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Indian Journal for the Practising Doctor

Awareness of Eye Donation in Rural & Hospital-based Population

Author(s): Suresh K, Priyanka P, Shanmugha Priya

Vol. 4, No. 6 (2008-01 - 2008-02)

Suresh K, Priyanka P, Shanmugha Priya

ISSN: 0973-516X


Dr Kalpana Suresh, MS (Ophthal), FICO, FRCS (Glasg), Dr. Priyanka P and Dr. Shanmugha Priya are from the Department ofOphthalmology, Sri Ramachandra Medical College & Research Institute, Porur, Chennai.

Correspondence: Dr. Kalpana Suresh, Associate Professor,
Department of Ophthalmology,
C1 Staff Quarters, SRMC and RI,
Porur, Chennai – 600116.
Phone: 044-24767716; Mobile: 9841226738 [E-mail: kalpanasuresh23 (at) yahoo.com]


Abstract

Aim: This study was done to analyze the degree of awareness about eye donation and corneal transplantation in a hospital-based and rural population.
Methodology: 425 persons were included in the study, 80% from hospital-based population and 20% from outside the hospital in the community. The subjects were given a questionnaire containing 23 questions and asked to fill up and submit. The answers were given to them at the end. Chi square test at 5% significance was used for statistical analysis.
Results: Awareness of eye donation was high; people knew that eyes can be pledged during life and age is not a bar to eye donation. Majority was willing to donate eyes after death. Some feared that it could cause disfigurement of face. People wrongly believed that eyes could be bought or sold. Diabetes mellitus and cataract were considered contraindications to eye donation by a subset. Some had a belief that all blind people can be cured by eye transplantation.
Conclusions: The awareness about eye donation and corneal transplantation is quite high. This may be due to the fact that the majority of the study subjects were hospital-based. Nevertheless, certain misconceptions need to be clarified. These include fear of disfigurement after eye removal; sale/purchase of eyes; diabetes and cataract as contraindications; and finally, the view that all blindness be cured by eye transplantation.

Key words: eye donation, corneal transplantation, and public awareness


Introduction

In India, the total number of overall treatable corneal blindness is about 3.1 million; children constituting 35% of the burden. Total Vision Quality Corneas needed are almost 3.6 million1. Hence, maintaining awareness programs at a high pitch, backed by timely grief counseling, continues to be a necessary and vital input, to ensure that eye donations are not only maintained but actually increased.

This study, conducted in Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, aims to find out the degree of awareness about eye donation and corneal transplantation among the general public.

Materials & Methods

A total of 425 people were selected from two major groups: 1) patients presenting directly at various outpatient departments (ophthalmology, general medicine, ENT), and inpatients (ophthalmology, general medicine) of Sri Ramachandra Medical College Hospital, and  2) people from 20 villages through the help of health volunteers. (20 villages with an average population of 750 – 900, situated in Sriperumpudur, around 25 – 45 kms from Sri Ramachandra Hospital). After obtaining informed consent, all the subjects were asked to fill up a questionnaire containing 23 questions. All the questions were of objective type, printed in English and Tamil. After the subjects filled up the questionnaire, correct answers were given to them to increase their awareness. For the illiterate, social workers noted the response. Chi Square test was used to compare between the responses at 5% CI.

Results

Table 1 shows the demographic characteristics of the study group.

Table 1: Extent of awreness about eye donation

Attribute Total No. Aware No %
Age in years
<20 83 81 97.6
21-40 267 265 99.3
41-60 62 61 98.4
61-80 12 12 100
>80 1 1 100
Gender
Males 219 218 99.5
Females 206 204 99
Religion
Hindu 355 353 99.4
Christian 54 52 96.3
Muslim 16 15 93.8
Place
Corporation 164 164 100
Municipality 138 135 97.8
Town panchayat 55 53 96.4
Village panchayat 68 65 95.6

Of the 425 interviewees, 417 (98.11%) were aware that eyes could be donated after death. 367 (86.35%) knew that eyes should be removed within six hours after death. The fact that cornea is the only transplantable part in the eye was known to only 269 (63.3%). One hundred and thirty five, however, (31.76%) held the wrong belief that the whole eye is transplanted.

Two hundred of the subjects (47.06%) were aware that only cornea can be removed after death while 134 (31.53%) thought that the whole eyeball has to be removed; 66 (15.53%) felt that both these facts were correct. Three hundred and sixty six (86.12%) of the respondents knew that eye removal is a quick procedure consuming only 15-20 minutes.

Two hundred eighty respondents (65.88%) knew that eye removal does not lead to any facial disfigurement. However, 109 (25.65%) feared that it could cause disfigurement of the face. Most of the subjects were aware of the measures to be taken immediately after death as closing the eyelids, switching off the fan, and raising the head end of the deceased. Majority of them (374; 88%) said that people of any age group could donate eyes.

Respondents’ perceptions of contraindications for eye donation included HIV 300 (70.59%), cataract 62 (14.59%), and diabetes 42 (9.88%). Two hundred and forty nine (58.59%) affirmed that blood sample should be withdrawn from the deceased for investigations; 135 (31.76%) believed the contrary. To the question whether eyes could be bought or sold for money, 251 (59.06%) answered “No” while 101 (23.76%) said “Yes”. The common causes of corneal blindness were believed to be vitamin A deficiency – 213 (50.12%), injuries – 23 (5.41%), and birth anomalies – 8 (1.88%); 156 (36.71%) considered all these as common causes of corneal blindness.

Two hundred forty four (57.41%) of respondents held that there were 10 million blind people in India; 256 (60.24%) thought that corneal blindness accounted for 4 million of these.

Two hundred forty nine people (58.59%) felt that the recipient’s identity should not be revealed to the donor’s family; 126 (29.65%) felt that it should be revealed. Eye donation awareness was imparted mainly through films 157 (37%), television 97 (23%) and newspapers 51 (12%).

People knew that one eye donation gives vision to two blind persons 372 (87.53%). Two hundred and fifity one (59%) respondents were aware that all blind people cannot be cured by eye transplant. Two hundred ninety seven people (69.88%) were sure that eyes could not be donated during life. However, 66 (15.53%) said that eyes could be donated during life. Three hundred forteen of the subjects (73.88%) knew that eyes can be pledged during life.

Table 2. Common responses to the questions

No Questions Common response N (%)
1 Can eyes be donated after death? Yes 417 (98.1)
2 After death, eyes to be removed within 6 hours 367 (86.3)
3 Eye transplant means Only cornea 269 (63.3).
4 Eye transplant is done for Corneal disease 355 (83.5)
5 Eye donation means Whole eye removal 134 (31.5)
6 Time taken for eye removal 15 to 20 minutes 366 (86.1)
7 Disfigurement to the face Yes 280 (65.8)
8 Immediate measures to be done Aware 399(93.8)
9 Eye donation can be done by Any age 374 (8)
10 Eyes cannot be used if the donor has HIV 300 (70.6)
11 Blood samples required Yes 249 (58.6)
12 Can eyes be bought or sold No 251 (59.1)
13 Common causes of corneal blindness are Vit A deficiency 213 (50.1)
14 Total no of blind people in India 10 millions 244 (57.4)
15 Total no of corneal blind people in India 4 millions 256 (60.2)
16 Can patient’s identity revealed No 249 (58.6)
17 Knowledge about eye donation Films 157 (37)
18 How many can regain vision from a donor Two 372 (87.5)
19 All blind people are cured by eye transplant No 251 (59)
20 Can eyes be donated during life No 297(69.9)
21 Can eyes be pledged during life Yes 314 (73.9)
22 Have any family members donated eyes Yes 334 (78.6)
23 Willing to donate your eyes after death Yes 342 (80.5)

In the study group, 334 (78.59%) persons had experienced eye donation by one of their family members. Finally, when asked about the willingness to donate eyes, 342 (80.47%) said yes and 83 (19.53%) were not willing to donate eyes after death. Male: female ratio was equal for both the groups. Younger people were more willing to donate eyes than older ones.

Statistical analysis used was chi square test at 5% CI level. P value was found to be significant (< 0.05).

Discussion

Although the level of awareness about eye donation is quite high2,3, it still needs to be supplemented vigorously. The high level of awareness in our study is because the hospitalbased population formed the major respondents.

Many of them had a close relative or friend as eye donor in their family. The limitation of the present study is that the majority of respondents belonged to hospital-based population and therefore the study is not a true representation of the general population. However, despite being predominantly to hospital-based, it revealed many interesting concepts that were hidden in people’s mind.

Media was the major source of information about eye donation4. Awareness was less in the uneducated, low- monthly income group.

Willingness to donate eyes after death was more evident in young people. A higher willingness to donate among the younger age groups may augur well for the future. The data indicate that more attention must be given to persons 50 years of age and older to increase their awareness of their ability to donate5.

The decision to donate is ultimately made by family members of a suitable candidate, yet nearly half of those who wish to donate have not made their wishes known. Interventions targeted to individuals at different stages of commitment are needed so that more family members can respond in accordance with their loved one’s wishes6.

The positive points highlighted in this study were that people knew that eyes could be donated within six hours after death, that eye transplant is done for corneal diseases, and that the immediate measures to be taken after death were known to most of them.

There were certain misconceptions which included the following:

  • Whole eye is transplantable
  • There will be disfigurement after removal of eyes
  • Eyes could be bought for money from Eye Banks
  • Cataract is a contraindication for eye donation
  • Recipient’s identity could be revealed to donor family
  • All blind people could be cured by eye transplantation
  • Eyes could be donated during life

The most common reasons for opposition were religious beliefs and unfamiliarity with the donation process7. Many were in favour of providing healthcare for the donor’s family or monetary incentives as a reward for eye donation8. Although the subset of people with the above misconceptions is small, it still implies that the awareness is incomplete. Our awareness generation and motivational campaigns should target these people effectively. A few effective ways of imparting education include health education through media by the Central/State government, benefits for the donor family which may include job opportunities to the kins, and even legalization of compulsory eye donation by all.

References

  1. Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Nanda A, Srinivas M et al. Is current eye-carepolicy focus almost exclusively on cataract adequate to deal with blindness in India? Lancet 1998; 351:1312-16.
  2. Dandona R, Dandona L, Srinivas M, Naduvilath TJ, McCarty CA, Rao GN. Awareness of eye donation in an urban population in India. Aust NZJ Ophthalmol 1999:27:166-69.
  3. Dandona L, Dandona R, John RK, McCarty CA, Rao GN. Awareness of eye diseases in an urban population in southern India. Bull World Health Org 2001; 79:96-102.
  4. Weber F, Philipp T, Broelsch CE, Lange R. The impact of television on attitudes towards organ donation—a survey in a German urban population sample. Nephrol Dial Transp 1999 Oct; 14(10): 2315-8
  5. Armstrong GT. Age: an indicator of willingness to donate? J Transpl Coord 1996; 6(4): 171-3
  6. Guadagnoli E, Christiansen CL, DeJong W, McNamara P, Beasley C, Christiansen E, Evanisko M. The public’s willingness to discuss their preference for organ donation with family members. Clin Transplant 1999; 13(4): 342-8
  7. Park MA. A statewide assessment of attitudes, beliefs, and behaviors among blacks toward donation. J Transpl Coord 1998;8(1): 25-9
  8. Hai TB, Eastlund T, Chien LA, Duc PT, Giang TH, Hoa NT et al. Willingness to donate organs and tissues in Vietnam. J Transpl Coord 1999; 9(1): 57-63
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