Eye donation: Mere awareness and willingness not enough. Only a catalyst can improve corneal harvesting rates

Dear Editor,

We congratulate Bhandary et al. for documenting the awareness and willingness to donate eyes among the populace of Melaka, Malaysia.[1] Although they have reported an awareness of 69% and the willingness to donate at 34.4%, the actual eye donation in entire Malaysia (population in 23 million) was 20 (eyes or persons has not been mentioned). Similarly, relatively high figures of awareness and willingness have been recorded from Indian studies from Delhi (55.4% and 41.5%), Tamil Nadu (50.7%), rural (30.7%, 32.9%) and urban (73.8% and 44.9%) Andhra Pradesh, and Pune.[2–6] But the actual eye donation figures for the country have been very low, even though India has a death rate of seven per thousand individuals.[7,8]

When queried about such donations, many people have an abstract “willingness to donate their body organs” after death. This stems from a genuine belief in doing something good and for some, giving the “right” or acceptable answer to the questionnaire.

It was estimated that 200000 corneas were needed, just 1 lakh donors, to fulfill the eye banking needs of the nation.[7] With a death rate of 8 per thousand, even if 10% of the populace were willing to donate their eyes and actually did so, it would suffice.[8] Although hospital cornea retrieval programs form the backbone of most eye banks, home deaths also contribute a significant proportion. What is needed is a catalyst to convert this intention into a deed. The first few hours after a person's death are most traumatic to his/her near and dear ones. If someone would gently suggest them the triple benefits of eye banking–potentially vision to two blind persons and third–a good deed registered in the name of the deceased, many would be willing. Certifying doctors and persons of faith (priests who perform the last rites) are the most obvious catalysts. We have reported how persons of faith have a tremendous potential to enhance eye donation.[9] Similarly, if the need and benefits of eye donation were to be popularized among general practitioners of modern medicine (MBBS), ayurvedic (BAMS), and homeopathic (BHMS), as they are the ones most often certifying deaths, they would ensure that the nearest eye bank got more calls from relatives wanting to donate their departed one's eyes.

Eyes from younger individuals have far better endothelial cell counts and are more useful for corneal transplants. The significant causes of death in 18 to 40 years old are road traffic accidents and suicides.[10] Casualty medical officers, emergency medical personnel, and police officers can play a yeoman role in improving eye donation figures.

Although mass media can prime a community in awareness and improve willingness to donate,[1–3] only a catalyst in those few crucial hours after death can actually ensure that the corneas are harvested. Raising awareness through mass media is a necessary, but not sufficient condition, to improve human organ harvesting. The focus should be on having more “catalysts” who facilitate the reaction.