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   Table of Contents      
Year : 2002  |  Volume : 50  |  Issue : 3  |  Page : 209-212

Enhancing eye donation rates. Training students to be motivators

Department of Ophthalmology, University College of Medical Sciences, GTB Hospital, Delhi, India

Correspondence Address:
U Dhaliwal
Department of Ophthalmology, University College of Medical Sciences, GTB Hospital, Delhi
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Source of Support: None, Conflict of Interest: None

PMID: 12355696

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Purpose: Medical professionals could enhance eye donation rates by reminding relatives during grief counseling at the time of patient's death. This study was designed to assess the knowledge and attitudes of final year medical students (future doctors) towards eye donation, prior to instruction in eye banking. Methods: The responses of 49 final-year medical students to a questionnaire on eye donation were compared with 24 non-medical students (controls). The results were analysed statistically using the
chi-square test. Results: More than one-third of students and controls were unaware that eyes are removed within six hours of death. Eight (16.3%) students and 6 (25.0%) controls felt that a close relative's eyes could be donated after death only if he had indicated willingness (P=0.05). Three (6.1%) students and 3 (12.5%) controls were undecided about donating their own eyes. Nineteen (38.8%) students and 6 (25%) controls did not know where to go in order to pledge/donate eyes. The controls had poorer knowledge of ocular and systemic contraindications, and they did not know that storage could be prolonged (P<0.001). Only 27 (55.1%) students had knowledge of corneal storage. Conclusions: Controls were poorly informed about various aspects of eye donation suggesting
inadequate dissemination of information by the media. Students and controls alike had misconceptions regarding donation of relatives' eyes and hesitation regarding their own. These aspects should be emphasized during undergraduate teaching to dispel misgivings regarding wastage of donor eyes and to encourage future doctors to promote eye donation.

Keywords: Solicited eye donation, corneal blindness, medical students

How to cite this article:
Dhaliwal U. Enhancing eye donation rates. Training students to be motivators. Indian J Ophthalmol 2002;50:209-12

How to cite this URL:
Dhaliwal U. Enhancing eye donation rates. Training students to be motivators. Indian J Ophthalmol [serial online] 2002 [cited 2021 Feb 27];50:209-12. Available from: https://www.ijo.in/text.asp?2002/50/3/209/14784


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Approximately 190,000 persons in India are blind from bilateral corneal disease.[1] Every year another 20,000 join the list.[2] This problem is compounded by the fact that, at last census only 11,878 donor eyes had been collected across the country; despite several million deaths every year.[3] Thus waiting corneal transplants constitute a considerable and constantly growing backlog. The need therefore is to educate the masses about eye donation in an effort to increase the procurement of corneas. To this end eye banks play an important role; they use the popular media to increase awareness of corneal blindness, its prevention and the potential for cure using donated eyes. There are however, very few fully functional eye banks in India and so their reach is limited.

Medical students constitute a major potential force to increase eye donations. This is nearly untapped. Medical students after graduation may often serve as terminal care doctors of suitable eye donors; therefore they have a great opportunity to motivate patients or relatives to donate eyes. To do this, they must be reasonably convinced of the proper utilization of donated tissue and the potential success of corneal transplants. Well-informed students in non-medical fields could also be expected to influence donation rates. The study was designed to assess the knowledge of and attitudes toward eye donation of both medical and non-medical students.

  Materials and Methods Top

Prior to routine instruction in eye banking, a class of final-year medical students were asked to respond in writing to open-ended questions in a questionnaire. Forty-nine students attended and all responded (the study group). The same questionnaire was administered to 24 non-medical students of comparable age who had completed at least three years of studies after school and were familiar with the English language (the control group). For purposes of analysis the questionnaire was divided into two parts. The first part dealt with social aspects of eye donation and some technicalities which both groups were expected to know. The second part dealt with contraindications, transport and storage of the donated eye, which could be considered essential knowledge for the study group only. The responses were compared and statistically analysed using chi-square test and significance obtained at the 5% level.

  Results Top

Thirty-nine (79.6%) medical students and 21 (87.5%) controls were aware that donations were done only after death (P=0.31) [Table - 1]. That the eyes should be removed within 6 hours after death was fairly well known to both groups. None of the controls were aware that the whole eyeball could be removed. Significantly more medical students knew that cornea was the transplanted structure (P<0.001). Twenty-four (49.0%) of the study group and 21 (87.5%) controls did not know what role the relatives were expected to play once the eye bank team had been informed of a donor's death (P=0.001). A majority of participants from both groups were willing to donate a close relative's as well as their own eyes after death. However, some were undecided as they felt that the relative should have expressed agreement while alive. Several participants from both groups did not know where to go in order to pledge or donate their eyes. Thirty (61.2%) students and 18 (75%) controls felt they would go to an eye bank but about one-third of each group could neither name any nor did they know of their location. Only 6 (12.2%) medical students were aware that this hospital had recently started an eye bank.

While 42 (85.7%) medical students knew that corneal diseases were a contraindication to eye donation, other ocular contraindications were mentioned infrequently [Table - 2]. Overall, infection with HIV was cited by only 19 (38.8%) students and Hepatitis B by 11 (22.4%) as contraindications to eye donation. Significantly more controls cited systemic malignancy as contraindication to donation (P=0.03). The controls were otherwise poorly informed of ocular and systemic contraindications. They were not aware of how the eyes were transported to the eye bank nor did they know that with storage the viability of the donated eye could be prolonged.

  Discussion Top

Statistics on eye donation in India[2],[3] paint a rather dark picture for persons blind from corneal diseases. Corneal transplantation is the most successful among all organ transplant procedures. Throughout the developing world there is a shortage of corneas. In order to increase eye donation it is essential to enhance awareness among potential donors and dispel their misconceptions. Medical professionals' attitudes towards eye donation can also be expected to influence donation rates. This study aimed to assess these attitudes in final-year medical students who had not yet been formally exposed to the subject. It was thus expected to assess their informal exposure via the media and other reading, or from seniors in medical college. The control group was included to assess the relative importance of information gathered from the media by both groups and that picked up in medical college (by the study group).

Only about two-thirds of each group were aware of the importance of removing donated eyes within 6 hours after death. Lack of knowledge of this aspect on the part of doctors and laymen would result in unnecessary loss of potential donor tissue. Since some of the controls admitted they would consult a doctor on what to do after a relative's death [Table - 1], it is imperative to stress this issue during undergraduate medical training.

Twelve (24.5%) medical students felt the whole eyeball was removed while 30 (61.2%) thought the cornea was removed from the donor. The 9 (37.5%) controls who responded to this question felt only the cornea was removed. While corneal removal from the donor is practical, successful and is being practiced in some parts of the country, the advantage of whole eyeball removal is that other parts of the eye like sclera can also be used and the endothelium is less likely to be damaged during transport and storage. However, whole eye removal is perceived as more mutilating by relatives than removal of the cornea alone. That no visible mutilation occurs should be demonstrated to medical students so that future doctors can confidently reassure relatives of prospective donors.

To preserve the integrity of the cornea the eyes should be kept closed and handled as little as possible after death. Wet packs may be applied to the closed lids in hot weather until enucleating. Only 6 (12.2%) students knew that the donor's eyes should be kept closed after death; three (12.5%) controls would seek the advice of a doctor on what to do once a relative died. Both findings show that it is vital for prospective doctors to be educated on this aspect of eye donation.

While most study and control group participants were willing to donate a close relative's eyes upon death, there was hesitation on the part of 8 (16.3%) students and 6 (25.0%) controls who felt that the relative, while living, should have indicated willingness to donate. In most Asian countries, including India, a voluntary consent system is in place where one depends heavily on surviving family members to donate the eyes of a dead or dying relative. Since death can come unexpectedly and the subject of donation may have never been discussed, the next of kin should be encouraged to make a decision. They would be better persuaded by the treating/family doctor than an anonymous eye-bank representative. Reminding a family about eye donation is a service provided to them and should not be considered as the asking of a favor. In the USA, the concept of 'presumed consent' has legal sanction, where, if the dead person had not registered any objection to donation while alive, consent is presumed and eyes can be removed as required. This legislation has led to a manifold increase in the availability of corneal tissue.[4]

Only 2 medical students had already pledged their eyes for donation but more than 80% participants of both groups were willing to donate, which was an encouraging finding. Unwilling and undecided individuals need to be persuaded by showing them the merits of eye donation. Medical students who are uncomfortable with the idea of eye donation will obviously make poor spokespersons for eye banking.

There was lack of knowledge in both groups regarding the logistics of eye donation. Nearly one-third of the participants from each group were unable to name or locate an eye bank. Since all the participants in this study were educated, this indicates a gross inadequacy of media publicity on eye donation.

Most medical students listed corneal disease as contraindication to eye donation. However, other contraindications were listed infrequently [Table - 2]. Not surprisingly, the control group was inadequately informed about ocular contraindications. HIV and Hepatitis-B infection were cited infrequently as systemic contraindications to eye donation by both groups. This was surprising in view of the current publicity given to these diseases. Both groups had limited knowledge of other systemic contraindications.

Since transport of the donated eye and its subsequent storage in an eye bank is purely the job of ophthalmic personnel, lack of knowledge of both groups regarding these aspects was not considered a significant lapse. However, if a relative could be reassured by the motivating doctor that the donor's eyes can be used later if a recipient is not immediately available, it would dispel misgivings regarding wastage of the donated tissue.

The study group was significantly better informed than the controls on aspects of eye donation like enucleation, which tissue to transplant, treatment of the donor eye until enucleation [Table - 1], ocular and systemic contraindications to eye donation and transport and storage of the eyeball [Table - 2]. This information is picked up by self-directed reading and from peer groups. However, this knowledge too was limited to a few participants, suggesting the learning process has to be more explicit and informative. Media publicity too, was found inadequate and inefficient as seen by the responses of the control group.

To enhance eye donation rates in India current media publicity is not enough; students should be targeted as present and future motivators. The results suggest that we should be willing to modify medical teaching-learning experiences in a way to make them more informative and to encourage positive attitudes towards eye donation. Unwillingness of healthcare professionals to facilitate donations has been ascribed to lack of initiative and fear of liability.[2] It could also be due to their ignorance of the success of corneal transplantation procedures and lack of faith in proper utilization of donor tissue. Medical students should be shown enucleation of eyeball to demonstrate that it is compatible with cosmesis. They should also be exposed to storage of eyeball in the nearest eye bank, and introduced to patients who have received successful corneal transplants. This should dispel misgivings regarding wastage of donated eyes.

Thus, there is a greater need to educate students in all fields, particularly those in the medical profession, about eye donation so as to enable the younger generation to act as motivators for enhancing eye donation rates. It might be a good idea to make it mandatory for medical students to motivate at least 10 eye donations every year.

  References Top

National Programme for the Control of Blindness. Report of National Survey by National Programme for the Control of Blindness, India and World Health Organization, 1986-89.  Back to cited text no. 1
Saini JS, Reddy MK, Jain AK, Ravindra MS, Jhaveria S, Raghuram L. Perspectives in eye banking. Indian J Ophthalmol 1996;44:47-55.  Back to cited text no. 2
Saini JS. Realistic targets and strategies in eye banking.Indian J Ophthalmol 1997;45:141.  Back to cited text no. 3
Farge EJ, Silverman LM, Khan MM, Wilhelmus KR. The impact of state legislation on eye banking. Arch Ophthalmol 1994;112:180-85.  Back to cited text no. 4


  [Table - 1], [Table - 2]

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