6. The Indian Scenario
India needs 25 lakhs corneas each year
Collection per year through 109 eye banks: 25000
Utilization is about 17500 (70%). 30% corneas are not
suitable for transplantation.
7. What is an Eye Bank ?
Recovery
or retrieval
Cornea
Processing
Distribution
8. Deceased family calls Eye
Bank
Retrieval/ Recovery of
tissue
Society or organization
obtains consent
Grief counselor motivates
and obtains consent
15. Awareness
Public awareness meeting with various
societies, schools etc.
Advertisement in Print media
Advertisement in TV, Movie
Hoarding, Banners, Posters, Leaflets
Other campaigning methods like rally, skits
etc
27. Conclusion
Eye Bank in a Lions Eye Hospital is considered a viable
option.
Commitment for social service, wide spread network of
members from different background and competitive
attitude is prominent in Lions Club atmosphere.
These are the key requirements for sufficient tissue
collection and survival strategy.
All these will lead to the primary Goal to give vision to
the cornea blinds..
Eye donation is basically to treat cornea blindness, where the diseases of the transparent cornea make them something like a frosted glass, obscuring vision like in this photograph
The Global scenario of Cornea blindness as per 2002 data is 5.1%. Cataract still leading with about 48% share REFERENCE?
But in India out of 15 million blinds Corneal blindness has a share of 20% that is 3 millions. This is much higher than the international figure REFERENCE?
To combat this India needs 25 lakh corneas each year. But the collection is only 25000, one hundredth of the requirement. Moreover out of these collections 30% corneas are unsuitable for transplantation.
Eye banking services basically involves three steps. First is the recovery or retrieval of corneas from the deceased. Then these corneas are processed and examined. In the last step processed cornea, those are found to be suitable for transplantation are distributed as per requirement of in house cornea surgeons, or to other centers.
The collection team proceeds when the family of the deceased calls the eye bank or the collection center on their own. In other situation the family is motivated by the grief counselor or the organization for the consent.
Tissue processing involves several steps after collection. These are serological tests for communicable diseases, slit lamp examination and grading of tissue and specular microscopic evaluation. These are to determine the quality of the tissue.
Suitable corneas are then utilized in house by cornea surgeons or distributed to other hospitals as per requirements.
Eye donation is not yet a spontaneous activity in India. Constant effort is required to obtain the consent for tissue retrieval.
The first objective is to make the society aware of the eye donation procedure and removal of the myths. The society can be reached through print, media, hoarding or banners. Many tries the rallies and skits
The Awareness campaign increases pledge recruitment, but shows little impact on cornea collection.
The most fruitful method to increase cornea collection is to approach the grieving family at that crucial moment to obtain consent under presumed consent law. This means that if the deceased has never pledged his/her eyes during his life, the next of the kin can decide to donate his/her eyes presuming that the deceased has no objection to it.. So called the ‘presumed consent’.
To approach the grieving family, the role of the grief counselors and volunteers of social service organizations is immense. They are the one who can remind or motivate them to obtain the consent. Lions club members can be in the forefront in this regard.
The most successful model to increase cornea collection is hospital cornea retrieval. The affiliated hospitals informs the eye bank upon death of a patient. The grief counselors then approaches the family to obtain the consent. If the approach turns out to be positive a pair of cornea is collected. This model is successful because of two aspects. The deceased family is within the reach of the grief counselors. If every such family is approached this way, there is a definite chance of obtaining consent from some willing families. The second aspect is availability of thorough medical history of the patient thereby eliminating the chance of communicable diseases to the recipient.
When Eye Bank is set up by Lions club, it tends to be successful because of a big advantage of the widespread network of lions club members. All the members can act similar to grief counselors in the society to increase cornea collection. I have witnessed this from my association with Lion K K Saharia Eye Hospital and Drishti Lions Eye Bank.
Lions club is already a leader in controlling cataract blindness. Similarly they also can be the leader in controlling cornea blindness by promoting eye banking services.
To set up an Eye Bank one would need an Ophthalmic surgeon, one technician, and two persons who can multitask as counselor/health educator/ clerk/ driver etc.
The necessary equipment list is shown here as recommended by NPCB. The approximate cost to procure all these would be around 15 lakhs.
To set up a Cornea collection center is much easier as it needs only the manpower required to collect the corneas and simple refrigeration facility along with the vehicle. There is no need of THOA certification, serology lab, slit lamp etc.
There are several legal issues relating to eye banking services. First is the THOA act. Any health organization doing human organ transplantation requires to fulfill the THOA guidelines and obtain the certification. The Presumed consent law has a positive impact in increasing cornea collection. In this law the next of the kin of the deceased is the most important person to give consent for eye removal, provided the deceased has never spoke against eye donation during the lifetime.In several countries there is a law called Mandated Choice Consent. Here the person is required to respond to a question if he/she is willing to donate eyes after death when they apply for driving license etc. The response is then recorded in the license. In routine inquiry law, it has been made mandatory for the paramedics and the attending officials to inquire the family of the deceased if they are willing to donate the eyes of the deceased. However these laws are yet to be implimented in India
An Eye Bank need continued financial input for self survival and improvisation. Initial expense in setting up the eye bank can be obtained from the NPCB funding. They have certain guidelines how to apply for this. For continued financial input fund is generated from the keratoplasty surgeries done by the in house surgeon. Though the cornea is provided free of cost to the recipient, all other costs shall be borne by the recipient.
