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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 28  |  Issue : 1  |  Page : 43-47

Concerns regarding eye donation among health seekers attending a reputed eye care institution in North Kerala


Department of Ophthalmology, Government Medical College, Kozhikode, Kerala, India

Date of Web Publication11-Nov-2016

Correspondence Address:
Padma B Prabhu
Prabhu, Department of Ophthalmology, Government Medical College, Kozhikode - 673 008, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-6677.193867

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  Abstract 


Background: Creating awareness regarding eye donation is the prime factor responsible for promoting voluntary pledging and donation of eyes. Planning awareness campaigns is determined by the prevalence of dearth of understanding of eye donation.
Aims and Objectives: To assess the awareness and perception among eye care seekers toward eye donation.
Material and Methods: A cross-sectional study was conducted among patients attending ophthalmology outpatient department seeking eye care, using a predesigned, pretested, semistructured, selfadministered questionnaire.
Results: The study group included 250 participants. The male to female ratio was 1:1. A total of 94.4% participants had heard about eye donation. A total of 71.7% were willing to donate their eyes; 90.3% had not pledged their eyes; 63.7% were ready to implement eye donation as a family custom. Willingness, consent, and wish to make eye donation as a family custom was more among males (P = 0.049), graduates (P = 0.013), Christians (P = 0.019), those who were aware of the subject (P = 0.00), and who were single (P = 0.00). Only 7.6% had faced discouragement from the society or kith and kin when pledging of eye was considered. A total of 66.1% knew about the existence of a registered eye bank in the institute. Nobility was the main motivation (87.7%). A total of 61.8% felt that donated eye can give vision to the needy.
Conclusion: This study revealed that eye care seekers were well aware of eye donation with a favorable attitude towards it; most of them were inclined to pledge their eyes. Counseling of this receptive group and identifying interested candidates among them as volunteers for eye donation is helpful in promoting eye donation among the community.

Keywords: Awareness; beneficiary; corneal transplantation; eye bank; eye donation; pledging.


How to cite this article:
Prabhu PB. Concerns regarding eye donation among health seekers attending a reputed eye care institution in North Kerala. Kerala J Ophthalmol 2016;28:43-7

How to cite this URL:
Prabhu PB. Concerns regarding eye donation among health seekers attending a reputed eye care institution in North Kerala. Kerala J Ophthalmol [serial online] 2016 [cited 2019 Jul 23];28:43-7. Available from: http://www.kjophthal.com/text.asp?2016/28/1/43/193867




  Introduction Top


Corneal diseases constitute a major cause of visual loss and blindness in the world.[1] Majority of these diseases are avoidable. Treatable or curable blindness is expected to be tackled by the existent health care service delivery network. Many of those currently blind from corneal diseases can be visually rehabilitated by corneal transplantation. The World Health Organization (WHO) has reported that corneal blindness affects more than 10 million people worldwide, however, only 100,000 receive corneal transplants each year.[1],[2] Tissue procurement needs to be enhanced to meet the present demand. The major obstacle in surgical intervention in the setting of a developing country like India is lack of reliable eye-bank facilities and affordable surgical centers at the ground level. This difficulty is augmented by the inadequate accessibility of good quality corneas. The availability of the tissue is dependent not only on the voluntary pledging of donors but also the willingness of the family members to initiate organ donation in the event of the death of their relative. It is observed that the awareness and perception among individuals regarding the prerequisites and technicality of eye donation is the main factor behind timely collection of utilizable tissue.


  Material and Methods Top


The work was designed as an observational, descriptive cross-sectional study. The study was undertaken after approval from institutional ethics committee. Two hundred and fifty eye care seekers attending the ophthalmology outpatient department with various ocular diseases were included in the study by convenient sampling. A predesigned, pretested, semi-structured, self-administered questionnaire was used. The patients were requested to participate in the study, and informed consent was obtained. Those who were not willing to participate or gave incomplete response, those with age less than 18 years, and illiterates were excluded. The outcome variables considered were individual knowledge and awareness regarding the social and technical aspects of eye donation and corneal transplantation and their willingness to donate eyes. The study also estimated the effect of demographic profile, the reasons for eye donation by donors, the reasons for not donating eyes, and sources of information. The data was analyzed with the Statistical Package for the Social Sciences (SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc). Chi-square test was used for univariate analysis.


  Results Top


The study group included 250 cases; 125 males and 125 females. The age ranged between 20 and 86 years. The mean age was 44.88 (SD: 15.74) years. A total of 88.4% were married (n = 223). A total of 38.6% (n = 97) had primary education, 26.35% (n = 66) had secondary education, and 10.4% (n = 26) had higher secondary education. Fifty-two participants were graduates (20.7%) and 9 were postgraduates (3.6%). One hundred and fifteen cases led a sedentary life (46%). 32.8% were manual laborers. 6.8% (n = 17) were professionals. 60.2% belonged to the Hindu religion, 30.3% were Muslims, and 9.2% were Christians. 62.9% (n = 158) came from rural areas. Media was the most common source of information (43.4%, n = 109) [Figure 1]. This was especially true among males (P = 0.031; male/female = 67/42) and those educated beyond higher secondary education (P = 0.00).
Figure 1: Distribution of cases based on the source of information

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A total of 94.4% participants (n = 237) had heard about eye donation. Awareness about eye donation was not related to the age, gender, occupation, marital status, religion, and place of residence. It was related to the educational status (P = 0.007). 71.7% were willing to donate their eyes (n = 180); 9.8% had pledged their eyes (n = 24); 63.9% (n = 160) were ready to implement eye donation as a family custom. 92.2% were willing to share the information they had obtained with others (n = 231). Nineteen participants (7.8%) responded that they had faced discouragement from the society when pledging of eye was considered [Table 1].
Table 1: Distribution of cases based on favorable response to eye donation

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Willingness, consent, and wish to make eye donation a family custom was more among males (P = 0.049), graduates (P = 0.013), Christians (P = 0.019), those who were aware of the subject (P = 0.00), and who were single (P = 0.00). Age and place of residence did not determine these factors [Table 2].
Table 2: Distribution of cases based on demographic profile

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Two hundred and twenty-two participants knew the eye is retrieved after the death of the donor; 50.6% were not sure about the time of retrieval; 10.8% said it should be removed within 6 hours. 18.3% knew that the eye will be removed at the site of the body whether home or hospital. 43.8% felt there is no age limit for donation. Ninety-four participants claimed usage of spectacles as a contraindication for the donation. 27.9% believed lifestyle diseases such as diabetes and hypertension are also relative contraindications. Only 20.3% responded that cornea alone is harvested during retrieval; 15.5% claimed that the whole eye will be enucleated. 70.9% were aware that the tissue retrieved is utilized for corneal transplantation. One hundred and sixty-six participants (66.1%) felt eye donation does not result in disfigurement of the donor. One hundred and fifty-five (61.8%) opined that the donated eye can provide vision to the recipient. 16.7% felt that visual prognosis can be poor also. 41.8% (n = 105) opined that the procedure did not incur expenses. Majority (55.6%) were not sure about the expenditure. 66.1% knew about the existence of a registered eye bank in the institute [Table 3].
Table 3: Knowledge regarding eye retrieval and its use

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The main motivation for donation was that the donated eye can give vision to a needy person (39.32%). This was followed by noble intentions (32.58%). The main reason for not donating was lack of awareness (23.61%). Fear was the next factor (16.67%). The details are presented in [Table 4] and [Table 5]. These factors were not related to the age, gender, religion, marital status, occupation, education, or socioeconomic status on logistic regression (P = 0.499).
Table 4: Reasons for willingness to donate eyes

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Table 5: Reasons for not donating eyes

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  Discussion Top


A positive attitude toward organ donation and transplantation is prevalent predominantly with widespread publicity campaigns mediated by mass media, community programs, and hospital works.[3],[4] However, the number of individuals willfully coming forward to donate the organs of their diseased relatives is limited. Various obstacles such as ethical grounds, political reasons, moral and cultural inhibitions, and religious factors stand in the way of voluntary pledging of organs including eyes.[5] Though tissue mismatch and recipient safety is of less concern in eye donation, procurement of good quality corneas and ensuring adequate organ conditions prior to transplantation remains a major hurdle.

Hospital-based surveys have shown that the information required about organ donation as such was higher among participants seeking care at various hospitals.[6] This can be extrapolated to eye donation as well. The medical and paramedical personnel involved in eye care form the major source of information regarding eye donation for the public. However, even in states such as Kerala with fair doctor–population ratio and access to medical care, this dissemination of knowledge is often partial and inadequate. Grief counseling and motivation is crucial for any organ donation.[7] This is often limited to medical personnel dealing with critical care in the hospital setup. Ronanki et al. reported that a significant majority (82%) of previous eyes donors included in their study had not pledged earlier for eye donation.[1] They commented that pledging is not influenced by the actual donation and a majority of donations were initiated by the family members belonging to the same community. Gogate et al. suggested the requirement of creating catalysts at the community level to act as grief counselors to promote eye donation in the community.[8] Affiliation to a non-governmental organization or educational institution or having a family member who has donated eyes formed the main motivation of volunteers promoting eye donation.[1],[7],[8] Detection of a receptive group of volunteers willing to create awareness, motivate the public, and clear misconceptions regarding eye donation can effectively improve the eye donation rate in the country.

The present study noted that eye care seekers can be identified as a potential receptive group to be part of the eye donation promotion campaign. Majority of the study group were willing to donate their eyes and were willing to implement eye donation as a family custom. Comparable willingness rates have been observed in the literature, ranging from 34% to 82.5%.[9],[10],[11],[12],[13] Willingness, consent, and wish to make eye donation as a family custom was more among males (P = 0.049), graduates (P = 0.013), Christians (P = 0.019), and those who were aware of the subject (P = 0.00) and were single (P = 0.00). Two-third of the participants were aware of the existence of a registered eye bank in the institute. Awareness regarding the availability of eye bank/eye collection centre in the institute was found to be marginally superior, probably owing to the presence of banners and boards provided with the required information at multiple places within and outside the hospital. The rate of voluntary pledging was less but could be accounted by poor understanding about the functioning of registered eye banks or access to such centers in their locality. Encouragement from the society and family members concerning voluntary pledging was evident. Nobility was the main motivation. Perceived reasons for not donating eyes need to be addressed.[14] These included lack of awareness, fear, religious reasons, being not sure about family support, and not sure about how to proceed with pledging. A small group had no specific reason to point. Such indecisive individuals can be motivated through posters, pamphlets, and meets with the beneficiaries of corneal transplantation.

The major source of information was mass media followed by word of mouth. Ophthalmologist as a source of information formed a minority. This could be due to lack of involvement of ophthalmic personnel in critical care. Linking eye donation campaigns and classes with the existing screening camps (cataract, glaucoma, DR, school screening) can enhance the public awareness.


  Conclusions Top


This study shows that each eye care seeker is a potential motivator. Educating these peer group regarding preventive and curative aspects of corneal blindness will help to spread the message among their friends and family members. Future campaigns should target at changing the existent pessimistic attitude toward eye donation in the community. Misconceptions need to be addressed. The receptive group trained in the technical details can be encouraged to volunteer as grief counselors in their locality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ronanki VR, Sheeladevi S, Ramachandran BP, Jalbert I. Awareness regarding eye donation among stakeholders in Srikakulam district in South India. BMC Ophthalmol 2014;14:25.  Back to cited text no. 1
    
2.
Bhandary S, Khanna R, Rao KA, Rao LG, Lingam KD, Binu V. Eye donation-Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia. Indian J Ophthalmol 2011;59:41-5.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Priyadarshini B, Srinivasan M, Padmavathi A, Selvam S, Saradha R, Nirmalan PK. Awareness of eye donation in an adult population of southern India. A pilot study. Indian J Ophthalmol 2003;51:101-4.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Dandona R, Dandona L, Naduvilath TJ, McCarty CA, Rao GN. Awareness of eye donation in an urban population in India. Aust N Z J Ophthalmol 1999;27:166-9.  Back to cited text no. 4
    
5.
Patil R, E RP, Boratne A, Gupta SK, Datta SS. Status of eye donation awareness and its associated factors among adults in rural Pondicherry. J Clin Diagn Res 2015;9:LC01-4.  Back to cited text no. 5
    
6.
Ahlawat R, Kumar V, Gupta AK, Sharma RK, Minz M, Jha V. Attitude and knowledge of healthcare workers in critical areas towards deceased organ donation in a public sector hospital in India. Natl Med J India 2013;26:322-6.  Back to cited text no. 6
    
7.
Tandon R, Verma K, Vanathi M, Pandey RM, Vajpayee RB. Factors affecting eye donation from postmortem cases in a tertiary care hospital. Cornea 2004;23:597-601.  Back to cited text no. 7
    
8.
Gogate B, Gogate P. Eye donation: Mere awareness and willingness not enough. Only a catalyst can improve corneal harvesting rates. Indian J Ophthalmol 2011;59:332-3.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
9.
Chu T, Wang LN, Yu H, Zhang RY. Awareness of cornea donation of registered tissue donors in Nanjing. Chin Med Sci J 2013;28:20-7.  Back to cited text no. 9
    
10.
Yew YW, Saw SM, Pan JC, Shen HM, Lwin M, Yew MS, et al. Knowledge and beliefs on corneal donation in Singapore adults. Br J Ophthalmol 2005;89:835-40.  Back to cited text no. 10
    
11.
Biswas J, Bandyopadhyay S, Das D, Mandol KK, Saha I, Ray B. A study in awareness about eye health care and eye donation among secondary level students of North Kolkata, India. Kathmandu Univ Med J 2010;8:317-20.  Back to cited text no. 11
    
12.
Bharti MK, Reddy SC, Tajunisah I, Ali NA. Awareness and knowledge on eye donation among university students. Med J Malaysia 2009;64:41-5.  Back to cited text no. 12
    
13.
Krishnaiah S, Kovai V, Nutheti R, Shamanna BR, Thomas R, Rao GN. Awareness of eye donation in the rural population of India. Indian J Ophthalmol 2004;52:73-8.  Back to cited text no. 13
[PUBMED]  Medknow Journal  
14.
Lawlor M, Kerridge I. Understanding selective refusal of eye donation. Identity, beauty, and interpersonal relationships. J Bioeth Inq 2014;11:57-64.  Back to cited text no. 14
    


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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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