Donor proﬁ le and trends of eye donation in Central India

Background : The present study was conducted to study the donor proﬁ le and to assess the trends of cornea donation. Methodology : This was conducted as a hospital based cross sectional study at a tertiary care centre in Central India for a period of 5 years. Data was retrieved from 70 patients from eye bank who ﬁ lled form of eye donation at Eye bank of our institution. Sociodemographic proﬁ le of donors, cause of death and time since death was recorded. Source of information regarding corneal donation and reason for not willing to donate the cornea for research purpose was recorded from the ﬁ lled form. Further cornea enucleated were subjected to serology and their utilization for various purposes were recorded in questionnaire. Results : The present study retrieved data from a total of 70 donor forms with mean age of 65.84 ± 18.4 years. Cornea obtained from younger patients were mainly utilized for corneal transplantation whereas that from elderly age group > 60 years were mainly utilized for research/ training purpose and the observed diﬀ erence was statistically signiﬁ cant ( p < 0.01). The corneas retrieved and utilized immediately after death were signiﬁ cantly used for optical or therapeutic purposes ( p < 0.05). Conclusion : The present highlights the donor proﬁ le and trends of corneal donation at the tertiary care facility of Central India. It was observed that though the younger population and older population both are aware regarding corneal donation but still they are less aware on purpose for which cornea can be utilized. Quality of donor cornea is better when death to enucleation time interval was less.


Introduction
Blindness is increasingly been recognized as a global health problem [1]. WHO states that approximately 80% of the blindness is preventable. The most common cause of preventable blindness include disease affecting cornea [2]. In India, corneal blindness affect approximately 6.8 million persons with vision less than 6/60 in at least one eye, however in about 1 million persons, both the eyes are involved [3,4]. According to data from National Programme for Control of Blindness (NPCB), about 1,20,000 persons are affected due to corneal blindness and approximately 25,000-30,000 cases of corneal blindness add to this pool every year [3].
The effective treatment with high success rate in restoring sight among patients with corneal blindness include corneal transplantation.National Programme for control of blindness (NPCB), initiated by Government of India through its continuous efforts tried to reduce the backlog of preventable corneal blindness through comprehensive eye care services, including corneal transplantation [5]. However, even after increasing awareness of corneal donation, the number of donors remains much lower and also waiting period for corneal transplantation remains high at most hospitals across the country [6]. Apart from the efforts of increasing awareness, the Eye Bank Association of India also made efforts to increase the corneal procurement rate over several years. The current procurement rate of cornea in India is approximately 49,000 per year, this rate is much lower than needed [7,8].
The procurement rate of corneal donation could possibly be enhanced by increasing awareness among population and also by identifying potential barriers and overcoming those barriers to eye donation. The present study was thus conducted at a tertiary care centre to study the donor pro ile and to assess the trends of cornea donation.

Methodology
The present study was conducted as a hospital based cross sectional study at a tertiary care centre in Central India for a period of 5 years i.e. from 1 st December 2014 to 1 st December 2019. Data was retrieved from 70 patients from eye bank who illed form of eye donation at Eye bank of Gandhi Medical College and associated Hamidia Hospital Bhopal. The family members of these deceased were enquired about the willingness to donate the cornea and reasons for not willing to donate to identify potential barriers. Sociodemographic pro ile of donors was recorded using questionnaire (which was self-designed). Cause of death and time since death was recorded. Source of information regarding corneal donation and reason for not willing to donate the cornea for research purpose was recorded from the illed form.
Further cornea enucleated were subjected to serology and their utilization for various purposes were recorded in questionnaire.
The performas were self-made and based on of icial eye donation form and were illed after proper written and informed consent.
Data analysis-Data was compiled using Ms Excel and analysed using SPSS 20 software. Data was grouped and expressed as frequency and percentage. Chi square test was applied and p value < 0.05 was considered statistically signi icant.

Results
The present study retrieved data from a total of 70 donor forms with mean age of 65.4 ± 19.11 years.
In present study, majority of donors belonged to age group of 61 to 80 years (42.2%) followed by 41 to 60 years of age (22.9%). About 71.4% of the donors were males. Most common cause of death was cardiopulmonary arrest in 45.7% cases. However, the cause remain unknown in 7.1% cases (Table 1).
Decision of donation was based on prior pledging in 44.3% cases whereas next of kin made the decision in 55.7% cases. Source of motivation was counselor in maximum cases followed by TV/ Radio in 25.7% cases (Table 3).
Also the present study observed statistically insigni icant association of age and gender with grading of cornea (Table 4).
In present study, cornea obtained from younger patients were mainly utilized for corneal transplantation whereas that from elderly age group > 60 years were mainly utilized for research/ training purpose and the observed difference was statistically signi icant (p < 0.01). Also the present study observed statistically signi icant association between death enucleation time and corneal utilization (p < 0.05). However no association of utilization with gender was observed (p > 0.05) ( Table 5).

Discussion
Corneal transplantation is considered as one of the most successful organ transplant which is utilized for the management of corneal blindness. The present hospital based study revealed sociodemographic pro ile and cause of death among donors and non donors. Initially organ donation was the topic of old age, now even younger age group is involved in corneal donation. About 34.4% donors belonged to less than 60 years of age. Majority i.e. 42.9% of donors belonged to 61 to 80 years. About 71.4% of the donors were males. The donorage distribution from literature reveals that the majority of the donors are over 60 years of age with a large population between 70 and 80 years age-group similar to present study [9,10]. Sugar, et al. observed maximum donors as males as compared to females [11].
The most common cause of death was cardiorespiratory failure. Similar indings were documented by Ranjan, et al. [12] and Patel, et al. [10] in which the most common cause-ofdeath among donors was cardiorespiratory failure (34% and 50.5% respectively).
Knowing cause of death is important as it helps in deciding the purpose of enucleation whether for transplantation or research purposes.
Even good grade corneas were not utilized for transplantation when cause of death was malignancy or sepsis Most of the donors in the present study were of elderly age group therefore most common cause of death among donor was cardiovascular disease.
In our study, donations were pledged priorly in 44.3% cases whereas next of kin made the decision in 55.7% cases. Source of motivation for corneal donation was counselor in 40% cases and TV/ Radio in 25.7% cases. Other sources included newspaper, family members, neighbors etc. Source of motivation for corneal donation was counselling in a study by Acharya, et al. in which about 41% participants were willing to donate cornea after counselling [13]. Sharma, et al. in their study observed 61 (57.5%) cases where the willingness come post direct motivation by grief counselors [6]. Yew, et al. concluded that imparting proper knowledge about eye donation can increase the corneal retrieval [14].
Kokab, et al. in their study observed major source of information for eye donation to be the mass media/TV/radio/ movies (43.5%) followed by posters/pamphlets in 24% cases [15].
About 44.3% corneas were utilized for training purpose in present study whereas 40% and 13.6% corneas were utilized for Optical and therapeutic purposes respectively. Cornea from younger donors were mainly utilized for corneal transplantation whereas that from elderly age group > 60 years were mainly utilized for research/ training purpose and the observed difference was statistically signi icant (p < 0.01). Corneas with lesser death utilization time were used mainly for optical and therapeutic purposes (p < 0.05). However no association of utilization with gender was observed (p > 0.05). Contrasting results were obtained by Raj, et al. in which 79.77% belonged to the age group of > 65 years which clears the doubt that higher age limit cannot be criteria for exclusion of utility of the tissue [16]. Armitage, et al. reported only 45% of utilization rate in donors belonging to greater than 80 years [17].
Our study is associated with certain limitations. As the study was conducted as a facility based study with the aim assess trends and donor pro ile, it could only cater only small group of population which could not specify geographic area. A large community based study with de ined geographic boundaries will help in revealing actual awareness and willingness of population regarding corneal donation and also help in assessing the potential barriers which if overcome can help in improving the corneal procurement rate.

Conclusion
The present highlights the donor pro ile and trends of corneal donation at the tertiary care facility of Central India. It was observed that:- Males donors were more eyes than females because they have higher literacy rate.
 Personal approach by medical personnel/counselor play main role in clearing all doubts and taboos regarding eye donation and to motivate public for eye donation. For this, awareness programs led by ophthalmologists, health workers/paramedics, nongovernmental organizations should be planned and executed at community level targeting all age groups for a better tomorrow.
 Also, the social media has been trying to in luence/ spread awareness about eye donation, but conversation rate of pledging into donation is less. High willingness to donate eyes and increase the actual eye donation among the communities can be achieved by more campaigning, educational programs through television, newspapers, radio and posters.
Quality of donor cornea is better when death to enucleation time interval was less.