Govt apathy, fund constraint and poor knowledge plague eye-banking

Rita Dutta - Mumbai

With more than 600 eye-banks in the country, and a thrust to have more to cater to the yawning gulf between demand and supply of corneas, experts point out the dismal medical standards of the existing eye-banks. While the Government of India in association with Eye Bank Association of India (EBAI) in 1999 had laid down medical standards to be followed by the eye-banks, according to G N Rao, director, L V Prasad Eye Institute (Hyderabad), and the person behind the formulation of medical standards for eye-banks, “not more than eight eye-banks follow the standards.”

Poor infrastructure of eye-banks, lack of knowledge about eye-banking, apathy of government to license/accredit eye banks and mobilise funds for the eye-banks have severely plagued eye-banking. Experts say that though the guidelines state that all eye-banks need to have sophisticated equipment, conduct HIV, Heptatitis B and syphillis test of the donor before e-nucleation, follow prescribed methods of performing e-nucleation and conform to infection control guidelines, most eye-banks do not abide by these standards.

Says Suresh Guptan, life member of EBAI, “Eye-banking is a sophisticated technique. But unfortunately it is dominated by do-gooders who believe that eye-banking is all about collecting as many corneas as possible.” When only around 7,500 corneas are collected annually as against a demand of ten million people who are blind and an estimated 25,000 to 30,000 people who are added to the backlog each year, emphasis on garnering of corneas is undoubtedly important. “However, collecting corneas should not be the only focal point. Complying with the standards should not be neglected at the cost of procuring more corneas,” says Guptan.

Expert state that eye-banking should be separated from corneal transplantation. “Corneal transplantation should be linked to centres with proper infrastructure and trained corneal specialists. ‘Specialist’ is the key word since it involves knowledge, diagnostic and surgical skills and not just ‘corneal surgery’. There are many centres with infrastructure and many well-trained specialists but we are yet to achieve a match of these two critical elements in most parts of India,” says Dr Rao. According to him, “Most organisations which can, at best, qualify to be eye-donation centres are being run as eye-banks.”

Not abiding by the standards have manifested in poor corneal transplant, which is an abysmal 20 per cent in the eastern states. Says Rekha Mehta, administrator, Eye Bank Co-ordination and Research Centre, (EBCRC), Mumbai,“It is not just important to collect corneas, but to ensure that the right corneas are chosen for transplant. Hence it is crucial that the corneas are processed to see whether the corneas are fit for transplant. Around 70 per cent corneas get rejected because of poor quality, HIV and Hep B. While with processing the success rate is 70 per cent, the rejection rate is an alarming 70 per cent without processing. However, not all eye-banks process their corneas.” Reportedly, in the eastern part of the country there is no processing facility.

Experts are irate about the lack of initiative of the state governments to license and accredit eye banks. It is only the state governments of Maharashtra, Kerala, Karnataka, Tamil Nadu, New Delhi and Andhra Pradesh which have licensed eye-banks. The Maharashtra government took the initiative to license eye-banks after Association of Consumers Action for Safety and Health (ACASH) had filed a writ petition in the Mumbai High Court. Recalls Dr Arun Bal, founder-member, ACASH, “Though the Transplantation of Human Organs Act (1994) included corneal transplant in its purview, and a government circular in 1997 said that all eye-banks have to be re-registered, we found that eye-banks were not re-registered till we filed a writ petition in the Mumbai High Court.”

The picture of accreditation is worse, with no states other than Andhra Pradesh having formed an accreditation body. According to the guidelines, an accreditation body has to be formed with 50 per cent representations from the state and 50 per cent from EBAI which would review the performance of the eye-banks. While a hue and cry is raised over non-compliance of standards, Jashwant Mehta, former president of EBAI, and chairman of EBCRC defends saying, “It is easy to point flaws with the eye-banks, but the question is who is going to pay? With the monthly expenditure incurred by an eye-bank ranging from Rs 50,000 to Rs 2 lakh, running an eye-bank is a costly proposition.” Mehta blames bureaucratic hassle and government apathy, which hinders getting funds to the tune of Rs 500 for processing each corneas under the National Blindness Control Programme(NBCP).

Under NBCP any private hospital which wants to start an eye-bank is supposed to get an amount of Rs 18 lakh. But because of bureaucratic hassle, not many eye-banks have been receiving funds, either for processing or establishing an eye-bank. “EBCRC has been trying to get funds for processing eye-balls for a long time. While the fund would be given by the central government, the recommendation has to go from the state government. The Maharashtra state government takes no initiative in sending an application to the central government,” laments R Mehta. S L Sonve, assistant director, directorate of health services, government of Maharashtra, could not give an answer as to why the state government has failed to take initiative to mobilise fund for eye-banks.

Talking about bureaucratic hassle in eye-banking reminds experts of a bitter experience- having a four digit telephone number (1919), whereby anybody who calls up the number gets connected to the nearest eye-banks. “Though this was pronounced as per the medical standards, in Maharashtra, MTNL gave the number to only one eye-bank because of political reason,” rues Guptan. Experts say that the need of the hour is not to have more eye-banks, but eye-banks with good standards. And that is where the concept of community eye-bank has come in. (Read more about community eye-bank in the box interview.)

The call to regulate the eye banks is also heard loud and strong. Says Dr Shanta Motwane, former head of ophthalmology at the LTMG hospital, Mumbai, and one who took initiative to intensify collection of coreneas in the hospital, “With the private eye-banks charging for processing and transplant, we need to have a regulatory body to remove any chances of misuse.”

Efforts are made by different NGOs to promote eye-banking in different parts of the country. Like a project by Ambuja Cement is trying to promote eye-banking in Rajasthan. Says Bhavna Jagwani, vice president, Eye Bank Society of Rajasthan with pride, “We have increased the collection of corneas from 20 annually to 57 last year. Now we are having almost 14 every month. It was a real feather in our cap when the police department authorised us extraction of corneas from bodies before post-mortem in case of medico-legal cases.” Suggests an expert, “EBAI should have zonal chapters to promote eye-bankig standards.”