EBCRC Initiates Awareness Campaign to Eradicate Corneal Blindness
Mumbai, August 27, 2012(Sachin Murdeshwar): 25th August to 8th September is observed as National Eye Donation Fortnight every year. Eye Bank Coordination & Research Centre (EBCRC), a model community Eye Bank in Mumbai has launched a campaign to spread message in favour of eye donation and create awareness on the urgent need of corneas.
It is observed that, more than 17,000 deaths take place every year in six major municipal / government hospitals such as KEM, Nair, Rajawadi, Cooper, Bhagawatil, Lokmanya Tilak Municipal General Hospital (Sion) in Mumbai. Presently the retrieval rate is a mere 1-2% from all these deaths taking place within these hospitals. As a part of the drive initiated by EBCRC, the members will travel in the key areas across the city and aware people about the serious issue of corneal blindness. The drive will put more emphasize on educating people about the eye donation process and myths about eye donation.
“There are over a million corneally blind patients who are waiting to get a good quality viable cornea for transplant. To eradicate corneal blindness and provide vision to the corneal blind patients within a timeframe of say 10 to 15 years, we need to perform at least 75000 to 100000 transplants per year. As against this, the actual number of transplants performed in the whole country are in the range of 12000 to 15000 per annum. It is essential to bridge the gap for procurement of required number of good quality corneas for transplant”, said Mr. Jashwant B. Mehta, Managing Trustee of EBCRC and Founder Member and Ex-President, Eye Bank Association of India.
Considering the fact that awareness campaign for eye donation has its own limitations, Shri Mehta has relentlessly pursued for the last several years with the Central Govt. to incorporate 3 legislative amendments in the HOTA act out of which, two have been incorporated under the Amended HOTA Act passed in 2011 by the Central Government. Under these provisions, it has become mandatory for the hospital authorities to solicit eye donation from the next-of-kin in all cases of death. Besides this as against the earlier the earlier provision of an allopathic Doctor only being allowed to attend to enucleate the amended law permits any ‘Technician’ trained in enucleation procedure in the Ophthalmic Department of a hospital or teaching institution is permitted to remove corneas from the dead body.
“It is the most heartening to know that the Additional Chief Secretary, Ministry of Health and Family Welfare, Govt. of Maharashtra Shri Benjamin has assured that the necessary mechanism for implementation of these two amendments, will soon take place in the State of Maharashtra. If the provisions of these amendments are enforced properly, at least 10-15% of the corneas can be retrieved from the total number of the deaths taking place in the Hospital,” Said Mr. Mehta. This is based on his own experience where such programmes have been initiated in private hospitals.
He further added, “To give momentum to these amendments, Grief Counselor / Social Worker should visit the wards on regular basis and establish a rapport with Doctor and paramedical staff including those engaged by eye banks and eye donation centres should also be permitted to visit ICU’s and establish contacts with concerned authorities and also display the posters in public areas especially visitors waiting area and distribute the brochures and other literature.”
Presumed Consent
As regards the third legislative amendment viz. Presumed Consent pertaining to deaths, involving medico legal cases Mr. Mehta mentioned that “We are still following up the matter and are hopeful that the same would be incorporated in near future”. In this regard the present wordings in the existing HOTA Act pertaining to removal of corneas / eyes in medico-legal cases are cumbersome and complicated and difficult to implement. In fact, in a PIL bearing No. 126 of 2009 pending with the Division of Bench of Bombay High Court, the Chief Justice Shri. Mohit Shah has asked the Central Govt. to consider favourably altering the present provisions in the HOTA Act so as to make Presumed Consent Law easier to implement.
Eye donation can be pledged by calling toll free 1919.
About Eye Bank Coordination & Research Centre (EBCRC)
EBCRC is a model community Eye Bank in Mumbai and since its inception in 1995, it has established a network of eye donation centres all over Mumbai and through these eye donation centres collected over 32000 eye balls till now and has provided 7800 viable corneas for transplant to the patients. This number is among the highest among all the eye banks in the country. These corneas are processed, evaluated, preserved and distributed as per the international standards and over 60% of these corneas have been sent to Govt./Municipal/Charitable hospitals at a highly subsidized cost. The processing, evaluation standards at EBCRC are at par with the best in the world and today it is considered a model community eye bank in Asia Pacific. It has also provided training to technicians not only from India but also from other countries such as Burma, Nepal, Thailand, China, Ethiopia etc. EBCRC is the only eye bank in the country which has given priority to the bilaterally blind patients and children below 7 years and today there is practically no wait-list in Mumbai city for this category of patients. It has provided corneas at a nominal fee of Rs.500/- to needy poor patients whereas the actual cost of processing, evaluation incurred by EBCRC is more than Rs.5000/- per cornea. EBCRC is the only eye bank in the city which grants this concession to needy poor patients.
Myths about Eye Donation.
1.Donor cards / Pledge cards are legally not required.
Only the kin of the deceased is to give consent for eye donation.
There is no disfigurement upon eye donation.
Any body can donate eyes irrespective of age, sex and religion.
Patients with diabetes, hypertension, who have undergone cataract surgery and
with spects can also donate eyes.
Patients suffering from cancer above neck, H I V, Hepatitis B & C cannot donate eyes.
Annexure
Legislative Amendments:
1.Required Request
Under this provision, it is mandatory for the hospital authorities to solicit eye donation from the next-of-kin in all cases of death. According to Mr. Mehta the best way to implement this would be while issuing the death certificate which is required for cremation purpose or burial purpose mentioning the cause of death, a column could be inserted where the person issuing the death certificate has to mention about the request made by him for eye donation and whether the family of the deceased has consented or not.
2.Permission for enucleation by trained technicians and paramedical staff
Any ‘Technician’ trained in enucleation procedure in the Ophthalmic Department of a hospital or teaching institution is permitted to remove corneas from the dead body. This provision will help a lot as it saves the precious time of a Registered Medical Practitioner to spend a minimum of two to three hours for attending to a call for enucleation of corneas from a dead body, in cases where the cornea is to be enucleated at the residence of the deceased. Sometimes, such calls may be received at odd hours when it is impossible for a medical practitioner to leave his practice and rush to the spot where the dead body is lying for the purpose of enucleation.
3.Presumed Consent in medico-legal cases
Under the present provision of the HOTA Act, the Coroner or person competent under the Act to give authenticity for the removal of the cornea has to satisfy that the deceased person had not expressed before his death any objection to any of his human organs being used, for therapeutic purposes, after his death or, where he had granted an authority for the use of any of his human organs for therapeutic purposes after his death, such authority had not been revoked by him before his death. These wordings need to be simplified & the coroner should be permitted to remove eyes / cornea unless there is prerecorded objection from the deceased for any of his human organs especially being used for therapeutic purposes.
It may be also mentioned that the corneas received from these medical/legal cases constitute the most concentrated source of excellent quality tissue from relatively young donors predominantly deceased from trauma and it makes the chief pathologist the pivotal figure in determining whether the eye collection will succeed or not. As compared to this, the quality of corneas procured from the dead body of a person dying due to old age is generally poor as the endothelium cell count, which is vital for a successful transplant especially in the case of a penetrating graft, deteriorates as the age advances. This is more so in a developing country like ours because of the generally poor standard of health of the average citizen. It may be mentioned that removal of cornea apart from being a relatively simple operation and which does not affect the post-mortem findings unlike other organs such as liver, kidney or heart which affects the post-mortem findings. It also does not disfigure the facial appearance.
Mumbai, August 27, 2012(Sachin Murdeshwar): 25th August to 8th September is observed as National Eye Donation Fortnight every year. Eye Bank Coordination & Research Centre (EBCRC), a model community Eye Bank in Mumbai has launched a campaign to spread message in favour of eye donation and create awareness on the urgent need of corneas.
It is observed that, more than 17,000 deaths take place every year in six major municipal / government hospitals such as KEM, Nair, Rajawadi, Cooper, Bhagawatil, Lokmanya Tilak Municipal General Hospital (Sion) in Mumbai. Presently the retrieval rate is a mere 1-2% from all these deaths taking place within these hospitals. As a part of the drive initiated by EBCRC, the members will travel in the key areas across the city and aware people about the serious issue of corneal blindness. The drive will put more emphasize on educating people about the eye donation process and myths about eye donation.
“There are over a million corneally blind patients who are waiting to get a good quality viable cornea for transplant. To eradicate corneal blindness and provide vision to the corneal blind patients within a timeframe of say 10 to 15 years, we need to perform at least 75000 to 100000 transplants per year. As against this, the actual number of transplants performed in the whole country are in the range of 12000 to 15000 per annum. It is essential to bridge the gap for procurement of required number of good quality corneas for transplant”, said Mr. Jashwant B. Mehta, Managing Trustee of EBCRC and Founder Member and Ex-President, Eye Bank Association of India.
Considering the fact that awareness campaign for eye donation has its own limitations, Shri Mehta has relentlessly pursued for the last several years with the Central Govt. to incorporate 3 legislative amendments in the HOTA act out of which, two have been incorporated under the Amended HOTA Act passed in 2011 by the Central Government. Under these provisions, it has become mandatory for the hospital authorities to solicit eye donation from the next-of-kin in all cases of death. Besides this as against the earlier the earlier provision of an allopathic Doctor only being allowed to attend to enucleate the amended law permits any ‘Technician’ trained in enucleation procedure in the Ophthalmic Department of a hospital or teaching institution is permitted to remove corneas from the dead body.
“It is the most heartening to know that the Additional Chief Secretary, Ministry of Health and Family Welfare, Govt. of Maharashtra Shri Benjamin has assured that the necessary mechanism for implementation of these two amendments, will soon take place in the State of Maharashtra. If the provisions of these amendments are enforced properly, at least 10-15% of the corneas can be retrieved from the total number of the deaths taking place in the Hospital,” Said Mr. Mehta. This is based on his own experience where such programmes have been initiated in private hospitals.
He further added, “To give momentum to these amendments, Grief Counselor / Social Worker should visit the wards on regular basis and establish a rapport with Doctor and paramedical staff including those engaged by eye banks and eye donation centres should also be permitted to visit ICU’s and establish contacts with concerned authorities and also display the posters in public areas especially visitors waiting area and distribute the brochures and other literature.”
Presumed Consent
As regards the third legislative amendment viz. Presumed Consent pertaining to deaths, involving medico legal cases Mr. Mehta mentioned that “We are still following up the matter and are hopeful that the same would be incorporated in near future”. In this regard the present wordings in the existing HOTA Act pertaining to removal of corneas / eyes in medico-legal cases are cumbersome and complicated and difficult to implement. In fact, in a PIL bearing No. 126 of 2009 pending with the Division of Bench of Bombay High Court, the Chief Justice Shri. Mohit Shah has asked the Central Govt. to consider favourably altering the present provisions in the HOTA Act so as to make Presumed Consent Law easier to implement.
Eye donation can be pledged by calling toll free 1919.
About Eye Bank Coordination & Research Centre (EBCRC)
EBCRC is a model community Eye Bank in Mumbai and since its inception in 1995, it has established a network of eye donation centres all over Mumbai and through these eye donation centres collected over 32000 eye balls till now and has provided 7800 viable corneas for transplant to the patients. This number is among the highest among all the eye banks in the country. These corneas are processed, evaluated, preserved and distributed as per the international standards and over 60% of these corneas have been sent to Govt./Municipal/Charitable hospitals at a highly subsidized cost. The processing, evaluation standards at EBCRC are at par with the best in the world and today it is considered a model community eye bank in Asia Pacific. It has also provided training to technicians not only from India but also from other countries such as Burma, Nepal, Thailand, China, Ethiopia etc. EBCRC is the only eye bank in the country which has given priority to the bilaterally blind patients and children below 7 years and today there is practically no wait-list in Mumbai city for this category of patients. It has provided corneas at a nominal fee of Rs.500/- to needy poor patients whereas the actual cost of processing, evaluation incurred by EBCRC is more than Rs.5000/- per cornea. EBCRC is the only eye bank in the city which grants this concession to needy poor patients.
Myths about Eye Donation.
1.Donor cards / Pledge cards are legally not required.
Only the kin of the deceased is to give consent for eye donation.
There is no disfigurement upon eye donation.
Any body can donate eyes irrespective of age, sex and religion.
Patients with diabetes, hypertension, who have undergone cataract surgery and
with spects can also donate eyes.
Patients suffering from cancer above neck, H I V, Hepatitis B & C cannot donate eyes.
Annexure
Legislative Amendments:
1.Required Request
Under this provision, it is mandatory for the hospital authorities to solicit eye donation from the next-of-kin in all cases of death. According to Mr. Mehta the best way to implement this would be while issuing the death certificate which is required for cremation purpose or burial purpose mentioning the cause of death, a column could be inserted where the person issuing the death certificate has to mention about the request made by him for eye donation and whether the family of the deceased has consented or not.
2.Permission for enucleation by trained technicians and paramedical staff
Any ‘Technician’ trained in enucleation procedure in the Ophthalmic Department of a hospital or teaching institution is permitted to remove corneas from the dead body. This provision will help a lot as it saves the precious time of a Registered Medical Practitioner to spend a minimum of two to three hours for attending to a call for enucleation of corneas from a dead body, in cases where the cornea is to be enucleated at the residence of the deceased. Sometimes, such calls may be received at odd hours when it is impossible for a medical practitioner to leave his practice and rush to the spot where the dead body is lying for the purpose of enucleation.
3.Presumed Consent in medico-legal cases
Under the present provision of the HOTA Act, the Coroner or person competent under the Act to give authenticity for the removal of the cornea has to satisfy that the deceased person had not expressed before his death any objection to any of his human organs being used, for therapeutic purposes, after his death or, where he had granted an authority for the use of any of his human organs for therapeutic purposes after his death, such authority had not been revoked by him before his death. These wordings need to be simplified & the coroner should be permitted to remove eyes / cornea unless there is prerecorded objection from the deceased for any of his human organs especially being used for therapeutic purposes.
It may be also mentioned that the corneas received from these medical/legal cases constitute the most concentrated source of excellent quality tissue from relatively young donors predominantly deceased from trauma and it makes the chief pathologist the pivotal figure in determining whether the eye collection will succeed or not. As compared to this, the quality of corneas procured from the dead body of a person dying due to old age is generally poor as the endothelium cell count, which is vital for a successful transplant especially in the case of a penetrating graft, deteriorates as the age advances. This is more so in a developing country like ours because of the generally poor standard of health of the average citizen. It may be mentioned that removal of cornea apart from being a relatively simple operation and which does not affect the post-mortem findings unlike other organs such as liver, kidney or heart which affects the post-mortem findings. It also does not disfigure the facial appearance.
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