The other day a security guard came to me with his daughter. He had decided to put his full faith in my abilities, probably because he had seen me working on the ORBIS flying eye hospital and had decided I must therefore be an amazing eye surgeon. While I do think of myself as being very good, I suspect that the "foreign stamp of approval" effect - which is a big thing in India - is what had really convinced him, rather than any knowledge of my intrinsic abilities.

The daughter was a cute young girl, about 9 years old, and had been more or less blind since birth. She had a history of corrective surgery to try improve her vision, followed by complications that set her back. The father was desperate to do something. He said it did not matter how much it cost, he would arrange for the money regardless. In a country where a security guard is quite poor, and the girl child is often treated badly and regarded as a burden, his love for his child was quite evident.

Then he asked if I could take one of his eyes and use it to replace one of his daughter's eyes.

With a feeling of sadness at his plight, I had to explain it didn't work like that. I make it a point to take care to explain things carefully to all my patients, and in this case I made especially sure that he understood what the best thing to do was, and why, and explained in particular why an eye donation like that was not going to help. I then referred him to the appropriate specialist at the RP Eye Centre at AIIMs for further handling, having decided it was the best option given all the parameters of this particular case. I waived the charge for the consultation.

Eye donations are an issue on which there are quite some misconceptions, even from people who should know better. For example, the Times of India had an article on March 2nd 2005 covering an unauthorized cornea (a part of the eye) sale at AIIMs. The article ended with the statement that almost 80% of blindness in India "is curable, but the acute shortfall of corneas is the limiting factor".

The reporter was actually a bit confused there. Yes, about 80% of blindness in India is curable. But corneas can take care of only about 8% of them. The rest of the blindess is mainly cataract and glaucoma blindness.

Well, never mind the bad interpretation. The point is, there is this great shortfall in eye donations, and it does lead to nearly 2 million people in India staying blind. That is the important thing to understand. It is this shortfall which has created a black market in corneas, somewhat reminescent of the organleggers of sci-fi author Larry Niven.

Some people may ask - why should organ trafficking be regulated in the first place? For me, the answer is that there is a slippery slope with these things - if you allow it for one thing, where do you draw the line? Without regulation, there is a danger of sliding down a slippery slope towards the level of people getting harmed, even killed in order to harvest their organs. There are enough examples of ignorant and poor people that have been exploited to sell their kidneys. Without a recognised authority for medical ethics deciding on this, people are at risk. With money involved, the whole issue becomes even more contentious.

Fortunately, this sort of controversy is pretty much sidestepped in the case of eye donors. In the case of eye donation, eyes are only taken from people who have died.

There are still relatively few people in India who sign up to donate their eyes after death, and fewer still whose family is in any state of mind to call up the eye hospital to arrange for an eye donation at the time of death. If you think about it, those who call up and ask for the surgeon to come over are certainly owed much gratitude. The most important factor is no doubt that the donor emphasize to his family in a calm manner that it is their wish to donate their eyes and to be prepared to arrange it at the time.

One way to improve donation rates may be for eyebanks to give eye-donor leaflets to ophthalmologists in their surrounding area. The ophthalmologist can place these leaflets in their waiting room, and patients could pick them up when they come for a visit. While having the film star Amitabh Bachchan and his wife on TV urging people to donate eyes is certainly good and helpful (and has certainly increased the number of eye donations), the shortage remains enormous. A campaign for eye donation will work better in tandem with the immediacy of having these leaflets actually in the waiting room at the ophthalmologist. Picture the scene:

Patient: Ho hum... [drumming his fingers on the arm of his chair in a bored manner] ...What a dull ceiling this doctor has. Ah, here are some magazines, and ... hullo ... what's this? ... Leaflets about eye donation. Like Amitabh Bachchan urges people to do. Well, it'd be nice to do this I guess. What use are my eyes to anyone after all, when I have croaked it...

[thumbs through the leaflet]

...Ah. Here is a slip I can fill in. It says I should keep it with my health papers and let my family know about my wishes in a very emphatic and clear manner. Hmm. OK, I'll just fill it in....wait a minute....what if there is something dodgy going on with this - like in those kidney donor cases I hear about sometimes? Let me just ask the eye doctor about it - I don't want my family to have problems because of this.

He meets up with the doctor, has his eye examination, and remembers the slip of paper in his hand.

Patient: Ah, yes, doctor - a question about this eye donation stuff. Anything wrong with getting it done? If I arrange for it, will my family have to drag my sorry corpse through hospital corridors to try to find an eye surgeon or what?

Doctor: No, no. Nothing like that at all. Absolutely nothing wrong with getting it done. In fact it is a very good deed to do, because there is such a shortage - about 100 people for each eye donated at present. And it is very simple for the family to arrange for the donation at the time of death. There are doctors available 24hrs on the phone that will come to wherever the dead person is. They remove the eyes at the premises neatly and quickly. The problem is of course that the donor needs to make his family aware of his wishes beforehand, and make sure they agree to make the phone call. That requires the donor to broach the subject in a calm way, probably a few times to let it sink in beforehand, so that the family is prepared to do the necessary.

After some further questions, the patient is reassured about the idea, and after filling in the leaflet takes it back with him to store it appropriately for the future.

Having leaflets at the ophthalmologist's waiting room in this way will make quite a difference. This way, eye donation doesn't become something that is merely mentally noted as a good thing to do - this way it is easily arranged for on the spot.