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|Year : 1989 | Volume
| Issue : 3 | Page : 110-111
Eye banking in India
|How to cite this article:|
Kalevar V. Eye banking in India. Indian J Ophthalmol 1989;37:110-1
There are over 120 eye banks formally established in different parts of the country. Most of them are only on paper, only about 20 are collecting 50 or more donor eyes in a year. It is at very few centres that the campaign of procuring donor human eyes has succeeded to some extent. Social organisations like Lions, Rotarians and Red Cross have made productive efforts in the eye donation programme.
The Government initiative in procuring donor human eyes has been only of limited help. The corneal grafting acts passed by Parliament and various legislatures can at best permit enucleation of eyes without waiting for post-mortem in medico-legal cases and declaring a dead body unclaimed sooner than the present prescribed limits. In any case, the quality of donor material from both these sources will depend on the time factor, not always favorable.
There are two methods of procuring donor eyes through voluntary organisations
1. From those who have signed a willing donation form during life for removal of eyes after their death.
2. By approach to the nearest relatives of those who have died at home or in the hospital and persuading them to allow removal of eyes.
The former, willing donation during life, is the principle source of donor eyes in developed countries. In countries like India however, it is a very small source in the present circumstances. If there are 10,000 listed donors with an eye bank, not more than a few may die in a year.
A campaign for willing donation of eyes during life however has the advantage, that of creating consciousness among public that donation of eyes is a noble act so that in the long run, more and more people may be motivated to allow removal of eyes of their relatives after death.
The most effective method of procuring donor human eyes is a direct approach to the relatives of the deceased. Ground for this can be prepared by educating the people through all possible media of communication which will help increase the success in getting more eyes.
The exact modus operandi is to divide the town in zones or mohallas and put two or three volunteers living in that area to be incharge. Whenever there is death in that area, they should approach the relatives as soon as possible . Even if two out of ten efforts succeed, more eyes will become available than by any other method. As soon as written consent is procured, the volunteer should rush the message to the eye bank and eyes should be enucleated, out of direct view of the relatives.
No law comes into picture in this method because there is a willing and written consent of the relatives who arc legal custodians of the dead body. The success of this method will entirely depend on the willing co-operation and the active interest of the members of social organisations who have organised a particular eye bank.
Most eye banks in developed countries are organised and run by non-governmental societies, active ones being the Red Cross and the Lions International through their district branches. They are funded by donors from the community. Each eye bank covers a particular area and caters to the needs of eye surgeons on first request first supply basis.
Eve banks in India are however mostly attached to the government medical institutions. This has a disadvantage that active effort is lacking. They mostly collect donor eyes from post-mortem medico-legal bodies. Eve Banks organised by social organisations, though few in number, have in some cases succeeded much better.
There is a great scope and urgent necessity in the circumstances that exist in India that eye bank activities in the country should not only improve in quality but should be coordinated at a national level. It is with this background that THE EYE BANK ASSOCIATION OF INDIA has recently been established. The objectives of the Association are not only to improve the quality of eye bank services in the country and co-ordinate all eye banks from a national level but also to provide training for eye hank technicians so that more eyes and better eyes are available to corneal surgeons in India.
The Government can and should however support this activity by sanctioning financial support and subsidising the hospital expenses for grafting done in non government institutions for poor patients. The Government can further help by preparing and providing publicity material free of cost.
Even though many state legislatures and even the Parliament have passed corneal grafting Acts, it has not increased the availability of donor eyes to the extent they are needed. Law cannot procure eyes. It can at best liament have passed corneal grafting Acts, it has not increased the availability of donor eyes to the extent they are needed. Law cannot procure eyes. It can at best protect the individual for an act done in good faith. So long as there is a properly documented will of the donor and written consent of relatives, no law prevents removal of donor eyes for corneal grafting.
Corneal blindness is a disaster because majority of corneally blind are blind from a young age and therefore cannot be educated and arc non-earning members of the family. If the corneally blind are not treated and cured, they remain a liability to the family and community for the rest of their lives.
The commonest cause of corneal blindness is infection made worse by malnutrition due to poverty. To prevent corneal blindness very little is being done and very little can be done till the people are educated and the economy of the masses improves. The immediate problem therefore is to cure as many as possible.
India has at least a million persons who are corneally blind or are suffering from gross corneal diseases. Even if one fourth of them can be cured by corneal grafting, there are a t least 250,000 patients needing corneal grafts. As against this, not more than 2000 corneal grafts are being done in the whole country in a year, a drop in an ocean effort. This is largely due to the paucity of donor human eyes. Over 200 senior eye surgeons have been trained in corneal grafting but most of them have not been able to procure eyes and could not do many grafts.
The successful examples of the Red Cross eye bank in Dholka (Gujarat) and the eye bank at Harkishandas Hospital in Bombay each collecting 500 to 700 donor eyes per year for the last few years are a silver lining to the darkness of the corneally blind in India.
More recently, brighter stars are appearing on the bhorizon, Neemuch in Madhya Pradesh is a very good example of 'where there is a will there is a way.' They have started only four years back and succeeded so well that messages now reach them from the city and nearby villages from the next of kith and kin offering donation of eyes of their deceased relation.
Eye surgeons can restore sight to many more persons if enough number of donor eyes are available. The press can play a vital role in the success of this objective and help educate and motivate people so that like blood donation, donation of eyes also becomes a routine matter.
These efforts are, however, also receiving critical comments. The possibility of misuse of donor material has been voiced. Some people feel that they know nothing after the eyes are donated and do not know whether eyes have been used or not and if used for whom and with what result.
It is therefore important that people should be informed of what is wrong and what is right. It is extremely important that such a noble effort should not be killed at its very beginning. In fact, the efforts should be continued, duplicated and multiplied by more and more organisations because we have a long way to go. Hundreds of eye surgeons can spend their lifetime to restore sight to those who are waiting. Many blind will die blind if this does not happen.
It is extremely important to emphasise at this stage that even in countries where the dead bodies are kept in a cool chamber and the unfavorable environmental and bacterial contamination factors are nearly absent, only 35 to 40 percent of eyes, when received, are found in usable condition. A still lesser number of eyes will be found ideally usable in tropical conditions as in India, because the bodies are exposed to tropical climatic conditions wherein eyes deteriorate in their viability sooner than in colder countries. It is therefore important to understand that all the eyes removed cannot always be used. It is on scientific basis that a donor eye is rejected because grafting an unusable cornea will invite failure of the graft operation and disappointment to all concerned.
Let us all therefore strive to get more and better eyes for the rehabilitation of the blind in the country.
Get more eyes
Do more grafts.