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How ‘an eye for an eye’ has turned noble

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Useful disc: The part of the eye useful for transplanting is the disc on the outer surface, called the cornea.
Useful disc: The part of the eye useful for transplanting is the disc on the outer surface, called the cornea.

Many organs can be retrieved within hours after death and transplanted

The Tamil proverb: ‘Yanai irundalum ayiram pon, irandalum ayiram pon’ values the elephant as worth a thousand gold pieces when alive (working for us) and just as worth in death (the tusk of ivory and other parts). I was reminded of this saying as we celebrate the Eye Donation Fortnight during August 25 – September 8.

The fortnight brings home the point that we humans too have value, at least physiological, whether alive or dead.

The Moghul King Babar is reported to have beseeched Allah to take his life, if need be, in order to save his son Humayun from a near-fatal illness.

Such sacrifice regularly happens every so often these days when we hear of people donating blood, and even a kidney, part of their lungs, liver or pancreas to save others.

The human body turns out to be useful to others even after death. Organs such as heart, kidneys, lungs, liver and pancreas can be retrieved within hours after death and used for transplantation to the needy.

The knowledge

Even some tissues such as some veins, skin, the heart valve, bone and tendons and the cornea of the eye can be taken out immediately after death and used.

Interestingly, the knowledge that such tissues and organ parts can be transplanted, and successful practice of such transplantation have come about and become popular during the last hundred years.

People have reacted to this advance with admiration and have nobly and increasingly come out to pledge their organs after death, for transplantation to others in need.

No objection

Happily, none of the religions and faiths — major or minor — have any objection to this personal act. In fact, legend has it that the devotee, Kannappa, thought he saw an idol of Lord Siva bleeding from the eyes, and gouged his own in an effort to transplant them on the lord.

Well, Kannappa Nayanar apparently got a bit carried away in his devotional sacrificial act.

We now know that the part of the eye useful for transplantation is the transparent disc on the outer surface, called the cornea. When we talk of eye donation, we mean donation of the cornea.

Pledging corneas

This then means that we do not need to gouge or remove the entire eyeball as Kannappa did. All that is needed is to take out the cornea, leaving the rest of the eye as is, so that there is no cosmetic objection. It is this realization that has led more and more people come forward to pledge their corneas for donation.

A helpful factor in corneal transplant, or grafting, is the fact that the cornea has no blood supply.

This allows the cornea of any donor to be used by a recipient, provided some other features are acceptable.

Blood carries among other things, a set of cells and proteins that look out for what might be ‘foreign’ and, when they sense this, go all out to mount an attack to destroy the foreign material.

Foreign invasion

This protection against foreign invasion is important since it protects the body against nasties such as viruses, bacteria and parasites. When this immunity is compromised, we fall sick. The HIV virus is particularly dangerous since it infects and weakens the very cells in the blood that offer us immuno-protection.

When organs like the heart, liver or kidney are transplanted on to a patient, the doctor has to necessarily add medicines that reduce the body’s immunity so that the organs are not rejected; they are, after all, foreign.

Different story

But the cornea is a different story. It does not have any contact with blood and is thus a tissue privileged against immunity, just as the skin is.

Why is corneal donation and grafting so important? It is estimated that over 1.2 million Indians suffer from corneal blindness.

Dr. Usha Gopinathan, Vice President of the Eye Bank Association of India (EBAI), tells us that we collect no more than 29,000 donor corneas per year all across India.

Of these, about 50 per cent are generally found free of infection and injury, and of the acceptable number of cells and therefore fit for grafting. This yawning gap has to be filled, and EBAI is trying its best to do so by motivating people to be cornea (and organ) donors, helping world class eye banks to be established and running trouble-free, and helping to train eye doctors in the practice of corneal grafting.

A long way

We have indeed come a long way since Eduard Zirm performed the first corneal grafting in 1905, and the first Indian corneal grafting was done half a century ago. India has caught up very well. Last year, the L V Prasad Eye Institute at Hyderabad created a world record by performing over 1,200 grafts. But we need to go far, far.

Proactive movement

As Dr. G N Rao points out in the March 2004 issue of the Indian Journal of Ophthalmology, there is no dearth of knowledge, skills and resources in India to create a world-class corneal transplantation network.

He argues for a proactive national movement to translate concepts and plans into a time-bound action.

Eye Donation campaign is one part of the strategy. Public-private partnership is the other. Non-profit global organisations are willing to support the movement.

Serving the needy

It is estimated that in order to establish a world class eye bank it would cost Rs. 50 lakhs. Rather than proliferate a large number of sub-optimal eye banks, it is more effective to have one such high-quality eye bank that can serve the needs of every 20 million people.

This translates to no more than 50 such eye banks across the nation. These banks would also serve as training centres — training both those that go to motivate people, retrieve and store corneas, and those who do the actual grafting.

We have the people, the plan, the programme of action and do not need to wait for the government to do everything.

As this year’s Eye Donation Fortnight ends on the 8th, let each of us pledge our corneas, promote and support the efforts to strengthen this field so that 1.2 million Indians need not be blind just because no donor corneas are available.

D. BALASUBRAMANIAN

dbala@lvpei.org

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