Should Eye Banks Accept Corneas From the Over 80s?

Following criticism of the amount of corneas that go to waste, Mumbai eye banks may soon begin refusing donations from the over 80s. Should eye banks be accepting corneas from elderly donors, or is a crackdown on donations the solution? Here, the Tej Kohli Cornea Institute explore the issue.

The current wastage among Mumbai eye banks is due to a disproportionate number of donations coming from people aged over 80, whose corneas have often deteriorated to the point where they can no longer be used for transplant. Although corneas are often donated by a wide range of age groups, those donated by the over 80s are less likely to be accepted by the host of the transplant, and in many cases are completely unusable.

The problem is that despite this low success rate, eyes from the 80 plus age bracket make up over 40% of all donations in India. Despite these being far more likely to be rejected or unusable, India’s eye donation campaign runs a policy of turning no donation away. The result of this is a disproportionate number of unsuitable donations, with only an average of 35% of eyeballs donated being used for sight restoration procedures.

In the UK, the NHS have placed restrictions on cornea donations for those aged 80 years or over. It has been argued that a similar age restriction for donations in India could help to reduce waste by ensuring that only healthy, usable corneas are donated. Statistically this makes perfect sense, but there are also strong arguments to be made that this is a question not of reducing the number of donations, but of finding a better way to allocate and utilise the organs which are already being donated.

Previously, many of the excess, unsuitable cornea donations were sent to the LV Prasad Eye Institute in Hyderabad, of which the Tej Kohli Cornea Institute is a proud partner. There, they would be used in the institute’s ground-breaking research into the causes, treatment and prevention of avoidable blindness. However, a state restriction on eye banks sending excess corneas outside has significantly reduced the amount of eyes that the LV Prasad Institute receives – one eye surgeon claims that prior to the restriction they were sending up to 100 corneas for research every month.

The importance of the LV Prasad Institute’s work in this field cannot be overstated – blindness is one of the most widespread health issues facing India today, with over 15 million people affected. That’s the largest blind population in the world, and up to 75% of these cases are preventable.

Despite the institute’s impressive successes and breakthroughs, there remains much work to be done, and this work requires donated corneas for research. There remains a greater reluctance in all parts of the world to donate the eyes than exists for any other organs, so making practical use of existing donations is crucial.

It is therefore vitally important that we grasp the opportunity that has been given to us and make the fullest use possible of the organs that are being donated by over 80s, rather than turning them away. If all of the unsuitable organs donated could be used for medical research instead of going to waste, it would significantly increase the chances of unlocking the secret of reversing and preventing preventable blindness on a mass scale.

For our own founder Tej Kohli, this would be a step closer to his goal of controlling corneal blindness worldwide by 2030.