## India Explores Presumed Consent for Cornea Donation Amidst Growing Shortage
India is grappling with a severe shortage of corneas, leaving thousands of patients on a waiting list for life-changing transplants. To tackle this crisis, the health ministry is exploring a paradigm shift in organ donation policy – adopting a presumed consent model for cornea retrieval.
Under the proposed policy, hospitals would be granted the authority to retrieve corneas from deceased individuals unless they had explicitly opted out during their lifetime. This approach, known as presumed consent, stands in contrast to the current explicit consent system, where individuals must actively express their willingness to donate. This shift aligns with international trends, where countries like Spain, Singapore, and the UK have already implemented opt-out policies for deceased organ retrieval.
The rationale behind this move is clear: Corneal conditions represent the leading cause of blindness among Indians under 49, accounting for a staggering 37.5% of cases. The urgent need for transplants is further underscored by the fact that only 25,000 transplants are performed annually, while the backlog demands 200,000 corneas. Adding to the challenge, approximately 100,000 new patients join the waiting list every year.
Eye Banks Under Strain
India’s eye banks are struggling to keep pace with the burgeoning demand. Despite the presence of 726 registered eye banks, only 200 are operational, many hampered by staffing shortages, inadequate infrastructure, and outdated equipment. The health ministry is taking a proactive approach, instructing states and Union territories to link all registered eye banks and transplant hospitals with a national registry managed by the National Organ and Tissue Transplant Organisation (NOTTO). This move aims to improve coordination and streamline the donation process.
Pandemic Impact and the Urgent Need for Change
The COVID-19 pandemic exacerbated the existing crisis, leading to an 80% decline in cornea donations. Although collections rebounded to 48,000 corneas last year, the figure remains significantly below the country’s requirements. The health ministry is determined to address this pressing issue and is considering further changes to streamline the donation process, particularly in medico-legal cases.
The proposed policy allows for cornea retrieval before post-mortem examinations, provided a no-objection certificate (NOC) is obtained from the police, forensic teams, and family members. This measure aims to facilitate timely transplants while upholding the principles of respect and transparency. Dr. Radhika Tandon, professor of ophthalmology at AIIMS’s RP Eye Centre, emphasizes the importance of clear regulations and legislation to safeguard the interests of donor families, healthcare teams, and recipients, ensuring open communication and minimizing misunderstandings.
The government’s push for a national eye bank registry forms part of its broader strategy to enhance coordination and guarantee timely treatment for individuals with vision impairments. This move signifies a critical step towards addressing the urgent need for corneal transplants in India, potentially transforming the lives of countless individuals affected by blindness.