(Chutian Metropolis Daily) Gao Jialong, Li Dan, and correspondent Liu Xiaohong
【Key Points】
On the 18th, the new version of the "Wuhan City Corpse Donation Regulation" was passed by the Standing Committee of the Wuhan Municipal People's Congress. The biggest change is that the scope of corpse donation for clinical treatment has been expanded from "limited to corneas" to "the entire body." This is undoubtedly good news for patients waiting for organ transplants.
However, it was learned yesterday from the Wuhan Red Cross Society that since they started accepting cornea donations in 2003, up until August this year, only 32 cases of cornea donation have been realized, with 22 used in clinical surgeries. This number is akin to a drop in the bucket and far from meeting the demand, as thousands of patients in Wuhan are waiting desperately for corneal surgery every year...
Patients who cannot wait for corneas often have no choice but to remove their eyeballs. A 56-year-old grandmother named Sun has been waiting for three months, but there has been no news about any corneas. She doesn't know if she will ever see the light of hope again. When she was young, she suffered from corneal ulcers, but her family was too poor to afford medical treatment at the time, which led to the deterioration of her condition. Now, her pupil has developed a layer of white spots like frosted glass, and her vision extends only one meter.
Her eye disease has tormented Grandma Sun immensely. At her age, she still needs to buy groceries, cook, and pick up her grandson from elementary school. Due to blurred vision, she frequently bumps into the edges of wardrobes, bruising her legs black and blue. When picking up her grandson, she relies solely on the faint light through the slits in her eyes and her familiarity with the route. Even so, she often trips over stones on the ground unexpectedly.
Her son feels sorry for her and accompanies her to Wuhan Aier Eye Hospital for a check-up. The results were not optimistic: corneal opacity and cataracts, leaving her with only tubular vision. The doctor said the only way to improve her vision was to undergo bilateral corneal transplant surgery, but there were no available donors in the eye bank; they could only wait for someone to donate corneas. "There are so many people waiting, but too few donors. I really don't know when there will be hope," sighed Grandma Sun's younger sister. "If my sister didn't need to wait for corneal surgery, I wouldn't have realized how close corneal donation was to us."
Fang Min (a pseudonym), a peasant woman, was in an even worse situation because her hope for regaining sight had completely vanished. This summer, Fang Min, who was in her forties, accidentally injured her left eye while working in the fields. Three days later, a white spot appeared above her eyeball, and as time went on, the white spot grew larger. A month later, she was diagnosed with fungal keratitis at Aier Eye Hospital. The doctor said that due to her late visit, the fungus had already grown deep into her cornea, making drug treatment ineffective. She urgently needed a corneal transplant. However, after waiting for more than 20 days, no corneal donor appeared. After contacting other eye banks, none had suitable corneas either.
In October, liquid resembling toothpaste began to flow from Fang Min's eyes. The doctor indicated that she could no longer wait and had to remove her left eyeball because the infection had spread inside her eye. If the eyeball was not removed, it would cause a wider range of infections. Although she now has a prosthetic eye (fake eye) installed in her left eye, making her appearance indistinguishable from normal people, she remains deeply saddened by her blindness.
Patients eagerly await, but the eye bank has nothing to offer. "Our cornea bank has been in a state of zero inventory for a long time. As soon as we receive a cornea, it is used immediately, and the supply is far from meeting the demand," said a staff member of the Wuhan Red Cross Society Aier Ophthalmology Hospital Cornea Donation Registration and Acceptance Station. Since its establishment in August last year, only 11 people have registered to donate corneas, and 5 donations have been realized. In contrast, more than 300 patients are already on the waiting list for corneal transplantation surgery at the hospital.
Cornea donation coordinator Peng Peipei receives an average of 2 to 3 calls per month from people interested in donating corneas, but fewer than half successfully sign agreements.
Each cornea donation and transplantation is considered news for the donation registration station, and doctors can recount the stories of the donors vividly. For example, there was an ordinary worker born and raised in Wuhan who left a deep impression on the medical staff - he convinced his family to sign the donation agreement just before his death.
This unnamed 55-year-old man worked at a factory in Hanyang during his lifetime. His idea of donating corneas stemmed from a casual conversation with his son several years ago. At the time, father and son watched on TV as a ten-year-old child went blind, and both expressed a desire to donate their corneas to children after death.
On January 22 this year, he was unfortunately diagnosed with advanced lung cancer. On his deathbed, he once again thought about donating his corneas. On March 29, he persuaded his son to register for donation at Aier Hospital. On the afternoon of March 30, the critically ill man leaned against the head of his bed and laboriously signed his name on the donation form, hoping to donate his corneas to children and students in Hubei Province. Aier Eye Hospital issued a call for recipients, ultimately performing corneal transplant surgeries on two Hubei-native children, fulfilling the worker's final wish.
"Every donor is noble. We must bow our heads and mourn silently when retrieving the corneas to express our respect for the deceased!" The doctor explained that some recipients, after surgery, also expressed their intention to donate their healthy corneas upon their own deaths.
Dr. Zeng Qingyan, director of the Cornea Department at Wuhan Aier Eye Hospital, introduced that due to the shortage of donors, donated corneas can only be prioritized for severe patients (severe infectious corneal diseases) and those who registered earlier. Therefore, some patients simultaneously register in multiple cities across the country, going wherever they first obtain a cornea for surgery.
Statistics show that since the implementation of the "Wuhan City Corpse Donation Regulation" in 2003, up until August this year, only 283 cases of corpse donation have been realized in six years, among which only 32 involved cornea donation, with 22 used in clinical surgeries. Secretary Gui Shunli of the Wuhan Red Cross Society estimated that there are thousands of patients in the city waiting for corneal surgery each year.
The national situation is also grim. Relevant data indicates that there are approximately 5 million double-blind patients in China, among whom about 800,000 suffer from corneal blindness, and about 200,000 are waiting for corneal transplants annually. However, only around 5,000 patients undergo corneal transplant surgeries each year in China, resulting in a severe shortage of corneas.
Many people do not understand what corneal donation entails.
One of the main reasons why there are not many volunteers donating corneas is the traditional belief that "the body is given by one's parents, and should not be damaged." Sometimes, although the individual wants to donate, the family disagrees, leading to a last-minute withdrawal.
In July this year, a 60-year-old grandfather suffering from terminal cancer wished to donate his corneas. The next day, the staff of the registration station brought the agreement to the old man's ward. At that moment, the bedridden elder looked at his wife and nodded forcefully, indicating for her to sign her consent.
At midnight a month later, the elderly man passed away. After receiving a phone call from his wife, the doctor rushed to the hospital, where several relatives were already waiting by the bedside. The doctor explained the steps involved in retrieving the corneas, but the family stated that they did not know that retrieving corneas required removing the eyeball and then installing a prosthetic eye, and they could not accept it.
A male relative suddenly stood up and said, "Dying without leaving a complete body is the greatest disrespect to the deceased. Whoever dares to touch me, I'll fight him!" The doctor patiently persuaded them, saying, "After retrieval, a prosthetic eye will be placed, and it will not affect the appearance of the deceased." However, the family still disagreed. Fifteen minutes later, the doctor had no choice but to give up.
Besides ideological reasons, some people are unfamiliar with the process of corneal donation, leading to the waste of hard-earned corneas, which makes doctors feel very regretful. Half a year ago, a teacher in Wuhan who had signed a corneal donation agreement passed away. Because the family had not carefully read the donation instructions, it was only four hours after his death that the family notified the hospital. By the time the doctor arrived, it had been nearly eight hours since the teacher's passing. After examination, the doctor found that due to the donor's older age and longer time since death, the cornea had become cloudy and unsuitable for the most clinically demanded penetrating keratoplasty.
The doctor explained that the faster the corneas are retrieved, the better. In summer, within six hours after death, and in winter, within twelve hours. If the body is placed in a refrigerated room or ice coffin immediately after death, the time can be appropriately extended.
In August this year, the Chinese Red Cross Society and the Ministry of Health jointly announced that pilot projects for publicizing, mobilizing, and allocating human organ donations would be launched in ten provinces, municipalities, and autonomous regions, including Wuhan, to alleviate the bottleneck encountered in the development of human organ transplantation. Since corneas belong to human tissues and are not part of the pilot content, Zeng Qingyan believed that currently, the number of voluntary corneal donations is limited, and the transformation of people's perceptions will take time. Therefore, it is necessary to further improve the corneal donation system to increase the number of donors. Moreover, many people do not know what corneal donation is, indicating that insufficient publicity is also an important reason for the depletion of the eye bank.
Suggestions: Amend the donation regulation, try incentive compensation
The issue of insufficient corneal donors in Wuhan has always been a concern for relevant departments. In November 2006, five units including the Hubei Provincial Red Cross Society jointly issued a "Notice on Carrying Out Cadaver Donation Work in the Wuhan Urban Circle," allowing residents of the eight prefecture-level cities in the Wuhan Urban Circle to donate bodies (corneas) in Wuhan, thereby broadening the path for corneal donation to a certain extent.
The person in charge of the Wuhan Red Cross Society stated that the implementation of the new version of the "Wuhan City Cadaver Donation Regulation" will also play a certain promoting role in corneal donation.
In Zeng Qingyan's view, some foreign practices are worth learning from. She introduced that the United States implements a "presumed consent" donation system. If the deceased did not explicitly state that they did not want to donate their corneas during their lifetime, then after death, it is automatically considered voluntary donation. In this country, the annual supply of corneas is not only sufficient but also surplus for use in medical research and teaching, as well as supporting other countries.
Spain's "incentive compensation" system is also a widely acclaimed method. Its practice is that voluntary donors of corneas or organs, if they need organ transplants during their lifetime, will receive free donors, and their families will enjoy certain preferential policies when undergoing organ transplant surgery after death.
Zeng Qingyan also expressed that she hopes relevant departments will increase the publicity of corneal donation, popularize knowledge such as donation procedures and significance, provide humanitarian care through consoling donors, and establish online volunteer homes for donations, etc., to enhance the awareness of corneal donation.
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How to Donate Corneas?
Posthumous donation of eyeballs must be voluntary and unpaid by the individual themselves, and no one may force them. The following procedures should be followed:
Make an oral application to the designated donation point of the Wuhan Red Cross Society (such as the Aier Ophthalmology Hospital Cornea Donation Registration and Acceptance Station) → Staff of the Donation Registration and Acceptance Station communicate with the applicant to confirm that it is the true intention of the applicant → Family members are aware and agree → Applicant signs the "Donation Volunteer Registration Form" → Officially becomes a corneal donation volunteer → When the volunteer is in critical condition, the volunteer or their family contacts the Donation Registration and Acceptance Station → Staff of the Donation Registration and Acceptance Station go to the scene to copy the death certificate and related medical materials → Retrieve the eyeball (cornea) → Post-donation work.
If for various reasons, the volunteer cannot fill out the form personally, they can ask relatives or friends to fill it out on their behalf, but the volunteer must stamp (or fingerprint). If the family disagrees but the volunteer insists on posthumously donating the eyeball, then relevant legal procedures must be handled. Once the volunteer passes away, the hospital or their family should notify the eye bank as soon as possible to remove the eyeball and provide a brief medical history.
The Wuhan Red Cross Society Aier Ophthalmology Hospital Cornea Donation Registration and Acceptance Station is located at No. 481 Zhongshan Road, Wuchang District. Phone numbers: 68893983, 68893846.
What are the contraindications for corneal donation?
People with the following diseases cannot donate their eyeballs for transplantation but can donate them for teaching and research purposes. These mainly include: Certain infectious diseases such as AIDS, syphilis, rabies, tetanus, leprosy, diphtheria, viral hepatitis, encephalitis, poliomyelitis, etc.; malignant tumors that have invaded eye tissue as well as leukemia, Hodgkin's disease, etc.; Certain eye diseases such as anterior segment malignant tumors, retinoblastoma, viral keratitis, corneal degeneration or scarring, glaucoma, iridocyclitis, suppurative endophthalmitis, etc.