On World Organ Donation Day, Dr Himanshu Shekhar turns our focus on the precious gift of eye donation.
Eye donation is known to be the most precious gift you can give someone even after your death allowing that person to cherish the world’s beauty with sight restored. India has an estimated 1.2 million people who are corneal blind, with 20,000 to 25,000 new cases every year. The gap between the transplants required vis-a-vis the actual transplants done is increasing and as against 200,000 transplants needed each year, there are only around 25,000 to 30,000 donations.
While the focus of promoting eye donation is on giving someone else the chance to see, there are situations where the donated eye turns out to be unsuitable for a transplant. It may be too old, scarred, infected, or below the cell-density threshold needed by a surgeon. But even in these cases, the donated eye is not wasted but is used by laboratories for training and research, with these donations driving progress in Indian ophthalmology.
There are many studies which show that even corneal tissue not used for transplant is of great help in progressing our understanding of sight. A 2022 study using slit-lamp and specular microscopy found that donor age and cause of death were closely tied to endothelial cell quality and overall graft suitability. The study recommended that eye banks should conduct specular microscopy examination to evaluate the health, density, size, and shape of the endothelial cells on the innermost layer of the cornea to increase transplantation success.
Another study involving fungal keratitis, an infection that affects agricultural workers more, compared corneal tissue from patients infected with Fusarium and Aspergillus flavus against healthy control corneas. This allowed the researchers to map how the immune system responds differently to each fungus and potentially work toward developing more effective therapeutic strategies. If there were no non-transplantable corneas to use as a healthy baseline, there would be no comparison group to study.
Stem cell research in autologous stem cell-based treatment of corneal stromal blindness is another area where non-transplantable corneal tissue is useful. This tissue is used to create autologous stem cells for investigation of direct treatment of corneal scarring. This research helped in the discovery of the Simple Limbal Epithelial Transplantation, a technique that involves taking a tiny piece of healthy limbal tissue from a patient’s good eye, cutting it into smaller fragments, and gluing them onto an amniotic membrane placed on the damaged eye. This would not have been possible without the years of research that required donated and biopsied eye tissue.
Studies have found that usually a family’s reason to hesitate for a donation is not religious, but uncertainty about how the donated tissue would actually be used. Eye banks must be more transparent with families about where a donation goes, whether it ends up restoring sight directly or advancing a study that could help patients in future. This will help in families deciding to donate the deceased relative’s eyes and decrease the transplant-donation gap.
A corneal transplant restores sight, often within weeks, and that will always be the key reason to donate eyes after death. But a donation that isn’t transplant-grade is still useful. It can become the control tissue in a fungal keratitis study, the sample that helps calibrate an eye bank’s screening criteria, or the raw material behind a stem cell technique that reaches patients a decade later. While we tell the family of a deceased person or anyone who is thinking of pledging their eyes after death about the first outcome of restoring sight, we must keep in mind and also inform them that the second outcome of the donated corneal tissue is just as important and critical to help ophthalmic research in India get better at treating the next patient.