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An ideal way to treat India’s Corneal Blindness Problem
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Context
India faces a critical shortage of corneas for transplants, despite widespread support for eye donation and public pledges. The government is considering an amendment to the Transplantation of Human Organs and Tissues Act (THOTA), 1994, to introduce a "presumed consent" model for corneal donation from deceased individuals in hospitals, aiming to meet the demand of 1,00,000 corneal transplants annually.
Magnitude of the Problem
- Prevalence of Corneal Blindness: Corneal opacities are the second leading cause of blindness in India, with approximately 1.2 million people suffering from it. A third of these cases could be treated with a corneal transplant.
- Shortage of Eye Banks and Surgeons: India lacks sufficient high-quality eye banks (only 12-14 exist, whereas 50 are needed) and corneal surgeons (only 500 active surgeons, instead of 500 needed).
- Potential for Treatment: Corneal transplants are a highly effective and common procedure globally, making the supply of corneas critical for addressing preventable blindness.
Presumed Consent vs Required Request
- Presumed Consent Approach: Under the proposed 'presumed consent' model, all hospital deaths would automatically be considered for corneal donation unless the deceased had explicitly opted out, speeding up the retrieval process.
- Risks of Presumed Consent: Critics argue that 'presumed consent' undermines the principle of obtaining explicit consent from the next of kin, which could negatively impact the voluntary nature of donations.
- Global Alternatives: Countries with high organ donation rates, such as Spain and the United States, do not operate a presumed consent system but rather employ a 'Required Request' policy, requesting consent from families even when citizens are presumed donors.
Successful Models and Solutions
- Hospital Cornea Retrieval Programme (HCRP): The 'Required Request' model, in which grief counselors approach families for consent, has been successful in increasing cornea donations.
- Success in India: The L.V. Prasad Eye Institute’s HCRP model has yielded over 70% of the corneas harvested and eliminated waiting lists for transplants in Andhra Pradesh, Telangana, and Odisha.
- Investment in Eye Banks and Surgeons: A focus on consent-driven donation, with the creation of more eye banks and trained surgeons, can address the corneal transplant shortage and eliminate avoidable blindness.
Practice Question:
Q. Evaluate the 'presumed consent' model for corneal donation in India and compare it with the 'required request' approach. Which model is more suited for India’s context, and why?
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