Racing against the clock: why one in three donated corneas is wasted

According to data for 2024-25, 51,249 corneas were donated in India, but this only met a quarter of the annual projected need of around 1,00,000 corneas. Only between 25,000 and 30,000 corneas actually underwent transplants. The primary reason is that a significant proportion of donated corneal tissue is not tested or processed in time.

Factors contributing to this include improper harvesting and storage, along with a decrease in endothelial cell density as donors age. However, the most critical factor is the timing and logistics of cornea retrieval after death. A cornea must be retrieved within six hours post-mortem, but this window can extend to six to eight hours in certain weather conditions.

Most Indian eye banks currently preserve corneas in McCarey-Kaufman (MK) medium for about 72 hours, while a few use newer intermediate media that extend this window to between 10 and 14 days. Engineers from IIT Delhi and doctors at Dr. Rajendra Prasad Centre for Ophthalmic Sciences (RPC), AIIMS Delhi, are testing a bioengineered graft to recycle discarded donor corneas for patients with surface-level corneal damage.

Until a solution for reusing corneas that miss the deadline is found, the six-hour retrieval window closes, and the tissue must be discarded. Most corneal collection and use occurs in six states - Andhra Pradesh, Telangana, Gujarat, Karnataka, Maharashtra, and Tamil Nadu. Corneas retrieved in smaller towns with no local surgeons can become unusable while in transit to cities with surgeons.

Extending storage life is key, and eye banks should shift from MK medium to intermediate media and eventually to organ-culture storage, which can keep corneas viable for up to a month. A national, real-time inventory linking eye banks to surgeons in 50 cities could help offer a cornea about to expire in Kozhikode to a waiting list in Chennai before it is discarded.

Hospital Cornea Retrieval Programmes, where hospitals proactively notify eye banks of deaths and train counsellors to approach grieving families, can reduce the time between death, retrieval, and preservation. Implementing better storage chemistry, faster hospital protocols, and a real-time database showing which corneas are expiring will improve corneal utilisation rates.