The Union Health Ministry is considering the adoption of an opt-out system for cornea donation to address the growing demand for transplants. In this proposed model, anyone who dies in a hospital would be presumed to be a cornea donor unless they or their family explicitly register an objection. This shift was discussed during a recent meeting with the Union Director General of Health Services, and the proposal has been accepted in principle. Currently, India follows an opt-in system for organ and tissue donations, requiring explicit consent from the deceased person or their family.
Experts participating in the discussion suggested that the opt-out system could increase the availability of donated corneas, a critical need in the country. An official confirmed that legal teams are now evaluating the necessary changes to existing legislation governing organ and tissue transplantation.
Corneal transplants are essential for patients suffering from various conditions, such as corneal thinning, bulging, ulcers, or complications following surgeries, which impair vision. In India, around 200,000 corneas are needed annually, yet only 50% of this demand is currently being met. Radhika Tandon, a professor of ophthalmology at the All India Institute of Medical Sciences (AIIMS), emphasized the benefits of the opt-out system, stating that it would likely increase donations while still respecting individual and familial autonomy through the ability to opt out. However, she acknowledged that emotional or cultural hesitations may need to be addressed.
There are several reasons why cornea donation is being treated differently from other organ donations under this new policy. Unlike organs that require blood supply, corneas can be harvested up to six hours after death. Additionally, trained technicians can retrieve corneas even from a deceased person’s home, making the process accessible across most healthcare settings. Another advantage is that harvesting corneas does not alter the facial appearance of the deceased, which can ease family concerns. Moreover, corneas are not required for forensic purposes in medico-legal cases, unlike other organs.
A comprehensive proposal outlining the necessary amendments to the law is currently being developed. Since the Transplantation of Human Organs Act will require amendments, all necessary legal changes will be introduced together in Parliament. The National Organ and Tissue Transplant Organisation (NOTTO) is working on setting up a national registry and coordination network for corneas, similar to the one in place for other organs.
“At present, individual eye banks may maintain waiting lists, but a national-level network will ensure better allocation,” the official explained. Under the proposed system, the hospital that retrieves the cornea would initially retain the right to use it. If there are no eligible recipients within that hospital, the cornea would be shared with other hospitals within the state, then with hospitals in the region, and finally with other regions across India.
Tandon also noted that the current system leads to underutilization of some donated corneas. “A more coordinated network will help improve the utilisation rate. If a particular center does not have patients in need, the corneas can be transferred to others,” she said, adding that surplus corneas could be similarly redistributed.
With the proposal still under legal review, experts remain hopeful that the opt-out system will pave the way for a more efficient cornea donation process, reducing waiting times for patients and saving many from preventable blindness.
(Input from various sources)
(Rehash/Ankur Deka/MSM)
