Around 0.25 million blind people are
currently on the waiting list for corneal transplantation in India. While the burden of corneal blindness increases with an
addition of 25,000-30,000 cases every year, the latest data from the union health ministry shows that half of donated eyes
go waste and are not utilized for corneal transplantation.
has become popular in India over the last couple of decades,
thanks to the awareness created by celebrities like Aishwarya Rai and the work
of many NGO's in the field. The credit of this success, in the end, also
greatly rests on the society's noble attitude to eye donation.
However, data from the Ministry is
somewhat alarming. It shows that as many as 51,354 eyes were donated in
2013-14, but only 22,384 were used for transplantation. The figures for
utilization have remained more or less the same over the past few years with
only 50% of the donated eyes getting utilized.
Medindia, in an exclusive,
investigated the reason behind this low utilization and had some surprising
revelations. Our investigations revealed two main reasons for the poor quality
of the corneas were as follows:
Lack of awareness and understanding
by relatives on how to preserve the eyes after death of their loved ones
Incentive payment of Rs.2,000 by the
government for each donation to the eye bank working against the system
The family members who wish to
donate the eyes of their relatives should understand that the eyes that get dry
and swollen after death, deteriorate very fast and cannot be used for
transplantation. To keep them from drying, one needs to keep the eyes moist by
using a wet cotton swab. Other precautions that need to be taken include
switching off the fan over the body, propping the head under a pillow (to
reduce swelling) and switching on air conditioner in the room, if available.
The payment issue is more
controversial and was started by the government many years ago to incentivize
promoting eye donation and get more corneal donations. However, public health
experts are skeptical and say that this practice maybe working against the
system. The system encourages eye banks to get as many corneas as possible
without worrying too much about the quality of the retrieved tissue. Manoj
Gulati, Sight Life country director for India, said that the financial
incentive to eye banks for eye retrieval is one of the main reasons that leads
to eyes being wasted."Eye banks get a handsome amount of Rs.2,000 per pair of
eyes. The scheme has shifted the focus to collecting as many as they can from retrieving
only transplantable tissues. There is also a standard protocol to follow before
retrieving a tissue. This includes the examination of the medical and surgical
history of the donor. In many cases, this protocol is not followed properly,"
Gulati, head of the non-profit
health organization that focused on eliminating corneal blindness
also said that government should encourage retrievals of only transplantable
tissues such as corneas. "In the next five-year plan, government should include
a new scheme to increase eye donation. Eye banks should be paid only for
transplantable eyes. Or else, the government should ensure a great amount for
transplantable eyes and a small amount for other retrievals. This will
encourage eye banks to collect more transplantable eyes," he added. He noted
that the initiative of the government to create awareness on eye donation is
still not successful. "There is only a narrow increase of 1 or 2% in the number
of voluntary eye donators in the country every year. This shows that government
awareness programs are not up to the mark and failing to attract more donors,"
But Lalitha Raghuram, country
director of MOHAN Foundation, said that
eye banks never say no to anyone who wants to donate their eyes. "If
they reject a cornea considering the age of a donor or citing some other
reasons, it will create a bad impression and people will not come forward to
donate their eyes," she said.
Lalitha, who had earlier worked with
the Eye Bank Association of India, said that half of donated eye are actually
not going waste. "The eye those can't be used for optical purpose is actually
used for research, " she said.
Dr. S. Tony Fernandes, a
Padmashree awardee for his contributions to eye care, said that lack of
coordination among eye banks also leads to eye wastage. "Tamil Nadu leads
the country in cadaver organ
. Unlike their cadaver organ donation program, there is no
free flow of information between eye banks to facilitate eye donations. Better
co-ordination among eye banks is important and they must be open to information
sharing," he said.
that Eye Bank Association
of India (EBAI)
should work as a centre for all India activities of coordination and
networking for procurement and distribution of eyes.
"A national level registry
should be maintained for eye donation and eye transplantation. The
association should also take necessary steps to make people aware of eye
donation. As of now, the situation is miserable and people are less aware of
activities of eye banks and what are they used for," he added.
Eyes donated in hospitals have a
better quality. The success with cadaver organ donation
has resulted in improved eye
donation in the hospitals. In fact, the number of eye donations are much more
than solid organ donation, thanks to this programme. An example of this success
is the Rajiv Gandhi General Hospital in Chennai. There were hardly any
donations taking place before the cadaver programme started. In the last three
years, there have been around 100 corneal donations.
To improve the quality of corneas
should be the focus of Government of India and Medindia's recommendations to
the Government are as follows:
1. Create more awareness on not only
eye donation but also the do's and don'ts of corneal donation
2. Provide incentives at two levels to
eye banks depending on the quality of the corneas and its utilization.
3. More corneal donation and
procurement should be encouraged in hospitals.
4. Better coordination between eye banks and corneal