Eye Banking and Eye Donation in India
Dr Sunita Chaurasia, Medical Director,
Ramayamma International Eye Bank,
L V Prasad Eye Institute, Hyderabad
According to WHO (World Health Organization), Corneal Blindness is the fourth leading cause of global blindness after cataract, glaucoma and age related macular degeneration. Corneal blindness is a significant problem, treated primarily by corneal transplants, a surgical procedure where the diseased or damaged cornea is removed and replaced by a healthy cornea from a deceased donor. If statistics are to be believed, of the 45 million blind people across the world, 15 million live in India. The downside is that 75% of these cases are of avoidable blindness, but due to the nation's acute shortage of donors, most of the cases either go untreated or inadequately treated. In India, blindness has devastating effects on individuals, families and communities, impacting education, economic development and child mortality rates. While there is no doubt that rate of eye donations has picked up recently, the myths associated with eye donation is still holding back many from contributing to the cause.
On an average, the country needs 200,000 corneas in a year, and only 44,806 are collected. Out of these, only 46% (20,632 eyes) are utilized for sight restoration as the other 54% do not meet the standards for transplantation. As a result, the patient line-up and wait to get a corneal transplant keeps getting longer with each passing day. Furthermore, the cost of cornea transplant in addition to unavailability for corneas makes it practically impossible for underprivileged people to access these medical remedies. Therefore, creating awareness amongst the masses and encouraging them to pledge their eyes for donation is critical.
Corneas can be preserved for two weeks for a viable transplantation. The transplantation involves harvesting a healthy cornea from a deceased donor and grafting it to replace the diseased cornea of a needy patient. In order to prolong the life of the tissue while the patient is being prepped for transplantation surgery, the cornea is stored in the Mc Carey Kaufman. (MK) Medium (a product developed by Ramayamma International Eye bank, LVPEI), which allows it to be preserved for 4 crucial days. The RIEB centre is a source for about 250 eye banks and eye donation centres in India for the procurement of MK medium. The centre is also helping neighbouring countries like Nepal, Bangladesh, Myanmar, Mongolia and also Kenya to meet their demand for cost-effective corneal preservation medium.
Hospital Cornea Retrieval Program?
In order to accomplish the goal of bridging the gap between the demand and supply of quality donor tissues, RIEB initiated the Hospital Cornea Retrieval Program (HCRP) in 1990. Prior to initiating HCRP, encouraging voluntary donation was the only means of procuring donor corneas. Voluntary eye donation is a result of realization of one’s social responsibility towards the corneal blind. However, in moments of grief, it is hard for grieving relatives to remember their social responsibility and make emotional decisions. In such time, eye donation counsellors step in to speak to the family and motivate them. The program involves trained counsellors who are stationed in multispecialty hospitals. RIEB also runs training programs for eye bank technicians and grief counsellors and is considered an international training and resource centre. It runs community banking initiatives, besides periodic public awareness programs.
Hopes of two visually-challenged persons are shattered every time a dead person is buried or cremated with the corneas intact. It's crucial that the family of the dead is aware about the pledge to donate eyes, and about retrieving corneas in time. Many times, though families are aware about the pledge, grief would give them little time to think about the donation.
To pledge your eyes or the eyes of any deceased loved one, go to the nearest eye bank and ask for a pledge form. Fill this form with the correct contact details, get it signed by at least two witnesses and submit it back to the eye bank. The eye bank will issue a donor card with their particulars on it. Carry this card with you always or keep it in a place where any family member can access it. You must also let your family know that you wish to be an eye-donor, because without their consent, the process cannot be completed. At the time of death, the family or friends may inform the concerned eye bank. There is no maximum age limit for eye donation. Even a person with poor vision or previous history of eye surgery can become a donor.
Which state has best donor ratio and which are improving/lagging behind
As per Eye Bank Association of India (EBAI) 2013-14 statistics, Tamilnadu had highest (7434) cornea collection followed by Andhra Pradesh (6518) and Gujarat (5631). On the other side, there are few states in India where there is no active eye donation program and cornea collection figures are very poor. The eye donation awareness and cornea retrieval programs still have a long way to go.