University of Toronto Faculty of Medicine, Toronto, Ontario.
Can J Ophthalmol. 2011 Oct;46(5):381-5. doi: 10.1016/j.jcjo.2011.07.009. Epub 2011 Aug 4.
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.
Cross-sectional survey of Canadian corneal transplant (CT) surgeons and eye banks.
Canadian CT surgeons and representatives from the 10 Canadian eye banks.
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.
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).
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.
评估是否有实施常规通知和请求（RNR）立法的省份能够持续增加角膜组织供应并缩短角膜移植手术的等待时间。
对加拿大角膜移植（CT）外科医生和眼库的横断面调查。
加拿大 CT 外科医生和 10 家加拿大眼库的代表。
2009 年 7 月至 10 月期间分发了自愿和匿名调查。符合条件的 CT 外科医生被定义为在加拿大行医的眼科医生；目前进行穿透性角膜移植术（PKP）、深板层角膜移植术（DALK）、深层角膜内皮移植术（DLEK）、撕囊角膜内皮移植术（DSEK）或去内皮角膜基质移植术（DMEK）；并从加拿大眼库获取组织。
从 2006 年到 2009 年，在有 RNR 立法且有数据的省份，从诊断到 CT 手术的平均等待时间有所增加：在安大略省，从 31±34 周增加到 36±27 周；在不列颠哥伦比亚省，从 39±20 周增加到 42±35 周；在马尼托巴省，从 32±23 周增加到 49±36 周。此外，在 2006 年至 2008 年期间，除不列颠哥伦比亚省外，RNR 省份适合移植的角膜组织数量有所下降：在安大略省，从 1186 个组织下降到 999 个组织（下降 16%）；在马尼托巴省，从 92 个组织下降到 83 个组织（下降 10%）；在新不伦瑞克省，从 129 个组织下降到 98 个组织（下降 24%）。
尽管最初有效，但 RNR 立法并没有持续增加角膜组织供应，也没有缩短大多数省份的等待时间。将社区医院纳入 RNR 集水区、加强执法以及继续对医院工作人员进行有关 RNR 流程的教育，可能有助于从长期来看使该立法更加可持续。
