title: Sustainability of Routine Notification and Request legislation on eye bank tissue supply and corneal transplantation wait times in Canada.
abstract: OBJECTIVE
  To assess whether provinces with Routine Notification and Request (RNR) legislation have sustained increases in corneal tissue supply and decreases in wait times for corneal transplantation surgery.
  
  
  METHODS
  Cross-sectional survey of Canadian corneal transplant (CT) surgeons and eye banks.
  
  
  METHODS
  Canadian CT surgeons and representatives from the 10 Canadian eye banks.
  
  
  METHODS
  Voluntary and anonymous surveys were distributed between July and October 2009. Eligible CT surgeons were defined as ophthalmologists who practice in Canada; currently perform Penetrating keratoplasty (PKP), Deep anterior lamellar keratoplasty (DALK), Deep lamellar endothelial keratoplasty (DLEK), Descemet stripping endothelial keratoplasty (DSEK), or Descemet membrane endothelial keratoplasty (DMEK); and have obtained tissues from a Canadian eye bank.
  
  
  RESULTS
  From 2006 to 2009, for provinces with RNR legislation and where data are available, mean wait times from date of diagnosis to date of CT surgery have increased: in Ontario, from 31 ± 34 weeks to 36 ± 27 weeks; in British Columbia, from 39 ± 20 weeks to 42 ± 35 weeks; in Manitoba, from 32 ± 23 weeks to 49 ± 36 weeks. In addition, the amount of corneal tissue in RNR provinces suitable for transplant, with the exception of British Columbia, has declined between 2006 and 2008: in Ontario, 1186 tissues to 999 tissues (16% decline); in Manitoba, 92 tissues to 83 tissues (10% decline); in New Brunswick, 129 tissues to 98 tissues (24% decline).
  
  
  CONCLUSIONS
  Although initially effective, RNR legislation has not sustained an increase in corneal tissue availability nor has it shortened wait times in most provinces. Incorporation of community hospitals into the RNR catchment, improved enforcement, and continued education of hospital staff regarding the RNR process may be effective in making this legislation more sustainable in the long term.
authors: University of Toronto Faculty of Medicine, Toronto, Ontario.
authors: Kenneth
authors: K
authors: Lee
authors: Corey
authors: C
authors: Boimer
authors: Samantha
authors: S
authors: Hershenfeld
authors: Linda
authors: L
authors: Sharpen
authors: Allan R
authors: AR
authors: Slomovic
mesh_terms: D002170:Canada; D003315:Cornea; D016039:Corneal Transplantation / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005125:Eye Banks / Q000600:supply & distribution*; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009885:Ophthalmology / Q000331:legislation & jurisprudence; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence*; D014850:Waiting Lists