ABSTRACT

COUNSELING FOR CORNEA RETRIEVAL IN HOSPITALS

Suresh Guptan

The Eye Bank Association of India, an NGO, began functioning in 1989. It's basic aim is to popularize eye donation, increase availability of high quality corneal tissue, and improve eye banking standards. In its early years it was believed that India's low - literacy multi-lingual population was refusing to donate eyes eveb where eye banks existed because of: a) lack of awareness b) negative religious sentiment c) fears of facial disfigurement.

So EBAI blanketed the country with a successful TV campaign featuring two leading icons of the film world. It was however found that though general awareness was improved, annual growth rate of cornea collection stayed unacceptably under 10% over a low base figure. And millions of pledges made by live well wishers were failing to convert into actual eye donation after death. Further, voluntary eye donations following home deaths were mostly by elderly donors with poorer quality of donated tissue.

It was suspected that the donors' families were either unaware of "pledges" or simply forgot about eye donation in the critical six-hour post death period. So EBAI switched focus to ICU, Trauma, Surgery and Medical wards of hospitals where deaths could be accessed easily. A timely reminder and rudimentary counselling of relatives of deceased patients was planned. Cynics predicted that asking grieving relative for eye donation would not work in India. Violent reactions were predicted from all communities, except Gujarati-speaking gains whose religion encouraged eye donation as an ultimate form of charity. But so far, only Muslim citizens have been consistently refusing to donate eyes purely on religious grounds though they constitute the major proportion of cornea transplant beneficiaries in some cities.

Yet, contrary to expectations, no extreme reactions were encountered even from illiterate citizens though 12 hospitals-and-partner-eye banks in 7 cities and 5 states are recording results. Counselling successes have been steady irrespective of languages spoken or economic status of donors relatives. And a range of models available for study show that counselling is presently being innovatively undertaken by doctors, nurses, trained social workers, college goers, post-graduate medical students and even dedicated housewives. Access to hospital records and younger donors has meant better cornea evaluation and utilization and the focus work within hospitals allows better awareness programs. One confident Hospital which has found that badly needed skin donations could also be motivated through counselling is in fact moving confidently towards retrieval of heart valves.

EBAI's program has shown that a counselor's timely sensitive appeal to the humanity latent in all of us, can yield an assured supply of organs even in a relatively poor developing country. So policy focus in India is now shifting rapidly to the administrators of hospitals and tissue banks. Their poor record in providing infrastructure for counselling and prompt organ retrieval after receipt of donor consent, seems to be the true bottleneck. Not shortage of donors.

Asian Psychological Services and Assessment (APSA)

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