0225">19</a>In general, a minimum value of 2000–2200 cells/mm2 is considered acceptable, in all cases measured immediately before delivering the tissue for implant and not at the initial processing stage, either live or in culture.<a class="elsevierStyleCrossRef" href="#bib0230">20</a>Donor physical examinationThis examination must be carried out in all cases as it is a very important information source to identify possible transmissible diseases and to confirm the medical and social history of the donor. Systematic physical examination involves recording the examination even when no relevant results have been found.IdentificationThis involves verifying the donor name as written in the familial informed consent with the donor identification: bracelets, tag, etc. In addition, donor sex, ethnic group, weight and height must also be recorded in the clinical examination report as well as describing the physical condition of the body, including signs of malnutrition or deformities.Physical explorationAutopsy: it is necessary to verify if the autopsy has been performed, whether it was full or partial or it will be carried out after tissue donation.Physical exploration must be performed systematically, with the anterior and posterior part of the body, looking for the following physical signs: genital lesions, large lymphatic nodes, tattoos, acupuncture or piercings, nonmedical injections and white spots in the mouth. In addition, a dermatological examination must be carried out looking for suspected malign skin injuries such as petechiae, inflammation, scabs, sores, herpes, trauma, fractures, lacerations, abrasions and jaundice.Taking blood samples and time up to extractionBlood samplesThe quality of blood samples for lab screening tests depends on several factors, all of which must be taken into account before taking the samples.<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0100">-The blood samples must be obtained as soon as possible after asystole to avoid blood degradation (hemolysis) and prevent false-positive serological results.<a class="elsevierStyleCrossRef" href="#bib0235">21</a> In general, laws and regulations set a limit of 24h for obtaining samples post-asystole.</li><li class="elsevierStyleListItem" id="lsti0105">-Hemodilution: if the donor has received transfusions of blood, plasma, colloids or crystalloids, these could invalidate donation if hemodilution exceeds 50%. In these circumstances, efforts must be made to recover a donor blood sample prior to said transfusions (it is allowed to utilize blood extracted up to 7 days pre-mortem).</li><li class="elsevierStyleListItem" id="lsti0110">-Sample preservation conditions prior to testing: centrifugation, refrigeration, etc.</li><li class="elsevierStyleListItem" id="lsti0115">-Serum or plasma can be obtained only with the kit used for carrying out serology. No other bodily fluids can be utilized.</li><li class="elsevierStyleListItem" id="lsti0120">-Screening test must be carried out in certified labs authorized for the activities established by law through competent authorities.</li><li class="elsevierStyleListItem" id="lsti0125">-Serology samples: the law requires that a donor blood sample is preserved in order to repeat tests of stored tissue if necessary. Said samples must be maintained at least 10 years until the last donor tissue has been transplanted.</li></ul>Serology in cornea donorsThe battery of required tests for cornea donors varies in the legislation of each country and with the recommendation of the scientific societies followed by each tissue bank. In Spain, Royal Decree 9/2014 requires in Annex III the following tests:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0130">•VIH1 and HIV2 antibodies: negative.</li><li class="elsevierStyleListItem" id="lsti0135">•Anti-HCV antibodies: negative.</li><li class="elsevierStyleListItem" id="lsti0140">•Hepatitis B surface antigen (HBsAg): negative.</li><li class="elsevierStyleListItem" id="lsti0145">•Core hepatitis B antibodies (HBcAc): can be positive.</li><li class="elsevierStyleListItem" id="lsti0150">•If the core is positive (IgG and IgM) and the HBsAg is negative, additional tests plus risk assessments must be carried out to determine donor feasibility (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0155">•Syphilis: a specific or nonspecific treponemic test can be carried out. A positive result is not a direct contraindication but requires risk analysis (donor reassessment) to make a decision.</li><li class="elsevierStyleListItem" id="lsti0160">•Some serologies must be carried out when the donor comes from regions with high prevalence of some transmissible diseases: HTLV I-II antibodies,<a class="elsevierStyleCrossRef" href="#bib0240">22</a> malaria and anti-Trypanosoma cruzi (Chagas) antibodies (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0165">•Even though at present the techniques utilized for detecting transmissibility markers exhibit high quality as regards the sensitivity, specificity and predictive value, it is still possible to get false negatives obtained in a window period or due to immunosuppressant treatment. In order to minimize this risk, in addition to a comprehensive study of the medical–social history, it is recommendable to adopt molecular biology techniques (polymerase chain reaction) for HIV, hepatitis B and hepatitis C.</li><li class="elsevierStyleListItem" id="lsti0170">•Finally, for many years the necessity of carrying out human leukocyte antigen on cornea donors to find compatible receptors and avoid rejection is an ongoing controversy. In recent years and with the advent of new lamellar transplant techniques, some studies indicate that this would be required only in very particular cases.<a class="elsevierStyleCrossRef" href="#bib0245">23</a></li></ul>Time for extractionCorneal tissue must be extracted as soon as possible, in general before 24h post-mortem, although the legislation of some European Union authorize said extraction up to 48h. The medical director of the tissue bank can establish additional criteria if deemed necessary. Early corneal tissue extraction enables avoiding post-mortem infection, preserving the cornea in adequate preservation and temperature conditions, maintaining the characteristics thereof. To this end, it is recommended to keep the eyelids closed from asystole up to extraction and to refrigerate the body as soon as possible.Family consent for donationTissues can be obtained after the appropriate certification of death and the execution of the police and judicial proceedings, if any. In Spain, as established by article 11 of Act 41/2002, dated November 14, tissues and cells of deceased persons can be extracted when no specific opposition has been registered. Any opposition, as well as acceptance if indicated, may refer to any type of organs or only some, and shall be respected.Requesting the consent of relatives of a recently deceased person is a very critical situation and must be asked only by professionals with sufficient training and experience to understand the phases of grieving. Generally, these are the transplant coordinators. In addition, it is the time to inform relatives about the need, nature and circumstances of donation, of specifying the restoration and preservation procedures to be carried out on the body and the postmortem health practices to be implemented.If the relatives are not aware of an explicit opposition by the deceased, once they have accepted the donation the medical history of the donor must be checked by means of the social risk survey. The survey must be taken by the relative that was closer to the donor and who may respond to intimate details such as travels, sexual practices and use of drugs. These questions must be set in a context, explaining to the relatives that they are made in order to ensure the success of a transplant and are not aimed at judging the donor's activities.Obtaining the corneaWhereThe cornea must be obtained in appropriate facilities by means of procedures that minimize any contamination of obtained tissues and cells. The area must be of restricted access for personnel involved in said processes, in addition to being clean and with maintenance actions as appropriate. The factors to be taken into account for adequate cornea extraction are: a private space available for extraction, air-conditioning, regulation of humidity, temperature, lighting, a clean and tranquil environment.WhoSince the beginning of corneal transplant activities, ophthalmologists were in charge of obtaining corneal tissue. In recent years, due to the increased number of extractions and the need to have more personnel available round-the-clock, ophthalmologists have trained physicians, nurses and health technicians for carrying out extractions.Basic extraction measuresBefore beginning the extraction, donor identity must be verified to make sure that the family has given consent for the donation. A macroscopic examination of the ocular globe and the cornea must be carried out to identify alterations or anomalies before beginning the extraction. Adequate garments for cornea extraction include a surgical mask, hair cover, sterile gloves and apron, the use of sterile instruments and devices of good quality, adequately validated and certified for extracting corneas and, whenever possible, with the CE label. For extracting corneal tissue, single use material is very useful and in this case the donor documentation must be filled in indicating the utilized material (batch) and expiry dates thereof.<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0175">Step 1. Surgical handwashing.</li><li class="elsevierStyleListItem" id="lsti0180">Step 2. Establishing a sterile field for placing instruments.</li><li class="elsevierStyleListItem" id="lsti0185">Step 3. Washing the extraction area (with 1% iodine povidone<a class="elsevierStyleCrossRef" href="#bib0250">24</a>) and cleaning the working areas with antiseptic solution. Excess povidone must be irrigated because it is toxic for the corneal endothelium and fibroblasts.<a class="elsevierStyleCrossRef" href="#bib0255">25</a></li><li class="elsevierStyleListItem" id="lsti0190">Step 4. Instilling broad spectrum antibiotic solution on the corneal surface.</li><li class="elsevierStyleListItem" id="lsti0195">Step 5. Separating eyelids with a blepharostat, taking care while inserting the speculum to avoid damaging the epithelial surface.</li><li class="elsevierStyleListItem" id="lsti0200">Step 6. Utilizing tweezers and conjunctiva scissors to carry out a 360° peritomy around the cornea close to the limbus but without damaging it, applying the least possible tension (traction can cause folds in the cornea).</li></ul>Specific corneal tissue extractionA circular incision must be made in the conjunctiva, leaving at least 3–4mm of the sclera. A circumference can be marked with a trepan to make a uniform incision. Once the sclerocorneal ring has been obtained, the cornea must be placed in the preservation fluid.Ocular globe extraction (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>)<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0205">Step 1. After performing the peritomy, the conjunctiva must be desiccated with scissors perpendicularly to the limbus in the 4 quadrants to facilitate access to ocular muscles.</li><li class="elsevierStyleListItem" id="lsti0210">Step 2. The 4 rectum and oblique muscles must be isolated with a strabismus hook and section them close to their insertion. The section must be made to leave the remainder of the tendon or even the muscle belly to facilitate global manipulation during extraction.</li><li class="elsevierStyleListItem" id="lsti0215">Step 3. Insert the enucleation spoon into the orbit through the medial side, applying slight upwards pressure. The spoon comprises a lower indentation for the optic nerve.</li><li class="elsevierStyleListItem" id="lsti0220">Step 4. Place the semi-open optic nerve scissors through the lateral side behind the spoon.</li><li class="elsevierStyleListItem" id="lsti0225">Step 5. Cut the optic nerve, leaving about 5mm attached to the ocular globe. Ocular tone must be maintained, avoiding any injury to the corneal surface. Ocular hypotony during extraction can produce endothelial lesions due to contact of the endothelium with the anterior chamber structures, rendering the cornea useless for transplants (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</li></ul><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The ocular globe must be placed in a humid chamber (a sterile container with gauzes imbibed in saline solution on the base and fixing the globe) with the cornea facing upwards. Irrigation with saline solution is necessary to preserve the humidity of the gauze but without submerging the eye.The above steps are modified when only the cornea is extracted. In this case it is not necessary to isolate the muscles or desiccate the conjunctiva in the direction of the optic nerve. The 360° peritomy is performed and, utilizing a 14mm or larger trepan, the sclera is cut circumferentially, the cornea is extracted with 2–4mm of sclera and part of the conjunctival surrounding the corneal limbus.ReconstructionFor reconstruction purposes, during the extraction of the globe a plastic or cotton ball is used together with a prosthesis in the form of a lid or, if only the cornea is extracted, only the lid-shaped prosthesis to recover donor appearance prior to donation. If necessary, the eyelids can be closed with sutures or adhesive.Once reconstruction is completed, access must be allowed to relatives and mourners if requested, and call the funeral parlor subsequently.Tissue preservation, packaging and labelingThe cornea or ocular globe must be sent to the bank for processing. It is recommended to do this as soon as possible, maintaining the preservation temperature between 2 and 8°C. Validated packaging must be utilized and it must be capable of maintaining adequate temperature in different weather conditions. Tissue must always be identified to maintain the donor-tissue traceability.Specific labeling at the tissue bank can be performed during extraction, taking into account the standards established by the European Commission.<a class="elsevierStyleCrossRef" href="#bib0260">26</a> The labeling proposed by the Commission comprises a single European code that must include information on the donation identification sequence as well as product identification sequence, in addition to country and authorized bank identification. This labeling is of particular importance as it provides donor-receptor traceability at all times.Preservation methodsIn order to maintain corneae feasible up to implant, preservation methods must be applied. The main 3 preservation methods for ocular tissue are the following.Hypothermic ocular globe preservation (2–8°C)The ocular globe is preserved in a humid chamber for a maximum period of 48h to prevent contamination risk.Hypothermic cornea preservation (1–10°C)Generally, preservation procedures prescribe a maximum storage of 7–14 days. The preservation medium includes antibiotic and phenol red that allows immediate detection of any pH variation that occurs when the medium and the cornea become contaminated. In these cases the endothelium must be inspected and it must be taken into account that said count diminishes during storage. Microbiological control protocols are recommended for surgeons to take samples of the medium or the remaining sclera at the time of implant.Preservation in tissue cultureA culture is utilized for up to 5 weeks in a container that maintains the cornea at a temperature between 18 and 34°C. During said preservation period, medium and culture must be replaced to ensure tissue sterility. During preservation, the cornea becomes edematous and for this reason it must be placed in a medium prior to distribution to diminish swelling in transport during 5 days. This medium also contains phenol red to detect infections.Preservation for lamellar transplantIn recent years, the use of lamellar corneae has increased. For this reason, it has been established that the lamellae obtained of hypothermic corneae can be stored refrigerated for up to 2–3 days. Lamellae for DSAEK that are obtained from corneae in culture must remain at least 24h in the dehydration medium before preparing the lamellae. In this case, the obtained lamellar can remain in the dehydration medium for one week prior to the implant.Conflict of interestsNo conflict of interests was declared by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres733561" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec737388" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres733560" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec737389" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Donation" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Tissue donation in the world" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Tissue donation in Spain" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Types of tissue donors" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Tissue donation models" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Evaluation of potential cornea donors" "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0045" "titulo" => "Medical–social records" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Cause of demise" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Current clinical records and medical antecedents" ] ] ] 1 => array:3 [ "identificador" => "sec0060" "titulo" => "Absolute contraindications for donation in medical records" "secciones" => array:10 [ 0 => array:3 [ "identificador" => "sec0065" "titulo" => "Infections" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Active systemic infections" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Chronic infections" ] ] ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Malign disease" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "Risk of transmitting disease caused by prions" ] 3 => array:2 [ "identificador" => "sec0090" "titulo" => "Receptor of an organ or xenotransplantation" ] 4 => array:2 [ "identificador" => "sec0095" "titulo" => "Recent vaccination records" ] 5 => array:2 [ "identificador" => "sec0100" "titulo" => "Intoxication due to toxic substances" ] 6 => array:2 [ "identificador" => "sec0105" "titulo" => "Exclusion for blood donation" ] 7 => array:2 [ "identificador" => "sec0110" "titulo" => "Additional relevant information to be taken into account in assessments which may contraindicate donation" ] 8 => array:3 [ "identificador" => "sec0115" "titulo" => "Social history. Evaluation of risk attitudes" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0120" "titulo" => "Social history, residency and travels" ] ] ] 9 => array:2 [ "identificador" => "sec0125" "titulo" => "Specific contraindications for cornea donations" ] ] ] ] ] 7 => array:3 [ "identificador" => "sec0130" "titulo" => "Donor physical examination" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0135" "titulo" => "Identification" ] 1 => array:2 [ "identificador" => "sec0140" "titulo" => "Physical exploration" ] ] ] 8 => array:3 [ "identificador" => "sec0145" "titulo" => "Taking blood samples and time up to extraction" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0150" "titulo" => "Blood samples" ] 1 => array:2 [ "identificador" => "sec0155" "titulo" => "Serology in cornea donors" ] ] ] 9 => array:2 [ "identificador" => "sec0160" "titulo" => "Time for extraction" ] 10 => array:2 [ "identificador" => "sec0165" "titulo" => "Family consent for donation" ] 11 => array:3 [ "identificador" => "sec0170" "titulo" => "Obtaining the cornea" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0175" "titulo" => "Where" ] 1 => array:2 [ "identificador" => "sec0180" "titulo" => "Who" ] 2 => array:2 [ "identificador" => "sec0185" "titulo" => "Basic extraction measures" ] 3 => array:2 [ "identificador" => "sec0190" "titulo" => "Specific corneal tissue extraction" ] 4 => array:2 [ "identificador" => "sec0195" "titulo" => "Ocular globe extraction (Fig. 3)" ] 5 => array:2 [ "identificador" => "sec0200" "titulo" => "Reconstruction" ] 6 => array:2 [ "identificador" => "sec0205" "titulo" => "Tissue preservation, packaging and labeling" ] ] ] 12 => array:3 [ "identificador" => "sec0210" "titulo" => "Preservation methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0215" "titulo" => "Hypothermic ocular globe preservation (2–8 °C)" ] 1 => array:2 [ "identificador" => "sec0220" "titulo" => "Hypothermic cornea preservation (1–10 °C)" ] 2 => array:2 [ "identificador" => "sec0225" "titulo" => "Preservation in tissue culture" ] 3 => array:2 [ "identificador" => "sec0230" "titulo" => "Preservation for lamellar transplant" ] ] ] 13 => array:2 [ "identificador" => "sec0235" "titulo" => "Conflict of interests" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-11" "fechaAceptado" => "2016-03-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec737388" "palabras" => array:5 [ 0 => "Organ donation" 1 => "Tissue procurement" 2 => "Donation Spanish model" 3 => "Cornea recovery" 4 => "Selection criteria" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec737389" "palabras" => array:5 [ 0 => "Donación órganos" 1 => "Donación Tejidos" 2 => "Modelo español de donación" 3 => "Extracción de córnea" 4 => "Criterios de selección" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Cornea transplant is the most common tissue transplant in the world. In Spain, tissue donation activities depend upon transplant coordinator activities and the well-known Spanish model for organ and tissue donation. Tissue donor detection system and tissue donor evaluation is performed mainly by transplant coordinators using the Spanish model on donation. The evaluation of a potential tissue donor from detection until recovery is based on an exhaustive review of the medical and social history, physical examination, family interview to determine will of the deceased, and a laboratory screening test. Corneal acceptance criteria for transplantation have a wider spectrum than other tissues, as donors with active malignancies and infections are accepted for keratoplasty in most tissue banks.Corneal evaluation during the whole process is performed to ensure the safety of the donor and the recipient, as well as an effective transplant. Last step before processing, corneal recovery, must be performed under standard operating procedures and in a correct environment." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "El trasplante de córnea es el más frecuente entre todos los trasplantes a nivel mundial. Al año se realizan aproximadamente unos 184.000 trasplantes de córneas. En España la detección y evaluación del potencial donante depende en muchas ocasiones de la tarea que realizan los coordinadores de trasplantes y del modelo de éxito en España para la donación de órganos y tejidos. Desde el momento de la detección de un posible donante hasta que se pueda realizar la extracción hay una exhaustiva evaluación del donante que incluye una revisión sistemática de la historia médico-social, examen físico, entrevista familiar para conocer la voluntad de donación del fallecido y análisis serológicos. La córnea, a diferencia de otros tejidos, tiene unos criterios de aceptación más amplios del donante que se describirán durante el capítulo. El objetivo de todos los estudios que se realizan durante todo el proceso es lograr una donación segura, para el donante y para el receptor, y un trasplante eficaz, intentando en todo momento ayudar a los que lo necesitan, para evitar transmitir enfermedades a través del trasplante. Además, se realiza una extracción protocolizada del tejido para que llegue en las mejores condiciones al banco de tejidos. Este capítulo analizará los criterios de selección del donante de córneas y su extracción, teniendo en cuenta también las nuevas técnicas de implante." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Navarro Martínez-Cantullera A, Calatayud Pinuaga M. Obtención de tejido corneal para queratoplastia. Arch Soc Esp Oftalmol. 2016;91:491–500." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2318 "Ancho" => 1601 "Tamanyo" => 234419 ] ] "descripcion" => array:1 [ "en" => "Worldwide deceased organ donor 2013. <a class="elsevierStyleInterRef" id="intr0005" href="http://www.irodat.org/">http://www.irodat.org</a>." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1702 "Ancho" => 2825 "Tamanyo" => 463530 ] ] "descripcion" => array:1 [ "en" => "Chagas disease 2011. Estimated infected population 2009. <a class="elsevierStyleInterRef" id="intr0010" href="http://thehealthcoach1.com/wp-content/uploads/2012/06/MapChagasJun09_large.jpg">http://thehealthcoach1.com/wp-content/uploads/2012/06/MapChagasJun09_large.jpg</a>." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 672 "Ancho" => 979 "Tamanyo" => 67569 ] ] "descripcion" => array:1 [ "en" => "Ocular globe extraction scheme. <a class="elsevierStyleInterRef" id="intr0015" href="http://www.barraquer.com/bancdulls/?i=4%26si=2%26lang=esp">http://www.barraquer.com/bancdulls/?i=4&si=2⟨=esp</a>." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ADN VHB \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HBsAg \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-HB core \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-HBs (AUSAB) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Donor situation/decision \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Window period/reject \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acute infection/reject \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pos/neg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive (IgM+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acute infection/reject \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive (IgM−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Carrier/reject \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive (IgM−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Carrier/reject \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cured/accept \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cured with loss of anti-HBs false positive anti-HBc/reject \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pos <200UI/ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive (IgM−) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hidden hepatitis/reject \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Positive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vaccinated/accept \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1210500.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Hepatitis B virus markers and decision on cornea donation." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global survey of corneal transplantation and eye banking" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Gain" 1 => "R. Jullienne" 2 => "Z. He" 3 => "M. Aldossary" 4 => "S. Acquart" 5 => "F. Cognasse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamaophthalmol.2015.4776" "Revista" => array:7 [ "tituloSerie" => "JAMA Ophthalmol" "fecha" => "2016" "volumen" => "134" "paginaInicial" => "167" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26633035" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S073510970802113X" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish experience as a leading country: what kind of measures were taken?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Matesanz" 1 => "B. Domínguez-Gil" 2 => "E. Coll" 3 => "G. de la Rosa" 4 => "R. Marazuela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1432-2277.2010.01204.x" "Revista" => array:6 [ "tituloSerie" => "Transpl Int" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "333" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21210863" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization of a novel collagen scaffold for corneal tissue engineering" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Zhang" 1 => "A.M. Sisley" 2 => "A.J. Anderson" 3 => "A.J. Taberner" 4 => "C.N. McGhee" 5 => "D. Patel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Tissue Eng Part C: Methods" "fecha" => "2015" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Newsletter transplant, vol. 19 (No. 1). September 2014. EDQM/Council of Europe. Available at: http://www.ont.es/publicaciones/Documents/NEWSLETTER%202014.pdf [accessed 07.04.15]." ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Word Health Organization Sixty-third World Health Assembly. WHA63.22. 21/05/2010. Available at: http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R22-en.pdf?ua=1 [accessed 07.04.15]." ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deceased donors of tissue" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Navarro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Essentials of tissue banking" "paginaInicial" => "23" "paginaFinal" => "40" "serieFecha" => "2010" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corneal transplantations from donors with cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. López-Navidad" 1 => "N. Soler" 2 => "F. Caballero" 3 => "E. Lerma" 4 => "O. Gris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.tp.0000264199.31913.75" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2007" "volumen" => "83" "paginaInicial" => "1345" "paginaFinal" => "1350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519785" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CEBT study: corneas from older donors suitable for transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Abdullayev" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "VII world cornea congress" "conferencia" => "San Diego" "serieFecha" => "2015" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://www.healio.com/ophthalmology/cb/%7Bce9b07f4-cf70-41c7-bf05-b892c9306714%7D/world-cornea-congress-viii" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of grafted patients with donor corneas that today are more than 100 years old" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Visby" 1 => "J. Hjortdal" 2 => "K. Nielsen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/aos.12231" "Revista" => array:6 [ "tituloSerie" => "Acta Ophthalmol" "fecha" => "2014" "volumen" => "92" "paginaInicial" => "478" "paginaFinal" => "481" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23819790" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clostridium perfringens endophthalmitis after penetrating keratoplasty with contaminated corneal allografts: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hou" 1 => "A. Tannan" 2 => "J. Rubenstein" 3 => "O. Lopez" 4 => "K. McCoy" 5 => "R. Epstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0000000000000303" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2015" "volumen" => "34" "paginaInicial" => "23" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25393093" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Guide to the quality and safety of tissues and cells for human application" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2nd edition" "fecha" => "2015" "editorial" => "European Directorate for the Quality of Medicines and Healthcare (EDQM)/Council of Europe" "editorialLocalizacion" => "Strasbourg" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Directiva 2006/17/CE de la Comisión de 8 de febrero de 2006 por la que se aplica la Directiva 2004/23/CE del Parlamento Europeo y del Consejo en lo relativo a determinados requisitos técnicos para la donación, la obtención y la evaluación de células y tejidos humanos. Anexo I. Artículo 3a." ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "European Center for Disease prevention and Control. Available at: <a id="intr0035" class="elsevierStyleInterRef" href="http://ecdc.europa.eu/en/activities/diseaseprogrammes/emerging_and_vector_borne_diseases/Pages/index.aspx">http://ecdc.europa.eu/en/activities/diseaseprogrammes/emerging_and_vector_borne_diseases/Pages/index.aspx</a> [accessed 07.04.15]." ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importance of donor selection and corneal viability" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Navarro" 1 => "C. Cabrer" 2 => "F.M. de Cabo" 3 => "D. Paredes" 4 => "J. Escalada" 5 => "J. Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transplant Proc" "fecha" => "1999" "volumen" => "31" "paginaInicial" => "2609" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10500741" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Minimum medical standards. European Eye Bank Association. Operativo desde 1 Feb 2015. Available at: <a id="intr0040" class="elsevierStyleInterRef" href="http://www.eeba.eu/downloads/EEBA%20Minimum%20Medical%20Standards%20Rev%202%20-%202015Final.pdf">http://www.eeba.eu/downloads/EEBA%20Minimum%20Medical%20Standards%20Rev%202%20-%202015Final.pdf</a> [accessed 06.04.15]." ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posterior lamellar keratoplasty: DLEK to DSEK to DMEK" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.J. Melles Gerrit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ico.0000243962.60392.4f" "Revista" => array:7 [ "tituloSerie" => "Cornea" "fecha" => "2006" "volumen" => "25" "paginaInicial" => "879" "paginaFinal" => "881" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17102659" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673607601949" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corneal and external disorders. Deep anterior lamellar keratoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Shimmura" 1 => "K. Tsubota" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.icu.0000233953.09595.91" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Ophthalmol" "fecha" => "2006" "volumen" => "17" "paginaInicial" => "349" "paginaFinal" => "355" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16900026" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "One cornea for 2 patients: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Nikolic" 1 => "V. JovanovicII" 2 => "M.R. 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Obtaining corneal tissue for keratoplasty

Obtención de tejido corneal para queratoplastia

A. Navarro Martínez-Cantulleraa,

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anavarro@bst.cat

Corresponding author.

, M. Calatayud Pinuagab

a Banc de Sang i Teixits, Barcelona, Spain

b Unidad de Córnea y Superficie Ocular, Servicio de Oftalmología, Hospital Vall d’Hebron, Barcelona, Spain

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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Worldwide deceased organ donor 2013&#46; <a class="elsevierStyleInterRef" id="intr0005" href="http://www.irodat.org/">http&#58;&#47;&#47;www&#46;irodat&#46;org</a>&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cornea transplant is the most frequent tissue transplant in the world&#44; even exceeding organ transplants&#44; and consists in replacing diseased corneal tissue by healthy tissue of a deceased donor&#46; The difference between cornea donation and transplant is very important&#44; although some difficulties have to be taken into account at the global level&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> the United States has the highest number of transplants per million people &#40;199 pmp&#41;&#59; developed countries with a quality health system carry out between 55 and 75 transplants pmp&#59; Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> with 60 cornea transplants pmp&#44; is within the European average&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The first published cornea transplant was performed by Zirm in 1905&#46; In Spain&#44; Arruga and Barraquer performed in 1940 the first operations in humans&#46; In 1960&#44; corneal transplants became widespread in Spain&#44; and in 1962 professor Barraquer established the Eye Bank in Barcelona&#46; At present&#44; there are 25 cornea banks throughout the country&#46; With the advent of new lamellar implant techniques&#44; tissue banks and health professionals have implemented new processing protocols for distributing the most adequate graft to each receptor&#46; In addition&#44; new cell therapy techniques have been developed in recent years&#44; including tissue engineering with the aim of creating an artificial corneae from stem cells&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Donation</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0015" class="elsevierStylePara elsevierViewall">At present&#44; a cornea transplant requires a donor who must voluntarily agree to donate his or her eyes to altruistically help other people&#46; Without this altruistic gesture&#44; transplants would not be possible&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Donation is a complex process involving many health professionals&#58; the treating physician&#44; nurses&#44; social workers&#44; transplant coordinators and many other professionals that participate in the process to enable receptors the definitive reception of the transplant&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In general&#44; organ donation is better known by the population and health professionals&#44; although the number of tissue donors and transplants is much higher&#46; Specifically&#44; the cornea is one of the most transplanted tissues in Spain&#46; An example of the lack of knowledge about tissue transplant among health professionals and general society is the refusal by the relatives of deceased patients&#44; which amounts to 18&#37; for organ donation and approximately 40&#37; for tissue donation&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2013&#44; 2861 cornea donations took place in Spain&#44; representing 61 donors pmp&#44; yielding 5162 corneae and 3465 transplants&#46; Comparing these data with organ donation&#44; in 2013 the pmp donation rate was of 36 and overall organ transplants amounted to 4281&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Organ and tissue donation are similar &#40;organs and some tissue save lives&#41; but also have differences &#40;organs are transplanted within hours but tissue can be stored for years&#41; which may allow us to better understand the process&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Tissue donation in the world</span><p id="par0040" class="elsevierStylePara elsevierViewall">Differences in organ and tissue donation and transplant in the world are huge&#46; According to the Global Observatory on Donation and Transplantation &#40;<a id="intr0025" class="elsevierStyleInterRef" href="http://www.transplant-observatory.org/">http&#58;&#47;&#47;www&#46;transplant-observatory&#46;org</a>&#41;&#44; all over the world more than 100&#44;000 patients receive a transplanted organ that saves their lives or improves their quality of life&#44; although only 10&#37; of transplant requirements are being covered&#46; In some countries like Spain&#44; Croatia and Malta<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> organ donations of deceased people reaches 30 donors pmp and the process is regulated after death&#46; On the contrary&#44; in other countries such as Japan&#44; Russia and Ecuador&#44; organ and tissue donation of dead people is nearly nonexistent &#40;5 pmp&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In what concerns cornea transplants worldwide&#44; the needs of only 53&#37; of the population are being met and there is one cornea available for transplant for every 70 that are needed&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Said differences give rise to long waiting lists and avoidable deaths due to the lack of organs&#46; For this reason&#44; during the 2011 assembly of the World Health Organization&#44; the World Health Assembly &#40;WHA&#41; approved resolution WHA 63&#46;22 calling on member states to reinforce national or multinational authorities or organizations to coordinate&#44; organize and supervise organ and tissue donation and transplant activities&#44; with special emphasis on optimizing cadaver donations to protect the welfare and life of donors jointly with adequate health services in the long-term&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> Said resolution also established the guidelines for transplants within an ethical and regulated framework&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Tissue donation in Spain</span><p id="par0050" class="elsevierStylePara elsevierViewall">Spain is the leader in organ donation and transplants&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a> The so-called &#8220;Spanish donation model&#8221; consists in a number of actions during the donation process that has made donation a standard and accepted procedure in the health system and among the general population&#46; The main characteristics of the Spanish donation model are&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Systematically organizing the donation process at the national&#44; regional and hospital level</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">the transplant coordinator as a key professional figure for the success of the program</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">quality program for the donation of deceased donors</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">training of personnel involved in the process and all health professionals</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">transparent communication of the process and ongoing availability for the public&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Types of tissue donors</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cornea donations can only be obtained from deceased donors&#46; A cornea donor is a person who is in brain death or asystole and who has not previously expressed opposition to said donation and altruistically donates tissues and cells for transplant to other human beings&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The most frequent tissue donations involve&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Cornea donors&#44; who only donate corneae&#46; These donations are produced in the largest numbers because oncological disease<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> and active infections are accepted in medical records&#44; which are not accepted for the rest of tissue &#40;excepting malignity in blood&#44; lymph or melanoma&#44; which are a contraindication for any donation&#41;&#46; In addition&#44; for many years no age limits were established for cornea donors as the effect of age on corneal tissue is limited&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#44;9</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Multi-tissue donors&#44; who donate at least 2 types of tissue&#46; These donations are less frequent because exclusion criteria are higher &#40;for example&#44; up to 55 years of age for donating arteries&#41; and a history or knowledge about neoplasia or active infection at the time of the demise are not accepted&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Organ and tissue donors who&#44; in addition to donating organs also donate one or more types of tissue&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Tissue donation models</span><p id="par0105" class="elsevierStylePara elsevierViewall">Very frequently&#44; tissue donation takes place at the same time as organ donation so that&#44; when transplant coordinators offer the possibility of donating organs they also mention the need for tissue&#44; leaving the decision up to the relatives&#46; Potential cornea donors are detected not only in hospitals&#44; as is the case of organ donors&#44; but also in funeral parlors&#44; forensic institutes or even at the home of the deceased&#46; The evaluation of donors is always exhaustive&#44; regardless of donor location&#46; Extraction is carried out by a trained professional in an authorized center&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Evaluation of potential cornea donors</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Medical&#8211;social records</span><p id="par0110" class="elsevierStylePara elsevierViewall">The selection of potential donors involves a comprehensive review of a number of parameters required for successful transplants&#46; This process is positive for the receptor and does not involve any problem or drawback that did not exist prior to the transplant&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Initially&#44; information must be obtained to identify any contraindication for the donation and to assess any risk of transmission of diseases&#44; or identifying risks of failure of the transplanted organ&#46; To this end&#44; standardized working protocols must be established to ensure that the entire process is systematically carried out with full control so that transplanted tissue will remain safe and perform as efficiently as possible&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Cause of demise</span><p id="par0120" class="elsevierStylePara elsevierViewall">The cause of death is crucial information to identify any contraindication for donation and to prevent the transmission of the disease that caused the death through the cornea transplant&#46; If the cause of death is not known at the time of extraction&#44; adequate actions must be carried out after donation in order to obtain relevant information&#44; such as anatomopathological analyses of organs or tissues or autopsy to determine the cause of death&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Current clinical records and medical antecedents</span><p id="par0125" class="elsevierStylePara elsevierViewall">The clinical history of potential donors prior to death is a very important source of information&#44; which comprises the reason for hospital admission&#44; clinic evolution&#44; treatment medication and clinical history annotations&#46; In addition&#44; analyses must be checked together with all the lab and imaging tests which may have been carried out during the hospital stay&#46; Received blood transfusions must also be checked to assess the blood to be subsequently submitted to serological tests&#46; Finally&#44; it is recommended to interview the treating physician to understand the antecedents and current medical history&#46; When the demise of a patient has taken place outside a hospital&#44; medical records must be obtained through the primary care physician or requesting information from the police or he forensic examiners&#44; when applicable&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Absolute contraindications for donation in medical records</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Infections</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Active systemic infections</span><p id="par0130" class="elsevierStylePara elsevierViewall">When&#44; at the time of death&#44; the potential donor had an uncontrolled systemic active infection &#40;bacterian or viral&#44; fungal or parasitic&#41;&#44; donation is contraindicated due to the risk of transmitting said infection to the receptor&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">10&#44;11</span></a> Donors with bacterian septicemia &#40;excepting encephalitis and meningitis&#41; can be assessed and considered for cornea donation but only when these are preserved in a culture enabling aerobic&#44; anaerobic and fungal microbiological tests prior to the implant&#46; Donors colonized with multi-resistant bacteria must always be excluded&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Chronic infections</span><p id="par0135" class="elsevierStylePara elsevierViewall">Persistent chronic infections must also be taken into account&#44; above all those caused by protozoa that could give rise to chronic infections &#40;tuberculosis&#44; brucellosis&#44; leprosy&#44; amyloidosis&#44; Q fever&#44; chlamydiosis&#44; salmonellosis and tularemia&#41; and arthropods &#40;brucellosis&#44; bartonelosis&#44; rickettsial&#44; trypanosomiasis&#44; leishmaniasis&#44; babesiosis and ehrlichiosis&#41;&#46; In addition&#44; the possibility that a bearer could transmit an infection through the cornea transplant must be assessed&#46; It is very useful to perform a risk analysis taking into account the germ&#44; the treatment received by the patient and the tissue being transplanted&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Malign disease</span><p id="par0140" class="elsevierStylePara elsevierViewall">In accordance with the European directive on tissues and cells&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> antecedents or presence of neoplasia can be considered an absolute exclusion criteria for tissue donation&#44; with the exception of primary basal cell carcinoma&#44; in situ uterus carcinoma and primary central nervous system carcinoma&#44; which must be assessed as established by the WHO&#46; In contrast with the rest of tissue&#44; cornea donations can be made even when the donors suffered a malign disease&#44; excepting antecedents or presence of retinoblastoma&#44; hematological neoplasia &#40;leukemia&#44; lymphoma&#44; multiple myeloma&#41; and anterior segment malign tumors&#44; which are also contraindication criteria for cornea donation&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Any cornea donation for human application that is not limited to the non-vascularized portion of the cornea &#40;for instance&#44; limbus or limbar cell transplant&#41; cannot be considered in the case of cancer history&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Risk of transmitting disease caused by prions</span><p id="par0150" class="elsevierStylePara elsevierViewall">The Creutzfeldt-Jakob disease or family history of this disease of non-iatrogenic cause&#44; or suspected rapid progressive dementia diagnostic&#44; is an absolute contraindication for ocular tissue donation&#46; History of dementia can only be accepted in a donor if the primary cause is known and non-transmissible&#44; such as dementia of vascular origin&#46; In addition&#44; it is necessary to discard the existence of demyelinization disease or central nervous system disease without a clear cause&#46; Donation must also be excluded if the donor was treated with human pituitary gland derivate or has received dura&#44; cornea or sclera transplant&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Receptor of an organ or xenotransplantation</span><p id="par0155" class="elsevierStylePara elsevierViewall">In the case of xenotransplantation&#44; receptors must be excluded if the xenotransplantation they received included live cells&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Recent vaccination records</span><p id="par0160" class="elsevierStylePara elsevierViewall">Attenuated virus or bacteria&#46; Donations must be excluded if the donor received a vaccination one month earlier &#40;according to blood donation criteria&#41;&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Intoxication due to toxic substances</span><p id="par0165" class="elsevierStylePara elsevierViewall">Exposure to cyanide&#44; mercury&#44; gold or toxic substances due to accident or type of work must be excluded as said intoxication can be transmitted through tissue&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Exclusion for blood donation</span><p id="par0170" class="elsevierStylePara elsevierViewall">If the cause is unknown&#44; the exclusion involves tissue donation&#46; In addition&#44; donors who have received transfusions in the United Kingdom are also excluded&#46;</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Additional relevant information to be taken into account in assessments which may contraindicate donation</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Medication</span>&#58; high dose immunosuppression treatments could weaken the immune system and produce unreliable serology results&#46; Overdose of any medicaments must be assessed&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Transfusions</span>&#58; it is necessary to know if the potential donor was a patient who chronically received blood transfusions or products&#44; or if at the time of obtaining blood samples a hemodilution exceeding 50&#37; was present&#46; In these cases&#44; it is necessary to find blood prior to said transfusion to carry out serology or contraindicate the donor&#46; Generally&#44; if the potential donor was admitted in hospital&#44; previous blood samples can be found at the hospital lab&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Previous surgery</span>&#58; antecedents related to surgery must be analyzed to assess any contraindication for tissue donation &#40;for example&#44; cornea surgeries could damage tissue&#41;&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Self-immune diseases</span>&#58; self-immune diseases can contraindicate cornea donation if treated with high doses of immunosuppressants or if the immune disease of the potential donor could have damaged the cornea&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Genetic diseases</span>&#58; potential donors with non-iatrogenic CJD disease must be excluded due to genetic predisposition&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Extended hospital stay</span>&#58; it is necessary to analyze the possibility that the potential donor may have acquired an infectious hospital disease if admitted for a long period of time or has spent many days with assisted ventilation&#46; Each case must be assessed on the basis of infection type&#44; received treatment and patient condition at the time of death&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Social history&#46; Evaluation of risk attitudes</span><p id="par0205" class="elsevierStylePara elsevierViewall">Social history must always be requested from the relative who is able to fill in the questionnaire&#46; If nobody can do this&#44; cornea donation must not be accepted&#46; Said questionnaire aims at identifying donor attitudes and actions that could involve higher risk of acquiring transmissible diseases&#46; It includes questions related to&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0210" class="elsevierStylePara elsevierViewall">The use of intravenous or nasal drugs&#58; this could be an absolute contraindication&#44; because it is very difficult to determine that the potential donor did not consume said drugs in the past few months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0215" class="elsevierStylePara elsevierViewall">Tattoos&#44; piercings or acupuncture 4 months prior to death&#44; if it cannot be determined that only sterile single use materials were used and that tattoo ink was changed between clients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0220" class="elsevierStylePara elsevierViewall">Prison stay within the last 12 months&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0225" class="elsevierStylePara elsevierViewall">Living with someone with VHB or VHC</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0230" class="elsevierStylePara elsevierViewall">Risk of acquiring sexually transmitted diseases in the last 12 months&#46; The presence of venereal diseases must be assessed as it could indicate risk practices and could be an absolute contraindication in case of doubt&#46; Potential donors who engaged in sexual practices for money or drugs are definitely excluded&#46; In addition&#44; donors who were sexually promiscuous&#44; occasional partners or maintained intercourse with virus bearers &#40;HIV or HTLVI&#47;II&#41; must be assessed for risk&#46;</p></li></ul></p><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Social history&#44; residency and travels</span><p id="par0235" class="elsevierStylePara elsevierViewall">Risks due to travels or living in high-risk countries where they could have contracted emerging infectious diseases such as dengue&#44; yellow fever&#44; Chagas disease&#44; tuberculosis&#44; <span class="elsevierStyleItalic">West Nile virus</span>&#44; Q fever&#44; CJD&#44; malaria and HIV-1 group O&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a></p></span></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Specific contraindications for cornea donations</span><p id="par0240" class="elsevierStylePara elsevierViewall">The age of a cornea donor is not per se a contraindication because the tissue is exhaustively analyzed as its quality determines feasibility&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> Every tissue bank can establish the maximum and minimum age criteria&#44; taking into account that the lower age limit produces corneae with greater plasticity&#46; Contraindications for specific cornea donation<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> are&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Previous surgery&#58; radial keratotomy&#44; lamellar and obviously penetrating keratoplasty&#44; corneal or intraocular refractive surgery and photorefractive keratectomy &#40;PRK&#41;&#44; any intraocular surgery which could have compromised endothelial count&#46; All the above refers to cornea donations for penetrating keratoplasty&#46; The past decade has seen a shift in corneal transplants&#44; the current trend being to perform lamellar keratoplasty whenever possible&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> This procedure consists mainly in transplanting only the deficient part of the cornea&#44; i&#46;e&#46;&#44; the endothelium &#40;DMEK&#58; <span class="elsevierStyleItalic">Descemet&#39;s membrane endothelial keratoplasty</span>&#41; or the endothelium and a thin sheet of stroma &#40;DEAEK&#58; <span class="elsevierStyleItalic">Descemet&#39;s stripping automated endothelial keratoplasty</span>&#41;&#44; or the stroma&#44; leaving donor endothelium untouched &#40;DALK&#58; <span class="elsevierStyleItalic">deep&#47;descemetic anterior lamellar keratoplasty</span>&#41;&#46; There are different criteria in these cases so that a cornea with anterior leukoma or with previous corneal refractive surgery and an endothelium in good shape could be utilized for endothelial transplant and vice versa&#44; i&#46;e&#46;&#44; a cornea with deficient endothelium that is not apt for penetrating keratoplasty could be utilized in anterior lamellar transplants because the endothelium is discarded during surgery&#46; At present&#44; corneal surgeons request the tissue&#44; specifying the procedure to be carried out in each patient&#46; This has produced an increase in the amount of tissue available for transplant as a single cornea can be used for 2 patients&#44; implanting the endothelium in one and the stroma and epithelium in another&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Anterior pole diseases&#58; Central opacity&#44; scars&#44; pterygium&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0255" class="elsevierStylePara elsevierViewall">Congenital or acquired disease&#58; keratocone&#44; keratoglobe or leukomae affecting the central area of the cornea&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0260" class="elsevierStylePara elsevierViewall">Ocular inflammation &#40;even when caused by systemic diseases such as rheumatoid arthritis or sarcoidosis&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0265" class="elsevierStylePara elsevierViewall">Active ocular infections&#44; including ocular herpes history&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Malign eye tumors&#46;</p></li></ul></p><p id="par0275" class="elsevierStylePara elsevierViewall">After removing the tissue&#44; slitlamp must be used to assess its feasibility and carry out an endothelial count&#44; which is essential in the posterior &#40;endothelial&#41; penetrating and lamellar keratoplasty&#46; Donor age&#44; careless tissue extraction from the donor and glaucoma are considered risk factors for late endothelial failure &#40;occurring in the long-term due to progressive cellular deterioration&#41;&#46; A loss of up to 10&#37;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> of endothelial cell population has been reported during collection&#44; transport&#44; storage and implant&#46; Mirror microscopy provides adequate information about pleomorphism &#40;changes in cell hexagonality&#41;&#44; polymegatism &#40;variations in cell area&#41; and cell density&#44; and enables the diagnosis of cornea guttata&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a></p><p id="par0280" class="elsevierStylePara elsevierViewall">In general&#44; a minimum value of 2000&#8211;2200 cells&#47;mm<span class="elsevierStyleSup">2</span> is considered acceptable&#44; in all cases measured immediately before delivering the tissue for implant and not at the initial processing stage&#44; either live or in culture&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a></p></span></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Donor physical examination</span><p id="par0285" class="elsevierStylePara elsevierViewall">This examination must be carried out in all cases as it is a very important information source to identify possible transmissible diseases and to confirm the medical and social history of the donor&#46; Systematic physical examination involves recording the examination even when no relevant results have been found&#46;</p><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Identification</span><p id="par0290" class="elsevierStylePara elsevierViewall">This involves verifying the donor name as written in the familial informed consent with the donor identification&#58; bracelets&#44; tag&#44; etc&#46; In addition&#44; donor sex&#44; ethnic group&#44; weight and height must also be recorded in the clinical examination report as well as describing the physical condition of the body&#44; including signs of malnutrition or deformities&#46;</p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Physical exploration</span><p id="par0295" class="elsevierStylePara elsevierViewall">Autopsy&#58; it is necessary to verify if the autopsy has been performed&#44; whether it was full or partial or it will be carried out after tissue donation&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Physical exploration must be performed systematically&#44; with the anterior and posterior part of the body&#44; looking for the following physical signs&#58; genital lesions&#44; large lymphatic nodes&#44; tattoos&#44; acupuncture or piercings&#44; nonmedical injections and white spots in the mouth&#46; In addition&#44; a dermatological examination must be carried out looking for suspected malign skin injuries such as petechiae&#44; inflammation&#44; scabs&#44; sores&#44; herpes&#44; trauma&#44; fractures&#44; lacerations&#44; abrasions and jaundice&#46;</p></span></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Taking blood samples and time up to extraction</span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Blood samples</span><p id="par0305" class="elsevierStylePara elsevierViewall">The quality of blood samples for lab screening tests depends on several factors&#44; all of which must be taken into account before taking the samples&#46;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">-</span><p id="par0310" class="elsevierStylePara elsevierViewall">The blood samples must be obtained as soon as possible after asystole to avoid blood degradation &#40;hemolysis&#41; and prevent false-positive serological results&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> In general&#44; laws and regulations set a limit of 24<span class="elsevierStyleHsp" style=""></span>h for obtaining samples post-asystole&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">-</span><p id="par0315" class="elsevierStylePara elsevierViewall">Hemodilution&#58; if the donor has received transfusions of blood&#44; plasma&#44; colloids or crystalloids&#44; these could invalidate donation if hemodilution exceeds 50&#37;&#46; In these circumstances&#44; efforts must be made to recover a donor blood sample prior to said transfusions &#40;it is allowed to utilize blood extracted up to 7 days <span class="elsevierStyleItalic">pre-mortem</span>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">-</span><p id="par0320" class="elsevierStylePara elsevierViewall">Sample preservation conditions prior to testing&#58; centrifugation&#44; refrigeration&#44; etc&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">-</span><p id="par0325" class="elsevierStylePara elsevierViewall">Serum or plasma can be obtained only with the kit used for carrying out serology&#46; No other bodily fluids can be utilized&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">-</span><p id="par0330" class="elsevierStylePara elsevierViewall">Screening test must be carried out in certified labs authorized for the activities established by law through competent authorities&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">-</span><p id="par0335" class="elsevierStylePara elsevierViewall">Serology samples&#58; the law requires that a donor blood sample is preserved in order to repeat tests of stored tissue if necessary&#46; Said samples must be maintained at least 10 years until the last donor tissue has been transplanted&#46;</p></li></ul></p></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Serology in cornea donors</span><p id="par0340" class="elsevierStylePara elsevierViewall">The battery of required tests for cornea donors varies in the legislation of each country and with the recommendation of the scientific societies followed by each tissue bank&#46; In Spain&#44; Royal Decree 9&#47;2014 requires in Annex <span class="elsevierStyleSmallCaps">III</span> the following tests&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">&#8226;</span><p id="par0345" class="elsevierStylePara elsevierViewall">VIH1 and HIV2 antibodies&#58; negative&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">&#8226;</span><p id="par0350" class="elsevierStylePara elsevierViewall">Anti-HCV antibodies&#58; negative&#46;</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">&#8226;</span><p id="par0355" class="elsevierStylePara elsevierViewall">Hepatitis B surface antigen &#40;HBsAg&#41;&#58; negative&#46;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">&#8226;</span><p id="par0360" class="elsevierStylePara elsevierViewall">Core hepatitis B antibodies &#40;HBcAc&#41;&#58; can be positive&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">&#8226;</span><p id="par0365" class="elsevierStylePara elsevierViewall">If the core is positive &#40;IgG and IgM&#41; and the HBsAg is negative&#44; additional tests plus risk assessments must be carried out to determine donor feasibility &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">&#8226;</span><p id="par0370" class="elsevierStylePara elsevierViewall">Syphilis&#58; a specific or nonspecific treponemic test can be carried out&#46; A positive result is not a direct contraindication but requires risk analysis &#40;donor reassessment&#41; to make a decision&#46;</p></li><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">&#8226;</span><p id="par0375" class="elsevierStylePara elsevierViewall">Some serologies must be carried out when the donor comes from regions with high prevalence of some transmissible diseases&#58; HTLV I-II antibodies&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> malaria and anti-<span class="elsevierStyleItalic">Trypanosoma cruzi</span> &#40;Chagas&#41; antibodies &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">&#8226;</span><p id="par0380" class="elsevierStylePara elsevierViewall">Even though at present the techniques utilized for detecting transmissibility markers exhibit high quality as regards the sensitivity&#44; specificity and predictive value&#44; it is still possible to get false negatives obtained in a window period or due to immunosuppressant treatment&#46; In order to minimize this risk&#44; in addition to a comprehensive study of the medical&#8211;social history&#44; it is recommendable to adopt molecular biology techniques &#40;polymerase chain reaction&#41; for HIV&#44; hepatitis B and hepatitis C&#46;</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">&#8226;</span><p id="par0385" class="elsevierStylePara elsevierViewall">Finally&#44; for many years the necessity of carrying out human leukocyte antigen on cornea donors to find compatible receptors and avoid rejection is an ongoing controversy&#46; In recent years and with the advent of new lamellar transplant techniques&#44; some studies indicate that this would be required only in very particular cases&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a></p></li></ul></p></span></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Time for extraction</span><p id="par0390" class="elsevierStylePara elsevierViewall">Corneal tissue must be extracted as soon as possible&#44; in general before 24<span class="elsevierStyleHsp" style=""></span>h <span class="elsevierStyleItalic">post-mortem</span>&#44; although the legislation of some European Union authorize said extraction up to 48<span class="elsevierStyleHsp" style=""></span>h&#46; The medical director of the tissue bank can establish additional criteria if deemed necessary&#46; Early corneal tissue extraction enables avoiding post-mortem infection&#44; preserving the cornea in adequate preservation and temperature conditions&#44; maintaining the characteristics thereof&#46; To this end&#44; it is recommended to keep the eyelids closed from asystole up to extraction and to refrigerate the body as soon as possible&#46;</p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Family consent for donation</span><p id="par0395" class="elsevierStylePara elsevierViewall">Tissues can be obtained after the appropriate certification of death and the execution of the police and judicial proceedings&#44; if any&#46; In Spain&#44; as established by article 11 of Act 41&#47;2002&#44; dated November 14&#44; tissues and cells of deceased persons can be extracted when no specific opposition has been registered&#46; Any opposition&#44; as well as acceptance if indicated&#44; may refer to any type of organs or only some&#44; and shall be respected&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">Requesting the consent of relatives of a recently deceased person is a very critical situation and must be asked only by professionals with sufficient training and experience to understand the phases of grieving&#46; Generally&#44; these are the transplant coordinators&#46; In addition&#44; it is the time to inform relatives about the need&#44; nature and circumstances of donation&#44; of specifying the restoration and preservation procedures to be carried out on the body and the postmortem health practices to be implemented&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">If the relatives are not aware of an explicit opposition by the deceased&#44; once they have accepted the donation the medical history of the donor must be checked by means of the social risk survey&#46; The survey must be taken by the relative that was closer to the donor and who may respond to intimate details such as travels&#44; sexual practices and use of drugs&#46; These questions must be set in a context&#44; explaining to the relatives that they are made in order to ensure the success of a transplant and are not aimed at judging the donor&#39;s activities&#46;</p></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Obtaining the cornea</span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Where</span><p id="par0410" class="elsevierStylePara elsevierViewall">The cornea must be obtained in appropriate facilities by means of procedures that minimize any contamination of obtained tissues and cells&#46; The area must be of restricted access for personnel involved in said processes&#44; in addition to being clean and with maintenance actions as appropriate&#46; The factors to be taken into account for adequate cornea extraction are&#58; a private space available for extraction&#44; air-conditioning&#44; regulation of humidity&#44; temperature&#44; lighting&#44; a clean and tranquil environment&#46;</p></span><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Who</span><p id="par0415" class="elsevierStylePara elsevierViewall">Since the beginning of corneal transplant activities&#44; ophthalmologists were in charge of obtaining corneal tissue&#46; In recent years&#44; due to the increased number of extractions and the need to have more personnel available round-the-clock&#44; ophthalmologists have trained physicians&#44; nurses and health technicians for carrying out extractions&#46;</p></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Basic extraction measures</span><p id="par0420" class="elsevierStylePara elsevierViewall">Before beginning the extraction&#44; donor identity must be verified to make sure that the family has given consent for the donation&#46; A macroscopic examination of the ocular globe and the cornea must be carried out to identify alterations or anomalies before beginning the extraction&#46; Adequate garments for cornea extraction include a surgical mask&#44; hair cover&#44; sterile gloves and apron&#44; the use of sterile instruments and devices of good quality&#44; adequately validated and certified for extracting corneas and&#44; whenever possible&#44; with the CE label&#46; For extracting corneal tissue&#44; single use material is very useful and in this case the donor documentation must be filled in indicating the utilized material &#40;batch&#41; and expiry dates thereof&#46;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0175"><p id="par0425" class="elsevierStylePara elsevierViewall">Step 1&#46; Surgical handwashing&#46;</p></li><li class="elsevierStyleListItem" id="lsti0180"><p id="par0430" class="elsevierStylePara elsevierViewall">Step 2&#46; Establishing a sterile field for placing instruments&#46;</p></li><li class="elsevierStyleListItem" id="lsti0185"><p id="par0435" class="elsevierStylePara elsevierViewall">Step 3&#46; Washing the extraction area &#40;with 1&#37; iodine povidone<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a>&#41; and cleaning the working areas with antiseptic solution&#46; Excess povidone must be irrigated because it is toxic for the corneal endothelium and fibroblasts&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a></p></li><li class="elsevierStyleListItem" id="lsti0190"><p id="par0440" class="elsevierStylePara elsevierViewall">Step 4&#46; Instilling broad spectrum antibiotic solution on the corneal surface&#46;</p></li><li class="elsevierStyleListItem" id="lsti0195"><p id="par0445" class="elsevierStylePara elsevierViewall">Step 5&#46; Separating eyelids with a blepharostat&#44; taking care while inserting the speculum to avoid damaging the epithelial surface&#46;</p></li><li class="elsevierStyleListItem" id="lsti0200"><p id="par0450" class="elsevierStylePara elsevierViewall">Step 6&#46; Utilizing tweezers and conjunctiva scissors to carry out a 360&#176; peritomy around the cornea close to the limbus but without damaging it&#44; applying the least possible tension &#40;traction can cause folds in the cornea&#41;&#46;</p></li></ul></p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Specific corneal tissue extraction</span><p id="par0455" class="elsevierStylePara elsevierViewall">A circular incision must be made in the conjunctiva&#44; leaving at least 3&#8211;4<span class="elsevierStyleHsp" style=""></span>mm of the sclera&#46; A circumference can be marked with a trepan to make a uniform incision&#46; Once the sclerocorneal ring has been obtained&#44; the cornea must be placed in the preservation fluid&#46;</p></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Ocular globe extraction &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;</span><p id="par0460" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0205"><p id="par0465" class="elsevierStylePara elsevierViewall">Step 1&#46; After performing the peritomy&#44; the conjunctiva must be desiccated with scissors perpendicularly to the limbus in the 4 quadrants to facilitate access to ocular muscles&#46;</p></li><li class="elsevierStyleListItem" id="lsti0210"><p id="par0470" class="elsevierStylePara elsevierViewall">Step 2&#46; The 4 rectum and oblique muscles must be isolated with a strabismus hook and section them close to their insertion&#46; The section must be made to leave the remainder of the tendon or even the muscle belly to facilitate global manipulation during extraction&#46;</p></li><li class="elsevierStyleListItem" id="lsti0215"><p id="par0475" class="elsevierStylePara elsevierViewall">Step 3&#46; Insert the enucleation spoon into the orbit through the medial side&#44; applying slight upwards pressure&#46; The spoon comprises a lower indentation for the optic nerve&#46;</p></li><li class="elsevierStyleListItem" id="lsti0220"><p id="par0480" class="elsevierStylePara elsevierViewall">Step 4&#46; Place the semi-open optic nerve scissors through the lateral side behind the spoon&#46;</p></li><li class="elsevierStyleListItem" id="lsti0225"><p id="par0485" class="elsevierStylePara elsevierViewall">Step 5&#46; Cut the optic nerve&#44; leaving about 5<span class="elsevierStyleHsp" style=""></span>mm attached to the ocular globe&#46; Ocular tone must be maintained&#44; avoiding any injury to the corneal surface&#46; Ocular hypotony during extraction can produce endothelial lesions due to contact of the endothelium with the anterior chamber structures&#44; rendering the cornea useless for transplants &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p></li></ul></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0490" class="elsevierStylePara elsevierViewall">The ocular globe must be placed in a humid chamber &#40;a sterile container with gauzes imbibed in saline solution on the base and fixing the globe&#41; with the cornea facing upwards&#46; Irrigation with saline solution is necessary to preserve the humidity of the gauze but without submerging the eye&#46;</p><p id="par0495" class="elsevierStylePara elsevierViewall">The above steps are modified when only the cornea is extracted&#46; In this case it is not necessary to isolate the muscles or desiccate the conjunctiva in the direction of the optic nerve&#46; The 360&#176; peritomy is performed and&#44; utilizing a 14<span class="elsevierStyleHsp" style=""></span>mm or larger trepan&#44; the sclera is cut circumferentially&#44; the cornea is extracted with 2&#8211;4<span class="elsevierStyleHsp" style=""></span>mm of sclera and part of the conjunctival surrounding the corneal limbus&#46;</p></span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Reconstruction</span><p id="par0500" class="elsevierStylePara elsevierViewall">For reconstruction purposes&#44; during the extraction of the globe a plastic or cotton ball is used together with a prosthesis in the form of a lid or&#44; if only the cornea is extracted&#44; only the lid-shaped prosthesis to recover donor appearance prior to donation&#46; If necessary&#44; the eyelids can be closed with sutures or adhesive&#46;</p><p id="par0505" class="elsevierStylePara elsevierViewall">Once reconstruction is completed&#44; access must be allowed to relatives and mourners if requested&#44; and call the funeral parlor subsequently&#46;</p></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Tissue preservation&#44; packaging and labeling</span><p id="par0510" class="elsevierStylePara elsevierViewall">The cornea or ocular globe must be sent to the bank for processing&#46; It is recommended to do this as soon as possible&#44; maintaining the preservation temperature between 2 and 8<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Validated packaging must be utilized and it must be capable of maintaining adequate temperature in different weather conditions&#46; Tissue must always be identified to maintain the donor-tissue traceability&#46;</p><p id="par0515" class="elsevierStylePara elsevierViewall">Specific labeling at the tissue bank can be performed during extraction&#44; taking into account the standards established by the European Commission&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> The labeling proposed by the Commission comprises a single European code that must include information on the donation identification sequence as well as product identification sequence&#44; in addition to country and authorized bank identification&#46; This labeling is of particular importance as it provides donor-receptor traceability at all times&#46;</p></span></span><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Preservation methods</span><p id="par0520" class="elsevierStylePara elsevierViewall">In order to maintain corneae feasible up to implant&#44; preservation methods must be applied&#46; The main 3 preservation methods for ocular tissue are the following&#46;</p><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Hypothermic ocular globe preservation &#40;2&#8211;8<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;</span><p id="par0525" class="elsevierStylePara elsevierViewall">The ocular globe is preserved in a humid chamber for a maximum period of 48<span class="elsevierStyleHsp" style=""></span>h to prevent contamination risk&#46;</p></span><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Hypothermic cornea preservation &#40;1&#8211;10<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;</span><p id="par0530" class="elsevierStylePara elsevierViewall">Generally&#44; preservation procedures prescribe a maximum storage of 7&#8211;14 days&#46; The preservation medium includes antibiotic and phenol red that allows immediate detection of any pH variation that occurs when the medium and the cornea become contaminated&#46; In these cases the endothelium must be inspected and it must be taken into account that said count diminishes during storage&#46; Microbiological control protocols are recommended for surgeons to take samples of the medium or the remaining sclera at the time of implant&#46;</p></span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">Preservation in tissue culture</span><p id="par0535" class="elsevierStylePara elsevierViewall">A culture is utilized for up to 5 weeks in a container that maintains the cornea at a temperature between 18 and 34<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; During said preservation period&#44; medium and culture must be replaced to ensure tissue sterility&#46; During preservation&#44; the cornea becomes edematous and for this reason it must be placed in a medium prior to distribution to diminish swelling in transport during 5 days&#46; This medium also contains phenol red to detect infections&#46;</p></span><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Preservation for lamellar transplant</span><p id="par0540" class="elsevierStylePara elsevierViewall">In recent years&#44; the use of lamellar corneae has increased&#46; For this reason&#44; it has been established that the lamellae obtained of hypothermic corneae can be stored refrigerated for up to 2&#8211;3 days&#46; Lamellae for DSAEK that are obtained from corneae in culture must remain at least 24<span class="elsevierStyleHsp" style=""></span>h in the dehydration medium before preparing the lamellae&#46; In this case&#44; the obtained lamellar can remain in the dehydration medium for one week prior to the implant&#46;</p></span></span><span id="sec0235" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Conflict of interests</span><p id="par0545" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors&#46;</p></span></span>"
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              "identificador" => "abst0005"
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        1 => array:2 [
          "identificador" => "xpalclavsec737388"
          "titulo" => "Keywords"
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          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Donation"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Introduction"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Tissue donation in the world"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Tissue donation in Spain"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Types of tissue donors"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Tissue donation models"
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        6 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Evaluation of potential cornea donors"
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            0 => array:3 [
              "identificador" => "sec0045"
              "titulo" => "Medical&#8211;social records"
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                0 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Cause of demise"
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                1 => array:2 [
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                  "titulo" => "Current clinical records and medical antecedents"
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            1 => array:3 [
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              "titulo" => "Absolute contraindications for donation in medical records"
              "secciones" => array:10 [
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                  "titulo" => "Infections"
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                      "titulo" => "Active systemic infections"
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                    1 => array:2 [
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                      "titulo" => "Chronic infections"
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                1 => array:2 [
                  "identificador" => "sec0080"
                  "titulo" => "Malign disease"
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                2 => array:2 [
                  "identificador" => "sec0085"
                  "titulo" => "Risk of transmitting disease caused by prions"
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                3 => array:2 [
                  "identificador" => "sec0090"
                  "titulo" => "Receptor of an organ or xenotransplantation"
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                4 => array:2 [
                  "identificador" => "sec0095"
                  "titulo" => "Recent vaccination records"
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                5 => array:2 [
                  "identificador" => "sec0100"
                  "titulo" => "Intoxication due to toxic substances"
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                6 => array:2 [
                  "identificador" => "sec0105"
                  "titulo" => "Exclusion for blood donation"
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                7 => array:2 [
                  "identificador" => "sec0110"
                  "titulo" => "Additional relevant information to be taken into account in assessments which may contraindicate donation"
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                8 => array:3 [
                  "identificador" => "sec0115"
                  "titulo" => "Social history&#46; Evaluation of risk attitudes"
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                    0 => array:2 [
                      "identificador" => "sec0120"
                      "titulo" => "Social history&#44; residency and travels"
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                  "identificador" => "sec0125"
                  "titulo" => "Specific contraindications for cornea donations"
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          "identificador" => "sec0130"
          "titulo" => "Donor physical examination"
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              "identificador" => "sec0135"
              "titulo" => "Identification"
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            1 => array:2 [
              "identificador" => "sec0140"
              "titulo" => "Physical exploration"
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          "identificador" => "sec0145"
          "titulo" => "Taking blood samples and time up to extraction"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0150"
              "titulo" => "Blood samples"
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            1 => array:2 [
              "identificador" => "sec0155"
              "titulo" => "Serology in cornea donors"
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        ]
        9 => array:2 [
          "identificador" => "sec0160"
          "titulo" => "Time for extraction"
        ]
        10 => array:2 [
          "identificador" => "sec0165"
          "titulo" => "Family consent for donation"
        ]
        11 => array:3 [
          "identificador" => "sec0170"
          "titulo" => "Obtaining the cornea"
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            0 => array:2 [
              "identificador" => "sec0175"
              "titulo" => "Where"
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            1 => array:2 [
              "identificador" => "sec0180"
              "titulo" => "Who"
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            2 => array:2 [
              "identificador" => "sec0185"
              "titulo" => "Basic extraction measures"
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            3 => array:2 [
              "identificador" => "sec0190"
              "titulo" => "Specific corneal tissue extraction"
            ]
            4 => array:2 [
              "identificador" => "sec0195"
              "titulo" => "Ocular globe extraction &#40;Fig&#46; 3&#41;"
            ]
            5 => array:2 [
              "identificador" => "sec0200"
              "titulo" => "Reconstruction"
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            6 => array:2 [
              "identificador" => "sec0205"
              "titulo" => "Tissue preservation&#44; packaging and labeling"
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        ]
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          "identificador" => "sec0210"
          "titulo" => "Preservation methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0215"
              "titulo" => "Hypothermic ocular globe preservation &#40;2&#8211;8 &#176;C&#41;"
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            1 => array:2 [
              "identificador" => "sec0220"
              "titulo" => "Hypothermic cornea preservation &#40;1&#8211;10 &#176;C&#41;"
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            2 => array:2 [
              "identificador" => "sec0225"
              "titulo" => "Preservation in tissue culture"
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            3 => array:2 [
              "identificador" => "sec0230"
              "titulo" => "Preservation for lamellar transplant"
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        13 => array:2 [
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          "titulo" => "Conflict of interests"
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          "titulo" => "References"
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    "fechaRecibido" => "2015-05-11"
    "fechaAceptado" => "2016-03-08"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec737388"
          "palabras" => array:5 [
            0 => "Organ donation"
            1 => "Tissue procurement"
            2 => "Donation Spanish model"
            3 => "Cornea recovery"
            4 => "Selection criteria"
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          "palabras" => array:5 [
            0 => "Donaci&#243;n &#243;rganos"
            1 => "Donaci&#243;n Tejidos"
            2 => "Modelo espa&#241;ol de donaci&#243;n"
            3 => "Extracci&#243;n de c&#243;rnea"
            4 => "Criterios de selecci&#243;n"
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cornea transplant is the most common tissue transplant in the world&#46; In Spain&#44; tissue donation activities depend upon transplant coordinator activities and the well-known Spanish model for organ and tissue donation&#46; Tissue donor detection system and tissue donor evaluation is performed mainly by transplant coordinators using the Spanish model on donation&#46; The evaluation of a potential tissue donor from detection until recovery is based on an exhaustive review of the medical and social history&#44; physical examination&#44; family interview to determine will of the deceased&#44; and a laboratory screening test&#46; Corneal acceptance criteria for transplantation have a wider spectrum than other tissues&#44; as donors with active malignancies and infections are accepted for keratoplasty in most tissue banks&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Corneal evaluation during the whole process is performed to ensure the safety of the donor and the recipient&#44; as well as an effective transplant&#46; Last step before processing&#44; corneal recovery&#44; must be performed under standard operating procedures and in a correct environment&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El trasplante de c&#243;rnea es el m&#225;s frecuente entre todos los trasplantes a nivel mundial&#46; Al a&#241;o se realizan aproximadamente unos 184&#46;000 trasplantes de c&#243;rneas&#46; En Espa&#241;a la detecci&#243;n y evaluaci&#243;n del potencial donante depende en muchas ocasiones de la tarea que realizan los coordinadores de trasplantes y del modelo de &#233;xito en Espa&#241;a para la donaci&#243;n de &#243;rganos y tejidos&#46; Desde el momento de la detecci&#243;n de un posible donante hasta que se pueda realizar la extracci&#243;n hay una exhaustiva evaluaci&#243;n del donante que incluye una revisi&#243;n sistem&#225;tica de la historia m&#233;dico-social&#44; examen f&#237;sico&#44; entrevista familiar para conocer la voluntad de donaci&#243;n del fallecido y an&#225;lisis serol&#243;gicos&#46; La c&#243;rnea&#44; a diferencia de otros tejidos&#44; tiene unos criterios de aceptaci&#243;n m&#225;s amplios del donante que se describir&#225;n durante el cap&#237;tulo&#46; El objetivo de todos los estudios que se realizan durante todo el proceso es lograr una donaci&#243;n segura&#44; para el donante y para el receptor&#44; y un trasplante eficaz&#44; intentando en todo momento ayudar a los que lo necesitan&#44; para evitar transmitir enfermedades a trav&#233;s del trasplante&#46; Adem&#225;s&#44; se realiza una extracci&#243;n protocolizada del tejido para que llegue en las mejores condiciones al banco de tejidos&#46; Este cap&#237;tulo analizar&#225; los criterios de selecci&#243;n del donante de c&#243;rneas y su extracci&#243;n&#44; teniendo en cuenta tambi&#233;n las nuevas t&#233;cnicas de implante&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Navarro Mart&#237;nez-Cantullera A&#44; Calatayud Pinuaga M&#46; Obtenci&#243;n de tejido corneal para queratoplastia&#46; Arch Soc Esp Oftalmol&#46; 2016&#59;91&#58;491&#8211;500&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Worldwide deceased organ donor 2013&#46; <a class="elsevierStyleInterRef" id="intr0005" href="http://www.irodat.org/">http&#58;&#47;&#47;www&#46;irodat&#46;org</a>&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Chagas disease 2011&#46; Estimated infected population 2009&#46; <a class="elsevierStyleInterRef" id="intr0010" href="http://thehealthcoach1.com/wp-content/uploads/2012/06/MapChagasJun09_large.jpg">http&#58;&#47;&#47;thehealthcoach1&#46;com&#47;wp-content&#47;uploads&#47;2012&#47;06&#47;MapChagasJun09&#95;large&#46;jpg</a>&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Ocular globe extraction scheme&#46; <a class="elsevierStyleInterRef" id="intr0015" href="http://www.barraquer.com/bancdulls/?i=4%26si=2%26lang=esp">http&#58;&#47;&#47;www&#46;barraquer&#46;com&#47;bancdulls&#47;&#63;i&#61;4&#38;si&#61;2&#10216;&#61;esp</a>&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ADN VHB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HBsAg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-HB core&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-HBs &#40;AUSAB&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Donor situation&#47;decision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Window period&#47;reject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Acute infection&#47;reject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pos&#47;neg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive &#40;IgM&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Acute infection&#47;reject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive &#40;IgM&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Carrier&#47;reject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive &#40;IgM&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Carrier&#47;reject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cured&#47;accept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cured with loss of anti-HBs false positive anti-HBc&#47;reject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pos &#60;200<span class="elsevierStyleHsp" style=""></span>UI&#47;ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive &#40;IgM&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hidden hepatitis&#47;reject&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vaccinated&#47;accept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global survey of corneal transplantation and eye banking"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Gain"
                            1 => "R&#46; Jullienne"
                            2 => "Z&#46; He"
                            3 => "M&#46; Aldossary"
                            4 => "S&#46; Acquart"
                            5 => "F&#46; Cognasse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamaophthalmol.2015.4776"
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA Ophthalmol"
                        "fecha" => "2016"
                        "volumen" => "134"
                        "paginaInicial" => "167"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26633035"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S073510970802113X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish experience as a leading country&#58; what kind of measures were taken&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Matesanz"
                            1 => "B&#46; Dom&#237;nguez-Gil"
                            2 => "E&#46; Coll"
                            3 => "G&#46; de la Rosa"
                            4 => "R&#46; Marazuela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1432-2277.2010.01204.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transpl Int"
                        "fecha" => "2011"
                        "volumen" => "24"
                        "paginaInicial" => "333"
                        "paginaFinal" => "343"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21210863"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of a novel collagen scaffold for corneal tissue engineering"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Zhang"
                            1 => "A&#46;M&#46; Sisley"
                            2 => "A&#46;J&#46; Anderson"
                            3 => "A&#46;J&#46; Taberner"
                            4 => "C&#46;N&#46; McGhee"
                            5 => "D&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Tissue Eng Part C&#58; Methods"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Newsletter transplant&#44; vol&#46; 19 &#40;No&#46; 1&#41;&#46; September 2014&#46; EDQM&#47;Council of Europe&#46; Available at&#58; http&#58;&#47;&#47;www&#46;ont&#46;es&#47;publicaciones&#47;Documents&#47;NEWSLETTER&#37;202014&#46;pdf &#91;accessed 07&#46;04&#46;15&#93;&#46;"
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Word Health Organization Sixty-third World Health Assembly&#46; WHA63&#46;22&#46; 21&#47;05&#47;2010&#46; Available at&#58; http&#58;&#47;&#47;apps&#46;who&#46;int&#47;gb&#47;ebwha&#47;pdf&#95;files&#47;WHA63&#47;A63&#95;R22-en&#46;pdf&#63;ua&#61;1 &#91;accessed 07&#46;04&#46;15&#93;&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Deceased donors of tissue"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Navarro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Essentials of tissue banking"
                        "paginaInicial" => "23"
                        "paginaFinal" => "40"
                        "serieFecha" => "2010"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Corneal transplantations from donors with cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; L&#243;pez-Navidad"
                            1 => "N&#46; Soler"
                            2 => "F&#46; Caballero"
                            3 => "E&#46; Lerma"
                            4 => "O&#46; Gris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.tp.0000264199.31913.75"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplantation"
                        "fecha" => "2007"
                        "volumen" => "83"
                        "paginaInicial" => "1345"
                        "paginaFinal" => "1350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17519785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CEBT study&#58; corneas from older donors suitable for transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Abdullayev"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "VII world cornea congress"
                        "conferencia" => "San Diego"
                        "serieFecha" => "2015"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;healio&#46;com&#47;ophthalmology&#47;cb&#47;&#37;7Bce9b07f4-cf70-41c7-bf05-b892c9306714&#37;7D&#47;world-cornea-congress-viii"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of grafted patients with donor corneas that today are more than 100 years old"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Visby"
                            1 => "J&#46; Hjortdal"
                            2 => "K&#46; Nielsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/aos.12231"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Ophthalmol"
                        "fecha" => "2014"
                        "volumen" => "92"
                        "paginaInicial" => "478"
                        "paginaFinal" => "481"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23819790"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Clostridium perfringens</span> endophthalmitis after penetrating keratoplasty with contaminated corneal allografts&#58; a case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Hou"
                            1 => "A&#46; Tannan"
                            2 => "J&#46; Rubenstein"
                            3 => "O&#46; Lopez"
                            4 => "K&#46; McCoy"
                            5 => "R&#46; Epstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICO.0000000000000303"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "23"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25393093"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Guide to the quality and safety of tissues and cells for human application"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd edition"
                        "fecha" => "2015"
                        "editorial" => "European Directorate for the Quality of Medicines and Healthcare &#40;EDQM&#41;&#47;Council of Europe"
                        "editorialLocalizacion" => "Strasbourg"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Directiva 2006&#47;17&#47;CE de la Comisi&#243;n de 8 de febrero de 2006 por la que se aplica la Directiva 2004&#47;23&#47;CE del Parlamento Europeo y del Consejo en lo relativo a determinados requisitos t&#233;cnicos para la donaci&#243;n&#44; la obtenci&#243;n y la evaluaci&#243;n de c&#233;lulas y tejidos humanos&#46; Anexo I&#46; Art&#237;culo 3a&#46;"
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "European Center for Disease prevention and Control&#46; Available at&#58; <a id="intr0035" class="elsevierStyleInterRef" href="http://ecdc.europa.eu/en/activities/diseaseprogrammes/emerging_and_vector_borne_diseases/Pages/index.aspx">http&#58;&#47;&#47;ecdc&#46;europa&#46;eu&#47;en&#47;activities&#47;diseaseprogrammes&#47;emerging&#95;and&#95;vector&#95;borne&#95;diseases&#47;Pages&#47;index&#46;aspx</a> &#91;accessed 07&#46;04&#46;15&#93;&#46;"
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Importance of donor selection and corneal viability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Navarro"
                            1 => "C&#46; Cabrer"
                            2 => "F&#46;M&#46; de Cabo"
                            3 => "D&#46; Paredes"
                            4 => "J&#46; Escalada"
                            5 => "J&#46; Costa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Transplant Proc"
                        "fecha" => "1999"
                        "volumen" => "31"
                        "paginaInicial" => "2609"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10500741"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Minimum medical standards&#46; European Eye Bank Association&#46; Operativo desde 1 Feb 2015&#46; Available at&#58; <a id="intr0040" class="elsevierStyleInterRef" href="http://www.eeba.eu/downloads/EEBA%20Minimum%20Medical%20Standards%20Rev%202%20-%202015Final.pdf">http&#58;&#47;&#47;www&#46;eeba&#46;eu&#47;downloads&#47;EEBA&#37;20Minimum&#37;20Medical&#37;20Standards&#37;20Rev&#37;202&#37;20-&#37;202015Final&#46;pdf</a> &#91;accessed 06&#46;04&#46;15&#93;&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Posterior lamellar keratoplasty&#58; DLEK to DSEK to DMEK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;J&#46; Melles Gerrit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ico.0000243962.60392.4f"
                      "Revista" => array:7 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "879"
                        "paginaFinal" => "881"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17102659"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673607601949"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Corneal and external disorders&#46; Deep anterior lamellar keratoplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Shimmura"
                            1 => "K&#46; Tsubota"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.icu.0000233953.09595.91"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Ophthalmol"
                        "fecha" => "2006"
                        "volumen" => "17"
                        "paginaInicial" => "349"
                        "paginaFinal" => "355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16900026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "One cornea for 2 patients&#58; case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Nikolic"
                            1 => "V&#46; JovanovicII"
                            2 => "M&#46;R&#46; Jankov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arq Bras Oftalmol"
                        "fecha" => "2010"
                        "volumen" => "73"
                        "paginaInicial" => "291"
                        "paginaFinal" => "293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20730291"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0225"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late endothelial graft failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;D&#46; Rola Ba-Abbad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Middle East J Ophthalmol"
                        "fecha" => "2006"
                        "volumen" => "13"
                        "paginaInicial" => "106"
                        "paginaFinal" => "112"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Flex center method versus center method for endothelial corneal evaluation in eye banking&#46; A comparative analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Villalba"
                            1 => "A&#46; Jim&#233;nez"
                            2 => "G&#46; Forn&#233;s"
                            3 => "M&#46; Eisman"
                            4 => "J&#46;L&#46; G&#243;mez Villagr&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10561-014-9434-0"
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                        "tituloSerie" => "Cell Tissue Bank"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "507"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24633397"
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                      "titulo" => "Effective serological and molecular screening of deceased tissue donors"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;D&#46; Kitchen"
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                            2 => "H&#46;L&#46; Gillan"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "633"
                        "paginaFinal" => "644"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23354598"
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "22"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global epidemiology of HTLV-I infection and associated diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46;A&#46; Proietti"
                            1 => "A&#46;B&#46;F&#46; Carneiro-Proietti"
                            2 => "B&#46;C&#46; Catalan-Soares"
                            3 => "E&#46;L&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1038/sj.onc.1208968"
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                        "tituloSerie" => "Oncogene"
                        "fecha" => "2005"
                        "volumen" => "24"
                        "paginaInicial" => "6058"
                        "paginaFinal" => "6068"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16155612"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0735109710039756"
                          "estado" => "S300"
                          "issn" => "07351097"
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                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "HLA matching in keratoplasty&#58; lessons learned from lamellar techniques"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; B&#246;hringer"
                            1 => "J&#46; Schwartzkopff"
                            2 => "P&#46;C&#46; Maier"
                            3 => "T&#46; Reinhard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0032-1328256"
                      "Revista" => array:7 [
                        "tituloSerie" => "Klin Monatsbl Augenheilkd"
                        "fecha" => "2013"
                        "volumen" => "230"
                        "paginaInicial" => "490"
                        "paginaFinal" => "493"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23695845"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0735109708019360"
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                          "issn" => "07351097"
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                  ]
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              ]
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            23 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preparation of corneal donor eyes comparing 1&#37; versus 5&#37; povidone-iodine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;D&#46; Lindquist"
                            1 => "A&#46;J&#46; Maxwell"
                            2 => "T&#46;D&#46; Miller"
                            3 => "T&#46;L&#46; Win&#8217;E"
                            4 => "T&#46; Novicki"
                            5 => "T&#46;R&#46; Fritsche"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICO.0b013e3181eeb5d2"
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                        "tituloSerie" => "Cornea"
                        "fecha" => "2011"
                        "volumen" => "30"
                        "paginaInicial" => "333"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21045655"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microbial decontamination of human donor eyes with povidone-iodine&#58; penetration&#44; toxicity&#44; and effectiveness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;G&#46; Pels"
                            1 => "M&#46; Vrensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Ophthalmol"
                        "fecha" => "1999"
                        "volumen" => "83"
                        "paginaInicial" => "1019"
                        "paginaFinal" => "1026"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10460768"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0260"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Commission Directive &#40;EU&#41; 2015&#47;565 of 8 April 2015 amending Directive 2006&#47;86&#47;EC as regards certain technical requirements for the coding of human tissues and cells&#46; Available at&#58; <a id="intr0045" class="elsevierStyleInterRef" href="http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32006L0086">http&#58;&#47;&#47;eur-lex&#46;europa&#46;eu&#47;legal-content&#47;EN&#47;TXT&#47;&#63;uri&#61;celex&#58;32006L0086</a> &#91;accessed 06&#46;04&#46;15&#93;&#46;"
                ]
              ]
            ]
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Article information

ISSN: 21735794
Original language: English

DOI:10.1016/j.oftale.2016.06.006

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