As Shakespeare rightly said, the eyes are, indeed, our windows to the world, and the windows to our soul. Of all the sense organs, the gift of sight is the most precious, and the impairment of vision is considered the most profound disability. It is heartening to note that not all blindness is irreversible, and today, medical science has advanced enough to restore vision for a lot of these patients, who struggle with day to day living because of the vision impairment. According to WHO (World Health Organization), corneal blindness is the fourth leading cause of global blindness after cataract, glaucoma and age-related macular degeneration, but it can be tackled with corneal transplantation. Corneal transplantation or Keratoplasty is dependent on the voluntary donation of the eyes in the event of a person’s death.
The magnitude of Blindness and Disease burden
An estimated 35 million people are either already or going blind in the developing world. Most of these can be cured with proper intervention. As many as 3 million of them can have useful vision back following a corneal transplant, and more than half of these patients (sixty percent) are children under the age of twelve years.
It is of immense concern that almost half of the world’s blind population resides in India, in fact, the number of people in India who are blind is as high as 15 million. 6.8 million of these have corneal blindness, with vision less than 6/60 in at least one eye. As many as 1 million are blind in both eyes, and this bilateral corneal blindness is potentially reversible.
The number of people with corneal blindness in India is projected to increase to 10.6 million by 2020. As many as 3 million of these people with profound vision impairment can benefit from corneal transplantation, which is the replacement of the cornea surgically. To clear this immense backlog of patients, and to efficiently tackle the patients who are added to this group, 150,000 corneal transplants must be performed every year in India alone.
This article aims to clarify the myths and misgivings around eye donation.
Who can donate eyes?
Eyes can only be donated when we don’t need them, that is, after a person’s death. Those of us who wish for eyes to be used, after we die, can pledge them while we are alive.
Pledging eyes is a noble act which ensures that your eyes continue to help someone else see the world, even after you are no more. It is an altruistic act, perhaps the greatest charity of all, and is entirely voluntary. The eye donation of the deceased has to be authorized by the next of kin even if the deceased has pledged his or her eyes. And a corollary to that is that the next of kin can also permit to donate eyes of the deceased, even if he or she did not pledge to donate his / her eyes before death.
The salient features to remember the criteria for eye donation are:
- People of all ages and gender can donate their cornea.
- Use of spectacles for short sightedness, long sightedness or astigmatism or even those operated for cataract is also not a contraindication.
- Patients who have diabetes, those suffering from hypertension, asthma patients and those without communicable diseases can also donate eyes.
The only contraindications for eye donation are listed below.
- Patients diagnosed with or died from AIDS, Hepatitis B or C, rabies, septicemia, acute leukemia, tetanus, cholera, meningitis or encephalitis cannot donate eyes. Eyes are not donated also in case of death by drowning.
In conditions considered absolute contraindications for transplantation, the donor family is informed clearly and made fully aware of this fact. Eyes are not be retrieved unless the donor family is fully aware of this and still wishes to donate.
How are the donated eyes used?
Traditionally each person who donates eyes can provide the gift of sight to two blind people. With the advent of component surgery of the cornea (in which layer of the cornea is transplanted for a specific indication) one eye has provided sight to five patients. When you donate a pair of eyes, you enable up to ten sight-saving operations.
All the eyes donated to the eye bank are used, and a record is maintained. Eyes that are not medically suitable for corneal transplant may be used for medical research and education. These “unfit” donated eyes provide the doctors with critical and valuable insight into many conditions of the eyes and can help to find the cure for several diseases hitherto considered untreatable.
Eye donation thus not only restores sight for the blind, it also makes research into new treatments possible.
What do I have to do to pledge my eyes?
To pledge your eyes, you need to fill a form which is available in all major hospital and eye banks. You can access this form online also, the link for doing so is provided below. In fact, this link will give you all the information you need to register on the website of the Eye Bank Association of India.
How to register: http://ebai.org/donator-registration/
It is crucial that you communicate your decision to your family since in the event of your demise, it is them who will need to inform the eye bank of your pledge, so that the eye bank may collect your eyes at the earliest.
How does one contact the eye bank?
The universal phone number in India to contact the eye bank is 1919. It is a toll-free number running across all states in India and available 24×7, for eye donation as well as information regarding eye banks.
Eye Banks in Delhi
If you are planning to donate your eyes in an eye bank in Delhi, below is a list of hospitals and their contact numbers:
|Guru Nanak Eye Centre||23234612|
|National Eye Bank (AIIMS)||26569461|
|Rotary Delhi Centre Eye Bank, Sir Ganga Ram Hospital||25781837|
|Sir Ganga Ram Hospital||25721800|
|Apollo Eye Bank||26925858|
More information about these is available at http://delhi.gov.in/wps/wcm/connect/doit/Delhi+Govt/Delhi+Home/Departments/Citizen+Services/Important+Telephone+Numbers/Eye+Banks
In addition to these, there are several eye banks run by private hospitals and charitable trusts, details of which can easily be obtained online.
What should I do if I am entrusted with taking care of the departed soul while the eye bank team arrives to collect the eyes?
In case you are entrusted with this extremely critical task, you must take this responsibility very seriously, since you are not only responsible for carrying out the departed soul’s dearest wishes, but also essential for providing sight to at least two blind persons, if not more. Time is of the essence, so you must not waste time in calling the eye bank since the eyes can only be harvested for up to six to eight hours after death.
These are the critical precautions to be taken to preserve the eyes:
- Close the eyes of the deceased gently, and place a piece of moist cotton over them.
- Raise the head with great care by about six inches with a pillow, to lessen the incidence of bleeding during removal of the eyes.
- Ensure that all fans, where the dead body is laid to rest, are switched off. It reduces desiccation and drying of the eyes and corneas.
- If acceptable to the family, try and put a polythene cover with few ice cubes on the forehead, especially in the summer months.
- If possible instill antibiotic eye drops periodically to prevent infection and drying of the cornea.
- Inform eye bank immediately after getting consent from the next of kin of the deceased.
What happens during the harvesting of eyes, or eye donation?
Once the eye bank is informed of the will to donate eyes, a team of trained personnel, along with an eye doctor and a grief counselor reach the house or hospital where the deceased has been laid to rest.
This team of medical professionals will talk to the family and take a proper, written, informed consent before proceeding with the eye donation. They might ask some questions regarding medical and family history of the donor.
The team will work with excellent efficiency in collection of the donation to not delay any funeral arrangements. The process takes less than ten minutes from start to finish.
The team will work in privacy to harvest the donated eyes under strict aseptic conditions, very respectfully. The area where the team harvests will be restored to its original state within minutes by the eye care professionals with high regard to the feelings of the grieving loved ones of the deceased. The team realizes and respects the act of altruism that they are witness to, and always are incredibly respectful of the families’ wishes.
The grief counselor will help the family resolve any last minute hesitations and questions, and thank the family for their act of charity, before transporting the donated tissue to the eye bank.
Usually, there are patients, waiting for eye transplants, in most hospitals, and therefore, most corneas are utilized within three to four days. Corneal and ocular donations remain viable for transplant for up to 14 days, and it is scarce for a tissue to be utilized after a week because of the extensive waiting lists for corneal transplants.
The identities of both the donor and the recipient remain confidential.
What about the appearance of the dearly departed soul?
Donating eyes (or indeed any other organ) does not affect the appearance of the deceased. After harvesting the eyes, the eye doctor places a plastic prosthetic eye in the socket, before gently closing the eyelids. The presence of the dead body, therefore, is unaltered. It is imperative to remember that eye retrieval does not cause any disfigurement of the face or body, nor does it defile the dead body in any way at all.
What about my religious beliefs?
No religion in the world condemns the art of giving. In fact, all religious leaders have unanimously decreed that charitable and voluntary giving to those in need is a great act of charity and kindness. All major religions either accept organ donation or allow the right of individual members to make their own decision. Most beliefs are in favor of organ donation as acts of charity and as a means of saving a life.
- Hinduism: Hindus are not prohibited by religious law from donating their organs at all. In fact, Hindu mythology includes stories in which parts of the human body are used for the benefit of other humans and society. To quote the Manusmriti, “Of all the things that it is possible to donate, to donate your own body is infinitely more worthwhile”. In fact, of the ten Niyamas (virtuous acts) Daan (selfless giving) is on number three, emphasizing its importance.
- Islam: The majority of Islamic religious leaders accept organ donation during life (provided it does not harm the donor) and after death to save a life. It must be emphasized that the dead body is in no way defiled or mutilated by the act of eye donation. To quote the Quarn, the Surat Al-Ma’idah [5:32] says: “And whoever saves one life it is as if he had saved entire humanity. “
- Christianity: The command to “love your neighbor” was quoted by Jesus (Matthew 5:43), Paul (Romans 13:9) and James (James 2:8), it may be traced back to Leviticus 19:18. It implies that majority of Christian leaders accept organ donation once the person is dead, and the process of harvesting the organ does not take away the life of the donor.
- Buddhism and Jainism: Both these religions place great importance on compassion and charity, which are considered to be important Organ donation has been widely supported by the community leaders and monks of these religions. In fact, Buddhists consider it a great virtue of donating one’s own flesh for the sake of another.
- Sikkhism: Sikh philosophy emphasizes the importance of giving and putting others before oneself, giving great merit to selfless giving and sacrifice. It is exemplified by the behavior of all the ten Gurus. For Sikhs, the greatest act of virtue is the act of saving a human life, and therefore donating organs after death has been advocated by all Sikh leaders.
Are transplants performed more frequently on elderly patients or younger patients?
Most of the patients who receive transplants are older since the most common cause of corneal blindness affects this age group. However, there are a lot of children and young adults who also benefit from corneal transplants.
Similarly, most of the donors are also elderly. Eye banks usually accept donations from donors between the ages of 2 to 70 years. As a rule of the thumb, patients receive corneal tissue from donors approximately the same age or younger than themselves.
Eye banks do not refuse any donations, but donations, from people older than seventy-five years, are usually used for research purposes.
Can the eye of a living person be donated?
The simple answer to this question is NO. However, in the unlikely event that the blind eye of a person is removed, but has a healthy cornea, that cornea may be used. That said, there are no instances of donation between people who are living in other circumstances. Another exceptional case where a person may donate a cornea to themselves is where one eye has some potential vision, but requires a corneal vision for the restoration of functional vision, while the other eye is blind with a clear cornea. In this case, the clear cornea may be removed and transplanted to the seeing eye, after discussing the risks and benefits of the procedure in great detail with the patient.
Can someone who has had LASIK surgery donate eyes?
There is no evidence to say that the cornea from eyes that have had LASIK cannot be used for corneal transplant. However, they will probably be preferred for new forms of component surgery of the cornea. The healthy portions of the previously operated cornea can be used for this new procedure, DLEK (Deep Lamellar Endothelial Keratoplasty) that helps people with corneal swelling from cataract surgery (pseudophakic or aphakic bullous keratopathy) or Fuchs Dystrophy.
Congenital or acquired disorders of the eye that would preclude a successful outcome for the intended use, e.g., a central donor corneal scar, corneas which have undergone refractive surgical procedures and corneas retrieved from patients who have been on ventilator support for >72 hrs are often not used for transplant. These eyes are also a valuable research tool and can be used to device safer refractive surgery procedures and component corneal surgeries which can provide hope for millions.
Myths and beliefs about eye donation
Myth: Donating eyes will disfigure the face of the donor, with holes in the eye socket causing face disfigurement.
Fact: Not at all. Retrieval of eyes does not Eye donation does not cause any disfigurement of the face as a prosthetic is placed in the socket.
Myth: Donating eyes when I die in this life will mean I will be blind by birth in my next life.
Fact: Gifting sight to someone is an act of great virtue and charity, and this act can only be rewarded by a perfect vision in the next life if the law of karma is to be believed. This myth has no basis in religion or logic.
Myth: If I pledge my eyes, doctors will not try to save me when I am critically ill
Fact: Completely false. Every doctor is committed to saving lives, on oath. They will never jeopardize your life or health to potentially help another patient.
Myth: My family will be distraught with my decision to donate my eyes.
Fact: You will be surprised by how accepting and appreciative your loved ones will be of your choice, when you tell them you are thinking of donating your eyes in death. In fact, you will be admired for your nobility, and your action will inspire friends and family to pledge their eyes too. Also, remember you can donate your eyes even if you have a previous history of cataract surgery.
Myth: Eyes of Indian donors are not suitable for corneal transplant.
Fact: All eyes, irrespective of nationality, race, caste, creed, and religion, can be used for corneal transplantation. The eligibility of each eye of each person is assessed independently as per stringent guidelines, by a trained eye care professional. All donated eyes are used to their utmost, either for restoring vision and transplants or for research, which will eventually help millions of blind people.
Myth: Corneal transplantation is an experimental procedure, with poor success rates.
Fact: Corneal transplant is a routinely performed procedure the world over, and it has provided the gift of sight to millions of blind people around the globe. Of all the organ transplants, corneal transplants are known to be the most successful.
Myth: My donated eyes can be sold.
Fact: Eye donation is entirely voluntary. Selling or buying human eyes or any other organs is illegal and is a punishable offense under the Transplantation of Human Organs Act (THOA, 1994). Eye banks have to establish and document a system of distribution that is just, equitable and fair to all patients served by the eye bank. In fact, any cost involved with cornea retrieval is borne by the eye bank.
Myth: If I have pledged my eyes for donation, no further consents are necessary after my death.
Fact: Even if you have pledged your eyes for donation, the consent of your family members (next of kin) is essential for completing the process. Not only it is up to them to inform the eye bank of your death, but also to complete the necessary formalities before your wish to donate your eyes in the event of your death can be executed.
Myth: My eyes cannot be donated if I have not pledged them.
Fact: If your next of kin inform the eye bank in the event of your death, and express their wish to donate your eyes, your eyes will be retrieved by the eye bank personnel.
An appeal to all
Given the magnitude of corneal blindness in our country, we should come forward to pledge, and donate our eyes. We must overcome any superstitions, myths and wrong beliefs and try to make a positive impact on someone’s life. When we donate our eyes, we change someone’s life forever, for the better. The gift of sight is a gift which will never be forgotten and will earn for you eternal gratitude from someone who will see the world through your eyes, granting your eyes immortality.
Biomedical engineers and clinician scientists all over the world are working diligently to develop artificial corneas to provide sight to those who await corneal transplantation. But until this becomes feasible, the only hope for these patients, who are deprived of the gift of sight, is your largesse and ability to give. If each of us will donate our eyes in the event of our death, the menace of corneal blindness can be removed from our country, and indeed the world.