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With corneal blindness becoming one of the leading causes of blindness in the country, and one which can be rectified by transplanting the dome-shaped layer of the eye with another healthy one, the Health Ministry has decided to give a big push to cornea donation. It is considering an “opt-out” method, whereby anyone who dies at a hospital will be presumed to be a cornea donor unless they (while alive) or their families register their dissent.
At present, India follows an opt-in system for harvesting any organ — including tissues like cornea — from deceased donors, meaning the patient (while alive) and their family members have to consent to the donation much before.
“Experts were of the opinion that the opt-out method — where everyone who dies in a hospital is presumed to be a donor — is likely to increase the number of corneal donations. This suggestion has been accepted in principle” said an official. The proposal, the official added, is being considered by legal teams as this would require changing the current law governing organ and tissue transplantation in the country.
Why is this necessary?
The move is aimed towards increasing the availability of corneas. First, corneal blindness is the most common cause of blindness in the country among those under 50, accounting for 37.5 per cent of all cases. For those above 50, it is the second-most common reason — after cataract —accounting for 8.2 per cent of the blindness among them, according to the National Rapid Assessment of Avoidable Blindness Survey conducted between 2015 and 19. India adds about 50,000 new cases of corneal blindness each year, according to the Indian Journal of Ophthalmology.
Second, there is a scarcity of donated corneas in the country. We need 100,000 corneal transplants a year to reduce the burden of corneal blindness. However, about half this number is collected each year.
How many cornea donations does the country see?
Before Covid-19, the country had registered 65,417 donations in 2019-20. However, post the pandemic, the numbers went down to 32,414 in 2022-23, according to data from the National Programme for Control of Blindness & Visual Impairment(NPCBVI). Collection was the highest in states such as Tamil Nadu, Gujarat, Karnataka, and Kerala, collecting 5,839, 2,549, 4,279 and 1,345 donations respectively in 2022.
Why was a push given to cornea donation?
There are several reasons. First, cornea is a tissue that does not need blood supply unlike other organs and can be harvested up to six hours after death. Two, cornea can be easily harvested by technicians even at home, meaning most hospitals will be able to do it. Three, harvesting cornea does not change any facial features of the deceased, an issue that bothers the family. Four, corneas are not necessary for collecting evidence in a medico-legal case.
“From the point of view of medical professionals and those waiting for cornea transplant, an opt-out method is beneficial,” says Dr Radhika Tandon, professor of ophthalmology at the All India Institute of Medical Sciences (AIIMS), who was one of the experts consulted. “It is likely to increase the number of donations while preserving the autonomy of the deceased and their family members by allowing them the choice to opt out. But, of course, people may be hesitant or emotional and that needs to be looked into,” she adds.
Who benefits from cornea transplant?
Patients with conditions that lead to weakening of the cornea, its thinning and change in shape may require a cornea transplant. Those with degenerative conditions — such as conditions that impact the functioning of the cell lining of the cornea — may also need a transplant. Most importantly, people whose cornea is damaged due to an injury or an infection that does not respond to antibiotics stand to benefit.
Can we improve utilisation of donated corneas and cut waiting lists?
Dr Tandon says there is a need to create a country-wide network of eye banks and retrieval centres so that corneas that may not be usable for patients in one centre may be used in another. “Higher centres that use newer techniques may be able to utilise corneas effectively. Also, certain corneas that cannot be used in many cases may be good for utilisation in emergency cases. So, if there is a network, the corneas can be sent to centres that receive such emergency cases.”
In addition, centres like AIIMS have also developed processes to divide a cornea and use one to treat two or three patients.
The National Organ and Tissue Transplant Organisation (NOTTO) is working to set up a national registry and coordination network on the lines of what already exists for other organs. “At institutional level, eye banks may be maintaining waiting lists but we are trying to streamline the process on a national level. This will improve utilisation of the corneas as well. A process similar to what is followed for other organs is being set up for corneas too, where the hospital that has harvested the tissue will have the first right over it. If there is no patient, it will be shared with other hospitals in the state, then others in the region, and finally other regions of the country,” the Health Ministry official clarified.
The government is also mulling developing a cheaper, indigenous medium for preserving the cornea.
