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Decline in eye donation in the UK
  1. ANITA PANDA,
  2. SANDEEP KUMAR,
  3. SANJAY K D THAKUR
  1. Department of Ophthalmology, B P Koirala Institute of Health Sciences, Dharan, Nepal
    1. W JOHN ARMITAGE
    1. CTW Eye Bank, Bristol

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      Editor,—It was alarming to read the newsdesk item “Decline in eye donation in the UK continues” published in the November 1999 issue of BJO (p 1214). As stated by Dr John Armitage, the dramatic fall in eye donation is definitely a cause for concern. So far, the general impression was that the issue of eye donation is more complex and problematic in developing countries mainly because of the lack of awareness among the masses, besides many other secondary factors.

      Could it be that rejection of more tissue samples, as a result of unsuitability has created resentment towards eye donation among the public? To overcome this problem we would suggest that if there is no systemic contraindication for the transplantation, all the donated tissues should be utilised either for PK/LK depending upon suitability.

      Certainly, Armitage's suggestion of enhancement of awareness about eye donation through different means is helpful. Besides, by strengthening the hospital tissue retrieval programme, more tissue procurement is possible. Moreover, the problem of uneven proportion of eye donations in different regions of the UK can be overcome by spreading eye information and eye collection centres evenly all over the country, which will be more cost effective.

      Reply

      Editor,—Data obtained from UK Transplant show that the number of eyes retrieved in the UK in 1999 was similar to 1998 and that the decline in eye donation has apparently halted. But that is certainly no reason for complacency as the demand for corneal tissue in 2000 is expected to continue to exceed supply. So, what can be done to improve this situation? I agree with Dr Panda and colleagues that the issues surrounding eye donation, or lack of it, are complex and the reasons for fluctuations are not always obvious. Dr Panda suggested that non-use of tissue may lead to resentment among the lay public and an unwillingness to donate. In the UK, however, virtually all corneas that are suitable for PKP are in fact used clinically. Corneas that are unsuitable for PKP owing to endothelial deficiencies are, as suggested by Dr Panda, relatively low. So far as improving eye donation is concerned, one way forward would be to focus resources on just a few hospitals—for example, to employ tissue coordinators to promote eye donation and to ensure the availability of staff to carry out the eye retrievals. This approach can be successful as shown by a scheme run by the tissue bank in Edinburgh, and pilot schemes are currently being planned in other centres. Moreover, it is already the case that fewer than 10 centres are responsible for almost half of all eye donation in the UK. Just a few more hospitals operating at similar levels would solve the UK shortage. Another significant advantage of this approach is that with fewer centres involved the maintenance of high standards in donor selections can be more readily assured.

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