Editorial Analysis: Addressing Corneal Blindness in India

Source: The Hindu

General Studies-2; Topic: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Introduction:

• India faces an acute shortage of corneas for transplantation, despite significant public support for eye donation.
• Policymakers are exploring solutions, including ‘presumed consent’ amendment to the Transplantation of Human Organs and Tissues Act (THOTA), 1994.

Corneal Blindness in India

• Prevalence: Over 1.2 million people suffer from corneal opacities, with a third eligible for treatment through corneal transplants.
• Demographics:
  • Corneal blindness is the second-leading cause of blindness among those aged 50+.
  • It is the primary cause of blindness in younger populations.
• Global Context: India has one of the highest populations with corneal blindness globally, making it a public health priority.

Demand-Supply Gap

• Annual Demand: India requires 1,00,000 corneal transplants annually.
• Current Fulfillment: Only 30% of this demand is being met due to the lack of donated corneas and limited processing infrastructure.
• Impact: Thousands of individuals live with preventable blindness, significantly affecting their quality of life and productivity.

Eye Banking and Surgeon Deficiency

• Eye Banks:
  • India has only 12-14 high-functioning eye banks; the need is for at least 50.
  • Eye banks are critical in processing and storing donated corneas for timely transplants.
• Corneal Surgeons:
  • There are only a limited number of trained corneal surgeons in India.
  • To meet demand, India needs 500 active corneal surgeons, each performing 200 transplants annually.

Proposed Solutions

Presumed Consent Approach

• Definition: Treats all hospital deaths as potential donors unless explicit instructions to opt-out were made before death.
• Advantages:
  • Streamlines Donation: Eliminates the need to seek next-of-kin consent, reducing delays in retrieval.
  • Improves Efficiency: Corneas must be harvested within 8-10 hours post-mortem; presumed consent ensures this timeframe is utilized.
  • Boosts Supply: A universal opt-in framework can potentially meet the 1,00,000 transplants/year target.
• Challenges:
  • Ethical Concerns: Presumed consent bypasses family involvement, risking public trust.
  • Cultural Sensitivities: Religious and socio-cultural beliefs might oppose automatic organ donation.
  • International Experience: Top-performing countries like Spain and the U.S. use ‘soft’ opt-in models, proving presumed consent is not a prerequisite for success.

Required Request Model

• Definition: Hospitals actively seek consent from families during patient deaths.
• Indian Success Story:
  • Hospital Cornea Retrieval Program (HCRP):
    • Hospitals approach families to request donations.
    • LV Prasad Eye Institute (LVPEI) has harvested over 1,40,000 corneas, with 70% sourced through HCRP.
  • In Andhra Pradesh, Telangana, and Odisha, there are no waiting lists for corneal transplants due to HCRP’s success.
• Advantages:
  • Builds Trust: Families feel involved, fostering goodwill and continued support for organ donation.
  • Provides Closure: Many donor families report satisfaction knowing their loved one’s donation helped others.
• Challenges:
  • Requires trained grief counselors to approach families sensitively.
  • Needs investment in staff, education, and awareness campaigns.

Comparison of Approaches

Key Recommendations

• Strengthen Infrastructure

• • Establish 50 high-functioning eye banks nationwide with standardized protocols for cornea processing and storage.
  • Train and deploy 500 active corneal surgeons, ensuring equitable distribution across urban and rural areas.

• Expand Hospital Cornea Retrieval Programs (HCRP)

• • Scale the successful HCRP model across all states.
  • Train grief counselors to approach families sensitively and professionally during critical moments.

• Legislative Framework

• • Focus on a ‘Required Request’ policy rather than presumed consent to align with public trust and cultural sensitivities.
  • Enforce clear guidelines on ethical practices for corneal retrieval and transplantation.

• Public Awareness Campaigns

• • Conduct nationwide campaigns to normalize eye donation.
  • Highlight success stories to inspire public participation and address cultural or religious concerns.

• Invest in Research and Development

• • Develop advanced technologies to improve corneal preservation and transplantation techniques.
  • Support studies to identify barriers to eye donation and design targeted interventions.

Conclusion

• India has the potential to eliminate avoidable corneal blindness by addressing infrastructure gaps, fostering public trust, and leveraging proven models like the HCRP.
• By strengthening eye banks, training surgeons, and investing in consent-driven frameworks, India can achieve its target of 1,00,000 annual transplants.
• The time to act is now, ensuring no individual lives a lifetime of avoidable blindness.

Practice Question:

Corneal blindness is a significant public health challenge in India, with a massive demand-supply gap for corneal transplants. Discuss the key factors contributing to this gap and suggest measures to bridge it.