Context: India is facing an acute shortage of corneas required for transplantation, whereas the cases of corneal blindness in the country are on the rise.
Relevance of the topic:
Prelims: Cornea; Transplantation of Human Organs and Tissues Act (THOTA), 1994
Mains: Ethical issue- balancing individual consent and public good in medical practices.
Corneal Blindness in India
- Prevalence: Corneal blindness, a leading cause of vision impairment in India, with the country seeing an estimated 20,000 to 25,000 new cases every year.
- Corneal blindness is vision loss due to damage or scarring of the cornea (the eye's transparent outer layer).
- Reasons include- Infectious diseases like keratitis, eye trauma, injuries, congenital conditions and deficiencies like vitamin-A.
- Without timely treatment, it can lead to irreversible blindness.
- Annual Requirement: Approximately 1,00,000 corneal transplants.
- Availability: Only 30% of corneal transplants demand is met.
- Infrastructure Deficit:
- India has only 12–14 high-functioning eye banks against the required 50 facilities.
- Shortage of skilled corneal surgeons with a current need for 500 active specialists.
Policy Proposals: Presumed Consent vs. Required Request:
- The Ministry of Health is proposing a policy to allow corneal retrieval from deceased patients without prior family consent, aiming to address the shortage.
- It will require a ‘presumed consent’ amendment to the Transplantation of Human Organs and Tissues Act (THOTA), 1994 to allow cornea retrieval from all eligible deaths in hospitals.
1. Presumed Consent:
- Definition: All deceased individuals are treated as donors unless they have explicitly opted out.
- Advantages: Quicker organ-retrieval, the process is simplified by by-passing the requirement of consent from the next-of-kin. (Corneas need to be retrieved within eight to 10 hours after death)
- Issues: Undermines public trust due to lack of explicit consent.
2. Required Request:
- Definition: Seeking consent explicitly from the next-of-kin of the deceased person even if a presumed consent law exists.
- Advantages: Builds trust between donors, recipients and the healthcare system.
- Challenges: Time-consuming and requires counselling at hospitals.
India’s Hospital Cornea Retrieval Programme (HCRP):
- India has a successful model of ‘required request’ corneal donation: a hospital cornea retrieval programme (HCRP).
- In an HCRP, a grief counsellor approaches the kin of the deceased and initiates a conversation, gently motivating them to consider a donation. The donation is processed only after receiving explicit consent from the kin.
- Of the 1,40,000 corneas harvested by the Ramayamma International Eye Bank in Hyderabad, over 70% have come from HCRP.
Way Forward
- Programs focusing on eye health education and nutritional support, particularly with Vitamin-A supplementation for vulnerable populations.
- Widespread educational campaigns using media and community events to inform the public about the significance of eye donation, the processes involved, and its positive impact.
- Building high-functioning eye banks, training corneal surgeons and building specialised units for grief-counseling in general hospitals.
- Enhance collaboration between public health bodies, NGOs, and private healthcare providers.
It is therefore possible for India to eliminate avoidable corneal vision loss by investing in a consent-driven donation paradigm, 50 high-functioning eye banks, and by activating 500 corneal surgeons.