Adjustments necessary to continue improvement of Indian eye banking

Eye banks in India have the ability to flourish but are not yet able to meet the eye-donation demands of the entire country, according to two Indian ophthalmologists.

M. Srinivasan, MS, and Samar K. Basak, MD, DNB, FRCS, agree that Indian eye banks are moving in a positive direction, with a more systematic and multi-tiered approach to eye banking expected to be implemented by 2012.

Dr. Srinivasan, president of the Eye Bank Association of India (EBAI), told Ocular Surgery News in an e-mail interview that eye donation in India has great potential, but is inadequate when it comes to meeting public demand.

Dr. Srinivasan said there are 533 eye banks registered with the EBAI. He said 2% of those registered collect 45% of all donations.

“There is no dearth of knowledge, skills and resources to create a world-class eye banking and corneal transplantation network. What seems to be missing, however, is a proactive national movement to transplant concepts and plans into time-bound action,” he said.

According to Dr. Srinivasan, issues with the quality of donations, the age of donors, public awareness and legislative pitfalls need to be addressed.

Quality vs. quantity

One of the core issues hampering India’s eye banking system is the quality of donated eyes. According to Dr. Srinivasan, one of the best ways to improve the quality is to establish hospital cornea retrieval programs (HCRPs).

Dr. Basak, medical director of the Prova Eye Bank and secretary of the EBAI, reiterated the importance of HCRPs and the option of in situ corneoscleral rim excision. He said McCarey-Kaufman medium preservation, compulsory serology for donors, and eye bank specular microscopy by trained personnel can also improve quality.

Dr. Srinivasan said health regulations are currently under the purview of each individual state, and “there is no uniformity in laws regarding eye donation.”

According to Dr. Basak, the EBAI is looking to implement a national three-tiered eye banking system.

The three-tiered system would include five regional eye bank training centers that would cover 45 fully functional eye banks that would draw from 2,000 eye donation centers.

The system, which has been submitted to the government for implementation by 2012, proposes to standardize donations and the donation process.

“In this way, both the quantity and quality can be assured,” Dr. Basak said.

Donor age, public awareness

The age of donors is another potential problem, these experts said.

“More than 90% of eye donations come from voluntary donations after death at home,” Dr. Srinivasan said. “However, despite the numbers, the quality of tissue received from home deaths is often suboptimal.”

According to a donation breakdown at the Rotary Aravind International Eye Bank for 2007, provided by Dr. Srinivasan, 86% of donors were between the ages of 60 years and 99 years, and 12.5% were between the ages of 30 years and 59 years. Of the 882 pairs of donated eyes, 56% were graded as not suitable for optical keratoplasty.

Dr. Srinivasan said he believes that this deficiency can be improved if more HCRPs are established and Indian law becomes more eye bank friendly.

“Most of the corneal surgeons prefer a younger donor,” Dr. Basak said. “In HRCP, we are getting much younger donor tissue.”

He added that the public, while aware of the need for eye donation, has yet to find motivation to change.

“Public education for eye banking is there,” Dr. Basak said. “But the motivational aspect is different. ... Herein lies the role of HCRP.”

HCRP

HCRPs stress the need for a proactive approach to securing donations within the hospital.

“HCRP entails being proactive and making an all-out effort to secure eye donations from hospital deaths,” Dr. Srinivasan said.

Those hospitals chosen for the HCRP should have a trauma unit and ICU/ICCU in addition to other specialties, he said. An eye donation counselor or a grief counselor is posted at the hospital to provide education about donation.

The grief counselor is a vital link between the family, the hospital and the eye bank, according to Dr. Srinivasan.

“Eye banks ... have successfully implemented the HCRP concept and receive approximately 70% of their eye donations through this program,” he said.

“The collection is good. The quality is good. And the utilization is greater than 50%,” Dr. Basak said.

Going forward

Dr. Srinivasan said there also is a need to amend eye banking legislation.

Adopting the required request law and the three-tiered system that Dr. Basak spoke about will all play a prominent role for the future, Dr. Srinivasan said.

A system of accreditation for eye banks is also being introduced, and Dr. Srinivasan said this will help to create much more uniform standards in eye banks across India.

For more information:

• M. Srinivasan, MS, can be reached at Aravind Eye Hospital [Madurai], 1, Anna Nagar, Madurai – 625 020, Tamilnadu; 452-4356-100; fax: 452-2530-984; e-mail: m.srinivasan@aravind.org.
• Samar K. Basak, MD, DNB, FRCS, can be reached at Disha Eye Hospitals and Research Centre, Barrackpore, North 24 Parganas, Kolkata – 700 120; 033-2593-1729; fax: 033-2592-8106; e-mail: basak_sk@hotmail.com.