The Cardinal Role of Family Physicians
In
Enhancement of Eye Donation
And
Effective Eye Banking

ASSESSMENT OF THE PROBLEM OF CORNEAL BLINDNESS IN INDIA

India has the dubious distinction of having the highest number (Approx. 10 million) 0f blind people in the world. (Approx. 40 million).

25% of the total blind persons in India are due to the diseases of cornea (approx. 2.5 million) and 60% of them are below the age of 12 years. Every year the number of Corneally blind person increases by 20-25 thousand.

The corneally blinds often can be helped to regain useful vision and take up to their occupation by a simple operation of Cornea grafting or Keratoplasty, only if, there is access to good quality donor corneas.

Every year approx. 10 million people die in India, but however, only 12-15 thousand persons donate eyes.

In spite of preventive and curative measures undertaken by authorities and social service organizations the net figure of Corneally blind people in India is increasing by leaps and bounds. At the prevalent rate of 20-25 thousand per year, the estimated figure of Corneally blind in 2015 will be 3 million.

The magnitude of corneal blindness prevalent, particularly in young people jeopardizes their future. The immensity of loss to the society and the Nation can be imagined.

Family Physicians are vital links between motivation of people for eye donation, procurement of large number of good quality donor eyes and successful functioning of Eye Banks.

MANAGEMENT OF THE PROBLEM

Theoretically, the problem of tackling corneal blindness with cornea grafting surgery seems very simple. There should be 20 million corneas available in India, if 10 million potential donors who die every year donate their eyes. But in practice very few people donate eyes.

50% of 25-30 thousand corneas harvested are from Gujarat and city of Mumbai. It is imperative to motivate people all over India for more eye donations on a war footing.

REASONS FOR FEW DONOR EYES

A survey was carried out amongst 127 doctors from different parts of Mumbai and Ahmedabad, to elicit the reasons for, “Why family was unwilling to donate eyes of deceased?”

The reasons elicited:

(1) Lack of awareness and knowledge:

Some people are not aware that the eyes of a deceased can be donated and utilized for giving sight to corneally blind person. Some families who are aware do not have knowledge about the procedure of Eye Donation.


(2) Misconceptions:

(a) Some people believe that, “If eyes are donated the donor will be born as a blind in the next birth.”
(b) If eyes are donated and the final rites are performed on incomplete body then the donor will not achieve “Moksha” (salvation).
(c) Not only illiterate people but also few doctors have the misconception that, “Eyes are to be donated just prior to death, and if, by any chance, the donor survives he has to lead a dark life through out the rest of life”.

(3) Emotional:

After the death of a person the bereaved family is under tremendous emotional stress and may forget about eye donation.

Few consoling words and proper request for eye donation by a doctor at this stage will positively motivate the family to donate eyes.



(4) Religion:

Bereaved family members believe that their religion may be against eye and other organ donations.

In fact, no religion is against such donations. On the contrary, Hindu religious scripture Mahabharata has positive mention of eye and bone donation. There are Fatwas issued by Maulavies in Islam. Similarly there is mention of such donations in Bible of Christians and Talmud of Jews

EYE BANKS

The statistics from Eye Bank Association of India (EBAI) reveals out of few hundred eye banks in India, only 20 collect even the bare minimum of 50 (Fifty) donor eyes in a year.

To procure large number of good quality donor eyes following measures are vital:

(a) Continuous motivation of people through mass media and any
other Innovative way.
(b) Upgrading existing eye banks.

(c) Establishing new effective eye banks.

Family Physicians are vital links between motivation of people, procurement of large number of good quality donor eyes and successful functioning of an Eye Bank.

It would be interesting to assess a well functioning eye bank.



PROFILE OF A SUCCESSFUL EYE BANK
(ARPAN EYE BANK)

Arpan eye bank at Ghatkopar, in Mumbai, was inaugurated on 26th April 1987. It is managed by a public charitable trust. Its area of operation is only Ghatkopar, one of the suburbs in Mumbai.

10 trained family Physicians available within the local area attend eye calls in rotation. Up to 03/09/2007 Arpan Eye bank has collected and distributed more than 8527 donor eyes.

On an average, each eye call was received 1 hour after death, was attended within 30-45 minutes of intimation and eyes were retrieved within 2 hours of death, ensuring good quality donor eyes

Success of Arpan Eye Bank confirms that Family Physicians are ideal personnel to work for an eye bank.

FAMILY PHYSICIANS IDEAL FOR MOTIVATION

Family Physicians are ideal persons to educate and motivate people because, he/she:

(1) Is usually present at the time of death.
(2) Is first one to declare and certify death.
(3) Has very good rapport with the family.
(4) His/Her word is a Gospel truth.

FAMILY PHYSICIANS IDEAL FOR EYE BANKING

Family Physicians working for an Eye Bank are ideal because, he/she:

(1) Is available round the clock at all places.
(2) Can master the Enucleation technique and other medical aspects of eye banking very easily.
(3) Eyes can be retrieved very early after death and in turn better quality of donor cornea is ensured.
(4) Is like a family member of bereaved family. Enucleation done by him/her is more acceptable to the family then the call attended by eye bank technicians or Ophthalmologists.
(5) It is not much taxing on their professional practice or family life. The fear of compromising with their practice and family life, very often, is misplaced.







CORRECTIVE MEASURES

Doctors should be exposed to the problem of Corneal Blindness, Eye Bank and it’s working from their student days in medical colleges.

If, Doctors get necessary training in Eye Banking, at this stage, then they will be definitely interested in motivating general public for eye donation during their professional careers. The will also extend co-operation to eye banks all over India, thus helping the National cause of “Removal Of Blindness”.

For government agencies this is very easy. If following suggested measures are implemented now, the problem of corneal blindness will be adequately tackled in near future.

(1) Eye Banking should be included in the subject of Preventive and Social Medicine (PSM).
(2) Performing a few Enucleations should mandatory. At present the medical students have to conduct few deliveries during Obstetrics term and also have to attend post mortem cases during pathology term. Similarly affixed number of Enucleations, also, should be a part of medical education. This can be easily implemented during anatomy term, when students dissect human body. Enucleation can be practiced on postmortem cases too.
(3) One to two weeks of practical training in Eye Bank should be a part of Internship. Performing Enucleations at donors’ residence will expose them to emotional atmosphere prevalent in bereaved family.
(4) This requisite will provide functioning eye bank in all medical colleges augmenting number of eye banks in India.
(5) Private charitable trust hospitals should be encouraged to set up new eye banks with the help of local doctors and social workers.
(6) Trained family physicians should be given a chance to take active part in eye banking by teaching others with lectures, training them with audio-visual aids and practical demonstrations.
(7) Facilities for training in eye banking should be made available to family physicians, who are interested in serving eye banks.
(8) Government authorities and Social service organizations should spare more energy and funds to tackle problem of corneal blindness, in view of affliction of young people.
(9) Mass media should take up the cause, give regular publicity and create awareness for Eye Donation as is done for blood donation and AIDS awareness.

RECOMMENDATIONS

(1) Training in Eye Banking should be a mandatory part of the Medical Curriculum.
(2) Trained Family Physicians should be given a chance to take active part in teaching.
(3) The training course in Eye banking should be made available for private practitioners.
(4) Private charitable trust hospitals and similar organizations should be encouraged to set up new eye banks. Its working should be totally transparent. An Ophthalmologist should be the Medical Director, looking after the quality aspect and other medial technicalities only. Day to day administration and other working should not be looked after by an Ophthalmologist.
(5) Government Authorities and Social Service Organizations should spare more funds and energy.
(6) Mass media should take up the cause, publicize it regularly and educate people.