Only 1/4th of corneal blind get transplants, push for ‘presumed consent’ for donation

Mumbai: The possibility of implementing a ‘presumed consent’ system for cornea retrieval in cases of hospital deaths, unless individuals had explicitly opted out during their lifetime, was extensively discussed at a recent national meeting in Delhi to discuss ways of improving eye bank operations.
Another significant point discussed was the necessity to simplify the registration process for corneal transplant centres, ultimately eliminating the requirement for separate, specialised registration for such facilities.

The meeting, chaired by Dr Atul Goel, director of Directorate General of Health Services (DGHS), brought together key stakeholders—including representatives from National Organ and Tissue Transplant Organization (NOTTO), leading ophthalmologists, and eye bank directors from across the country—to address critical issues in cornea donation, retrieval and distribution. With over 1.2 lakh individuals estimated to be corneal blind and an additional 25,000 new cases annually, India records about 60,000 cornea donations a year, with only half of these being transplanted.
A section of cornea donation experts said ‘presumed consent’ could address the significant gap. Presumed consent means cornea can be retrieved from all citizens who die in hospitals without any requirement of family’s consent unless the individual had explicitly opted out.
Dr Anil Kumar, director of NOTTO, confirmed that ‘presumed consent’ was discussed, but said it would require amendments to Transplantation of Human Organs and Tissues Act. He said no final decision was taken.
Jaswant Mehta, chairman, advisory board, Eye Bank Coordination & Research Centre, Mumbai’s largest cornea bank, who attended the meeting, said he has been batting for ‘presumed consent’, particularly in medico-legal cases. “In Mumbai, around 7,000 such cases occur annually, and donations in even 30-40% of them would greatly reduce the transplant waitlist,” he said.
On simplifying registration for cornea transplant centres, most eye banking experts said unlike transplants of liver, kidney or heart, corneal transplants are akin to other eye surgeries like retinal detachment repair or glaucoma surgery. It was proposed that the current registration process be replaced with a self-declaration system. The DGHS head said it could be considered.
Dr V Rajshekhar, assistant commissioner, National Programme for Control of Blindness, said there are 726 registered eye banks in India, but only 200 are operational. He said many registrations are pursued primarily to secure PG seats, and inspections frequently reveal deficiencies in equipment, infrastructure and manpower.
Emphasising on training, Dr Goel said at the meeting how even in big hospitals in Delhi-NCR, resident doctors from ophthalmology refuse to collect cornea citing inadequate training.