Eye Banking and HCRP: The New Task Ahead….
Dr. Samar K Basak, MBBS, MD, DNB, FRCS
Secretary, Eye Bank Association of India
Medical Director, Prova Eye Bank,
Disha Eye Hospitals, Barrackpore, Kolkata -700120
basak_sk@hotmail.com
There is a huge shortfall of donor corneas in India and approximately 2 million people are blind due to corneal disease. Voluntary donation and Hospital cornea retrieval programs (HCRP) are the two sources of corneas for Indian eye banks.
HCRP has an important role in Eye banking scenario in India. It helps in harvesting more number of donor corneas and at the same time we can have best quality tissue with maximum utilization for the benefit of corneal blind people. As a result of newer customized corneal lamellar procedures surgical and visual results have been improved dramatically.
Corneal Blindness: INDIA
- 2 million people
- 1.5 million = Unilateral
- 0.5 million = Bilateral
- New patients every year = 40,000 – 50,000
- Need = 100,000 Keratoplasty/year
= 200,000 Cornea/year if we can enhance our utilization up to 50%.
Eye Banking scenario: INDIA
- Eye Bank Training Centre (EBTC) = 5
- Eye Bank (EB) = 176
- Eye Donation Centre (EDC) = 428
- No. of active eye bank/EDC (>50 eyes/year) = 203
- No. of active Eye Banks/EDC collects >100 eyes/year = 46
Eye Banking: All INDIA (2002-08)
2002 |
2003 |
2004 |
2005 |
2006 |
2007 |
2008 |
|
Collection |
19,352 |
20451 |
24,160 |
26,865 |
28,857 |
31,686 |
34,506 |
Utilization |
7,562 39.1% |
8,014 39.2% |
9,700 40.1% |
11,369 42.3% |
12,975 44.9% |
13617 42.9% |
13827 40% |
Eye Banking: Bengal (2002-08)
Pre HCRP |
|||
Year |
Collection |
Utilization |
% |
2002 |
614 |
196 |
31.9% |
2003 |
658 |
208 |
31.6% |
2004 |
610 |
201 |
32.9% |
Post HCRP |
|||
Year |
Collection |
Utilization |
% |
2005 |
1164 |
381 |
32.7% |
2006 |
1483 |
547 |
36.9% |
2007 |
1708 |
694 |
40.6% |
2008 |
1456 |
582 |
39.9% |
HCRP in PROVA EYE BANK, Disha Eye Hospitals, Barrackpore Collaboration with R G Kar Medical College & Hospital (2004-2008)
Total Counseling Vs Actual Donation in last 5 years in HCRP at RG Kar MCH
|
2004 |
2005 |
2006 |
2007 |
2008 |
Total |
Counseled Family |
184 |
546 |
1014 |
1123 |
1026 |
3889 |
Retrieved after motivation |
11 (22) |
82 (164) |
205 (410) |
248 (494)* |
216 (432) |
762 (1522) |
Conversion Rate |
7.6% |
15% |
20.2% |
22.1% |
21.1% |
18.6% |
Voluntary Vs HCRP in PROVA Eye Bank (2003-08)
Collection |
2003 |
2004 |
2005 |
2006 |
2007 |
2008 |
Voluntary |
146 |
134 |
126 |
144 |
128 |
110 |
HCRP |
--- |
22 |
164 |
410 |
494 |
432 |
Total |
146 |
156 |
290 |
554 |
622 |
542 |
Collection Vs Utilization (2002-08) at PROVA Eye Bank, Disha
Year |
Collection |
Utilization |
% |
2002 |
130 |
43 |
33.1% |
2003 |
150 |
56 |
38.3% |
2004 |
156 |
46 |
29.5% |
2005 |
290 |
150 |
51.7% |
2006 |
554 |
270 |
48.7% |
2007 |
622 |
351 |
56.6% |
2008 |
542 |
286 |
54.6% |
Fig: Strategies Ahead… 3 Tier Eye Banking
5 Eye Bank Training Centre; 45 Eye Banks and 2000 Eye Donation Centre.
The basic Equation is:
- 50 EB and EBTC will Network with 2000 EDC
- One EB/EBTC for 20 million population and linked with 40 EDC
- Each EB/EBTC will develop HCRP with 10 major hospitals.
- Each EB/EBTC can process 4000 Corneas/year
- Half (2000) through HCRP and Half (2000) via EDC.
- Each EDC will harvest 50 eye/year (25 person)
Eye Banking Scenario in USA
- Organized sector – Good networking
- Rigid Govt. regulations and National feeling
- Collection = 100,000 eyes/year
- Utilization rate = 65% or more
- Utilization = 35,000/year – in USA alone
= 40,000/ year to other countries
- 51% of Americans wish to donate their eyes
- 73.7% Licensed Drivers are registered for Eye/Organ donation
Eye Banking education in INDIA
- 70.3% of urban people know something about eye donation
- Only 18.5% wish to donate their eyes
- But 87.5% of this willing person’s family members do not wish to donate eyes/body.
- 57% do not want to donate their eyes
- 48% believe that they will born blind in next life
- 24.5% - undecided
We, in PROVA Eye Bank, Disha Eye Hospitals, Barrackpore, have started our HCRP since September 2004 at RG Kar Medical College Hospital with collaboration of Health Deptt, Govt. of West Bengal. Since then there is a tremendous growth both in collection and utilization. In these 5 years we have collected 1786 eyes from HCRP and we utilized 942 eyes for different types of corneal grafting. That means, the collection is increased by 400% and the utilization is increased from 32% in 2000-03 to 52.7% in 2008-09 as compared to 2003-04.
Initially, we used to perform only Penetrating Keratoplasty (PK). Now because of improved collection and quality of tissue we are performing newer Lamellar Keratoplasty (LK) procedures. Now, our waiting period for any keratoplasty has reduced to 3-4 weeks as compared to 12-18 months in 2004.
Like quantity, Quality issues are now important in Eye Banking for long term graft survival of the recipients. We need to utilize MK medium for better and longer storage of the donor cornea. And at the same time, we need 2-5 ml of donor’s blood for certain important serology tests which are of extreme importance for the safety of the recipient as well as the personnel who handle donor tissue. HCRP and MK medium storage of the donor cornea are the two important steps to improve the quality. That means, the utilization will be much better and it can increase up to 50% with present infrastructure.
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