Kerala's corneal shortage hampers transplant goals despite donor awareness campaigns

'Young' cornea scarcity stalls Kerala's corneal blindness fight

Kerala retrieves only 1,700 corneas annually, far below targets, and just 40-50% prove usable for transplants, leaving ophthalmologists warning that poor tissue quality, not awareness alone, is crippling the State's effort to reverse preventable blindness.

Tissue quality, not awareness, drives shortage

While many residents understand eye donation, actual pledges fail to convert because families withhold consent, fear disfigurement, or donate corneas that prove medically unsuitable, specialists say. The crux lies in age: endothelial cell density, essential for post-surgery corneal clarity, declines with age, and elderly donor tissue carries higher rejection risk even when grafted. "The primary reason for the low utilisation rate is poor tissue quality," explains Dr. Reshmi P. Haridas, cornea specialist at Thiruvananthapuram General Hospital.

Demand-supply mismatch widens

National statistics project India needs one lakh corneal transplants yearly to serve 1.20 lakh people living with corneal blindness, yet at current utilisation rates the country must harvest double the present volume to meet demand. Kerala's 1,700-cornea annual haul pales beside Andhra Pradesh's 10,000, undershooting National Programme for Control of Blindness and Visual Impairment benchmarks. Corneal disease causes 40% of blindness in the 0, 49 age bracket and 18% among those over 50, while 25,000 fresh cases, including graft failures, join the waitlist each year.

Hospital retrieval programmes offer solution

Ophthalmologists are urging Kerala to scale Hospital Cornea Retrieval Programmes, a proactive model in which grief counsellors approach bereaved families in hospitals, dedicated teams harvest tissue within the six-hour window, and medical records enable swift contraindication screening. The model's advantage is access to younger donors and higher-quality tissue. Little Flower Hospital, Angamaly, which operates an established HCRP and eye bank, transplanted 645 of 1,624 corneas retrieved in 2023, a 48% utilisation rate, while Government Medical College, Kozhikode, managed just 25% without a robust programme.

"A team from the eye bank goes directly to the deceased person's home, retrieves just the cornea… and the process hardly takes 15 minutes. There is no disfigurement," Dr. Haridas notes, adding that anyone, diabetic, hypertensive, or with cataract, may donate. The push comes as Thiruvananthapuram General Hospital this year became India's first district government facility to perform keratoplasty, signalling expanded public-sector capacity that now awaits a matching supply chain.

Source: The Hindu