**7. Guidance and screening recommendations for corneal transplantation (Eye Bank Association of America, Updated Guidance – March 14, 2022)**

EBAA guidance and screening recommendations for COVID-19 pandemic are based on the latest guidelines from the FDA and CDC as well as available scientific evidence [50].

The most current set of guidelines specifies criteria for:

	- a.Were diagnosed with acute COVID-19; OR
	- b.Tested positive for COVID-19 by direct viral testing methods (e.g., NAAT and/or antigen); OR
	- c.Had close contact with a person diagnosed with or suspected to have COVID-19 and developed signs and symptoms of COVID-19, regardless of a plausible alternative etiology or vaccination history
	- a.In the 10 days prior to death, without a known close contact with a person diagnosed with or suspected to have COVID-19, developed new signs and/ or symptoms consistent with acute COVID-19 not explained by a plausible alternative etiology; OR
	- b.In the 10 days prior to death, had known close contact with a person diagnosed with or suspected to have COVID-19 AND was asymptomatic; OR
	- c.In the 11 to 20 days prior to death had a positive test for SARS-CoV-2 AND had ongoing signs and/or symptoms of COVID-19

EBAA contraindications to transplant are active ocular or intraocular inflammations, such as conjunctivitis, keratitis, scleritis, iritis, vitritis choroiditis, or retinitis.

Current EBAA Medical Standards require that 5% povidone–iodine solution shall contact the entire surface of any ocular tissue intended for transplantation at least twice between the time of the donor's death and tissue preservation, as povidone– iodine has been documented *in vitro* viricidal activity against coronaviruses.

Global Alliance of Eye Bank Associations (GAEBA) declared on November 12, 2020 that there is no evidence that coronaviruses can be transmitted by human tissue or cell transplantation and therefore measures in this response are precautionary, as there have been no reported cases of transmission of SARS-CoV-2, MERS-CoV, or any other coronavirus via transplantation of human ocular tissue [6, 51].

The European Eye Bank Association (EEBA) and European Association of Tissue and Cell Banks (EATCB) refer to guidance provided by the ECDC (European Centre for Disease Prevention and Control 1st update, April 2020): corneal transplants are usually disinfected with povidone (PVP) iodine and then stored in organ culture at 30–37°C for at least 14 days. The presence of viruses capable of reproduction after this procedure seems very unlikely. These data and the absence of known ocular transmission cases indicate that the risk of COVID-19 cases entering the eye donor pool and subsequent transmission is theoretical [52, 53].
