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EDITORIAL
Year : 1997  |  Volume : 45  |  Issue : 3  |  Page : 141-142

Realistic targets and strategies in eye banking


Correspondence Address:
J S Saini


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PMID: 9475016

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How to cite this article:
Saini J S. Realistic targets and strategies in eye banking. Indian J Ophthalmol 1997;45:141-2

How to cite this URL:
Saini J S. Realistic targets and strategies in eye banking. Indian J Ophthalmol [serial online] 1997 [cited 2019 Aug 24];45:141-2. Available from: http://www.ijo.in/text.asp?1997/45/3/141/15020

Throughout the developing world, the problem of corneal blindness is overshadowed by the backlog of cataract blindness and most of the resources have been earmarked for the alleviation of cataract blindness. Ignorance and poverty have contributed as much to the cataract blindness as to the corneal blindness. The NPCB-WHO (1986-89) estimates of corneal blindness (5.96 lakh unilateral blind and 1.91 lakh bilateral blind) are considered conservative figures by many based on several other indirect estimates. On an average, only 40-60% of the eyes collected by eye banks anywhere in the world are usable because of the quality constrains. In 1994, in the US, 96,700 donor eye were collected and only 41,300 could pass the quality and safety assessment criteria. In India in 1995 against 11,878 donor eyes collected, only 4,431 penetrating keratoplasties were performed. As the Eye Bank Association of India prescribed medical standards gain wider acceptance, the number of safe donor eyes in India may dwindle further.

Based upon our current ratio of available safe donor eyes, we will need 2.7 lakh donor eyes for performing 1 lakh corneal transplants in a year in India, an approximately 20 fold increase from the donor eyes available now. To achieve this in India, 100 eye banks will have to collect 2,700 eyes each. Most of the eye banks in this country cover a population of 104 lakh and about 9,400 deaths a year and thus the targeted donors will be 14.3% of urban deaths. It is accepted that soliciting for actual eye donation at the time of family death is necessary. The problem, however, is the low receptivity of the emotionally upset family to the idea of eye donation. The experience in this country and elsewhere has been that positive family consents remain poor in the absence of prior awareness and low (in the range 5-15%) among those solicited even with prior awareness. Increasing public education is an important first step. Our eye collections can only increase if we adopt operative mechanisms for enhanced solicitation for eye donation. Time of soliciting is not an opportunity for motivational effort. Rather it is the grief counselling, moral support, and tactful reminder about eye donation which works. For an estimated 10 lakh urban population covered by each of the 100 eye banks, and feasible coverage to solicit eye donation at 50% of urban deaths and 10% positive family consent rates, donor eyes collected will number 100,000 in a year from 50,000 donors. Logistically either our coverage for urban deaths has to increase or somehow positive consent rate has to increase or both if we are to reach the target number of donor eyes.

In Chandigarh, hospital deaths account for 70% of the urban deaths and on assuming a similar ratio for the country, it should be feasible to achieve 50% coverage for soliciting eye donations if eye banks concentrate their meagre resources on hospital deaths. This will have additional advantages of easy medical audit and operational efficiency. This strategy should help the country have a 10 fold increase in number of donor eyes. Involvement of hospital staff will give boost to the strategic hospital cornea retrieval programme.

It will be far more effective and cost-efficient if the caring hospital staff is legally obligated to request for eye donation in case of death. This will necessitate enactment of legal sanction on the pattern of 'Required Request Law' already in practice in many countries. Modification in law will also make it easy to procure eye donations from medico-legal deaths. Requests for eye donation made through the caring hospital staff are more effective. Non-urban deaths are best approached through spreading the network of peripheral eye collection centres and neighbourhood grief counsellors. Given the wide area of operation and low number of deaths per unit area, the processes can only be cost-effective and successful through large scale voluntary philanthropy work. Hospital cornea retrieval strategy can be equally aggressively practised, monitored and supported by central nodal centres, but non-hospital harvesting of donor eyes will depend upon the strength of the regional voluntary bodies.

To achieve 2.7 lakh donor eye collection a year will remain elusive without achieving 50% grief counselling coverage and at least 30-40% positive consents in the population covered by 100 eye banks. It will not materialise in the next decade at least through publicity alone and targeted hospital cornea retrieval programmes. We will need enactment of legal provisions to enhance positive consent yields through enforced facilitated solicitation for eye donation. From the experience in many parts of the world and limited surveys from India, people who are aware of eye donation, prefer to commit their consent pre-mortem in a routine manner, and then leave it to the family members to decide at the time of death. 'Mandated Choice Consent' legal provision already in operation in large parts of the world, obligate the state to elicit the choice of consent to eye donation along with some routine state functions like obtaining driver's license or with filling the income tax return. Such a provision will continue to give the right to refuse eye donation by choice. Experience however has been that given a choice most people will consent to donate. We will be able to increase immensely our public awareness and achieve higher consent rates at practically no extra cost to the state. The most drastic legal provision to 'presume consent' for eye donation is not favoured by people in surveys.

Eye banking in India is in a very nascent stage although the large number of corneal blind are adding to the social and economic burden. This has been increasing because of the huge gaps between demand and supply. Boosting eye collections will result from a combination of publicity, wider practice of grief counselling, targeted hospital retrieval programme, facilitator legal provisions, and public awareness regarding spontaneous voluntary eye donations. Besides enhanced eye collections, eye banking in India needs huge inputs by way of restructuring eye bank managerial and non-managerial staff placements, adopting uniform medical standards, upgrading equipment and tissue preservation techniques. Eye banking also needs to ensure quality through training of manpower at all levels. The task is undoubtedly huge and needs financial and technical inputs. Needless to say that eye banking will need sincere efforts from government, voluntary and international agencies.




 

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