Barriers to Corneal Donation

¶ … Corneal Donation within Hospitals and Medical Communities: Issues Surrounding Post Mortem Donations of Tissue

Qualitative Study

The purpose of this study is to identify barriers to corneal donation within hospitals and medical communities. A large body of research has focused on issues surrounding the post mortem donations of tissue. This research will take a different approach, examining what barriers exist within hospital and medical communities in an attempt to determine how these barriers may be overcome.

The number of potential corneal donors far surpasses the number of people available for traditional organ donations and in some states consent of the medical examiner alone is enough to allow use of corneal donations (family consent not required) (Lewin, 2000).

Traditionally the most significant barrier to organ donation and transplantation has been acquisition of organs and tissues (Murray et. al, 2002). The need for cornea tissue is rising. The average wait time for a corneal transplant is two or more years (Murray et. al, 2002). Typically patients with pain resulting from corneal disease and blindness in both eyes are considered priority patients (Murray, et. al, 2002). Thought there have been more corneas available, the wait time and list still remains long.

Significance of Research

Corneal Transplants qualify as cadaveric transplants, or organs donated from individuals clinically classified as dead (Lewin, 2000). There are many "taboos" surrounding such transplantations (Lewin, 2000), but these are usually significant only in the realm of the public. This attempts to contribute new research to the medical field by identifying the barriers that exist outside of the public realm, within hospitals and communities..

I am a Malaysian citizen, affiliated with Monash University, Malaysia. I am applying to undertake a research stint at the Corneal Eye Bank, Centre of Eye

Research Australia, located at the Department of Ophthalmology, University of Melbourne. As such my proposed area of study is transplantation of cultured corneal limbal stem cells.

The goal of this study is to undertake research abroad, in order to better understand what barriers exist to corneal donation within hospital and medical communities the world over.

The benefits of this programme of study are many. Reduce limitations on organ transplantation and tissue donation could potentially improve the quality of lives of thousands of people annually. At present research suggests the wait time for donation is greater than 2 years. Identifying and subsequently proposing solutions to the barriers that currently exist to donation will not only improve the quality of life for patients, but also help strengthen bilateral ties between Australia and Malaysia as well as strengthen Australian education and research relations with Malaysia.

Background/Literature Survey

Barriers that have already been identified in general with regard to organ transplantation include a shortage of donated organs; in 1990 approximately 16,945 individuals in the U.S. received cadaveric organ transplants (Lewin, 2000). More than 4,855 were still in need and of just under 6,000 deaths resulted in donations whereas potentially 15,000 qualified (Lewin, 2000).

Barriers to donation also include low rates of family consent and missed opportunities to "identify and refer potential donors" to organizations that would approach families (Lewin, 2000). Though Gallup surveys indicate that more than 85% of individuals support the cause of organ donations, less than 50% of families consent after death (Lewin, 2000). Requests are also sometimes not made to family members, which can present another barrier (Gortmaker, et. al, 1996; Lewin, 2000).

Barriers include lack of education among the public regarding corneal donation and education and training among medical, nursing and allied health professionals (Murray, et. al. 2002). Among the primary reasons for a transplant may include corneal failure after surgery, immunologic rejection of prior implant, hereditary or genetic corneal problems, scarring after disease or trauma (Murray et. al, 2002). Lack of Medical Suitability, age of donor and lack of consent are among the primary barriers with regard to corneal transplants (Murray, et. al, 2002).

Methods

The aim of this study is to discover barriers to corneal transplantation and donation from an administrative perspective. Thus the researcher proposes examination of donor registries and informed consent, as well as hospital policies, practices and procedures. A purely experimental study would not be feasible in this instance, as it would be virtually impossible in the short amount of time allocated to survey the number of people necessary to provide quantitative information on corneal donations. A qualitative study provides information relevant to exploratory processes, thus this type of technique will be utilized for purposes of this study.

The researcher intends to conduct research over a 6-month time frame. The first 1-2 months will be spent gathering adequate information from academic studies and journals to create the literature basis for the full study. The next 2 months will be spent developing and gathering responses for the interviews. The researcher will interview individuals from 4 major hospitals in the Australian and Malaysian areas. Next the researcher proposes examining and drawing logical conclusions from the data to form a hypothesis that will: