Ophthalmologists' perspectives on corneal transplantation and donation: a survey from Türkiye.

PURPOSE: To evaluate ophthalmologists' interest and opinions regarding corneal transplantation and donation in Türkiye. MATERIAL AND METHODS: An online questionnaire was prepared using Google Forms, and the electronic link to this questionnaire was sent via WhatsApp to ophthalmologists working in Türkiye. Eighteen open-ended/multiple-choice questions were asked about ophthalmologists' demographic information and their opinions regarding corneal transplantation and donation. The answers were analyzed by transferring the data to Excel. RESULTS: A total of 195 ophthalmologists participated in the survey. While 68.6% of them stated that they wanted to donate their corneas, 21.1% stated that they were undecided, and 10.3% did not want to donate their corneas. While 93.8% of the participants agreed to have a cornea transplant in case of need, 5.7% of them stated that they were undecided, and 0.5% said that they would not accept a cornea transplant. The most frequent (90.5%) reason for being willing to donate one's cornea was to give hope to patients with low vision. The most frequent (46.2%) reason for not wanting to donate one's cornea was the unwillingness to have one's body/eye integrity impaired. The vast majority (80.8%) of the participants thought that there was not enough corneal donation in Türkiye and that this was mostly (85.9%) due to cultural and/or religious reasons. CONCLUSIONS: Even in a sample with a high level of education and the most knowledge about corneal transplantation, the willingness to donate corneas may remain below the expected rates. Therefore, it is necessary to alleviate unrealistic concerns and prejudices about corneal donation and transplantation.

[Effect of keratoplasty on the quality of life of keratoconus patients]. / Effet de la kératoplastie sur la qualité de vie des patients atteints de kératocône.

Corneal deformations caused by keratoconus produce high levels of optical aberration (OA). Despite appropriate optical correction, these alter the quality of vision and diminish the patient's quality of life, especially since the affected population is predominantly young and of working age. When thinning is too severe or corneal transparency too impaired, a corneal transplant may be considered. In this study, we compare the quality of life of patients with keratoconus in the early (stages 1 and 2) or advanced (stages 3 and 4) stages of the Krumeich classification, as well as patients who have had keratoconus treated by keratoplasty. Quality of life was assessed using the NEI-VFQ 25 questionnaire, the most widely used for keratoconus. An aberrometric examination (OQAS®; HD Analyser, Visiometrics, Terrassa, Spain) was also performed to assess patients' quality of vision. Our results show that keratoplasty provides an improvement in quality of life compared with advanced-stage keratoconus in the areas of distance (p=0.0083) and near vision (p=0.029) activities. This improvement also applies to Best-Corrected Visual Acuity (BCVA) (p=0.032) and transparency (OSI) (p=0.049). Our study shows that keratoplasty improves corneal transparency, and it is interesting to note that it improves patients' quality of life over the long term.

Eye Donation: Awareness, Knowledge, Willingness, and Barriers among Paramedical and Allied Health Science Students at a Tertiary Care Teaching Hospital in South India.

BACKGROUND: Visual impairments have physical, emotional, social, and economical consequences and are a crucial element influencing one's quality of life. A total of 1.285 million people are estimated to be visually impaired worldwide of which 39 million are categorised as blind. These figures are startling, given that 80 percent of known vision impairments are either treatable or preventable. Corneal transplants appear to be our best hope for resolving this problem; however, a global shortage of available donors continues to dampen efforts addressing this issue. METHODS: This two-year cross-sectional study employed a convenience sampling technique and a standardised questionnaire to survey 150 paramedical and allied health science students at a tertiary care teaching hospital and assessed the awareness, knowledge, willingness and barriers regarding eye donation. RESULTS: The study revealed a 93.3% awareness rate of the donation procedure, of which 46% attributed their awareness to media sources. However, other aspects assessed had much lower awareness rates; when the eyes are donated (53.3%), optimal time period for retrieval of tissue/organ (54%), ideal part transplanted (54%), age limit not restricting donation (67%), donation by donors using spectacles (48%), confidentiality of the donor and recipient (54%), hospital having the facility of an eye bank (63%). 49 percent of the respondents were willing to pledge themselves as eye donors, and a majority of the unwilling respondents reported that familial opposition was the reason for their hesitation. CONCLUSION: Knowledge levels appear to be below expectations, and more effort is required to ensure that knowledge is imparted to our healthcare practitioners, who will then transfer this knowledge to the population, resulting in an increase in donation rates.

Determining the willingness of Australians to export their corneas on death.

BACKGROUND: 12.7 million people await a corneal transplant, but 53% are without access to corneal tissue. Sharing corneal tissue across nations can provide some access, however the willingness of export populations, like Australians, to export their donation on death, has never been evaluated. Our research samples the Australian population, determining their willingness to export. MATERIALS AND METHOD: We conducted e-surveys. N = 1044 Australians participated. The sample represented the Australian population, based on population demographics. Chi-Square and bivariate correlation coefficients examined associations between categorical variables, with a sample size of N = 1044, power of 0.80, and alpha of p = 0.05. Outcome measures were based on population sampling, by exploring willingness export, through the e-survey method. RESULTS: 38% (n = 397) of respondents said yes to exportation, 23.8% (n = 248) said no, and 38.2% (n = 399) were undecided. We found no relationship between willingness to export and general demographics, though those registered on the Donatelife Register (p = < .001), and those already willing to donate their eyes (p = < .001) were significantly more willing to export. DISCUSSION: More Australians are willing to export their corneas than not, though a significant portion remain undecided. The Donatelife Register, and donation awareness, are key components of respondent decision making. Therefore, the provision of information about exportation prior to, and at the point-of-donation, is essential for assisting Australian's to decide to export or not. Further examination and development of consent-for-export systems are necessary before routine exportation is undertaken.

Psychological complexities of visual restoration.

In this paper, we report the psychological and emotional experience of a patient who regained vision after over a decade of vision loss. The negative psychological implications of blindness are well recognised and there is a robust link between visual impairment and low mood and depressive symptoms. Although uncommon, low mood and depressive symptoms have been reported in patients whose sight has been restored, and lack of research gives rise to the possibility their prevalence may be grossly under-recognised in such patient groups. The effects can be so severe that patients may revert to living in darkness in mimicry of their previous lifestyle, effectively obviating the sight-restoring surgery. Healthcare professionals have a responsibility to address this traditionally neglected need by facilitating social, psychological and medical interventions that may ease the return to vision.

Awareness regarding eye donation among staff of a tertiary eye care hospital in North India.

PURPOSE: To assess the awareness, knowledge and attitude regarding eye donation in staff of a tertiary eye care hospital in North India. METHODS: A prospective, cross-sectional study was conducted on the employees of a tertiary eye care centre (urban area) along with its four secondary centres (rural area). Socio-demographic profile, awareness, knowledge and attitude of 507 employees regarding eye donation were evaluated through a pretested, self-administered questionnaire. Knowledge-based questions were scored. RESULTS: Of the 507 participants, 327 (64.5%) participants were from medical/paramedical field (Group 1) and 180 (35.5%) were from non-medical field (Group 2). Awareness about eye donation was 99%. Twenty (3.95%) participants scored poor (0-8), 90 (17.75%) had a fair score (9-16) and 397 (78.30%) had a good score (17-24). Good knowledge was found in significantly more (P = 0.01) participants in Group 1 (77.37%) as compared to Group 2 (70.1%). Four hundred and fifty-seven (90.13%) participants were willing to pledge their eyes for donation, the prime motivational force being spreading vision to the blind [346 (68.24%)]. The perceived reasons for not pledging were religious [28 (5.52%)], thought of family getting upset [29 (5.72%)] and scepticism regarding proper usage of tissue [64 (12.62%)]. CONCLUSION: The study demonstrated that although there is a substantial awareness about eye donation, there are certain lacunae in the knowledge and perceptions among staff of an eye care hospital. With the correct knowledge and attitude, they can contribute by creating awareness and motivating the people for eye donation while carrying out their routine hospital activities.

[Knowledge on the corneas donation in the adult population in a province of Apulia Region]. / Analisi delle conoscenze sulla donazione delle cornee popolazione adulta residente in una provincia della Puglia.

NTRODUCTION AND AIM: The spread of the donation culture is a crucial element in promo- ting solidarity and altruistic ideas necessary for meeting the needs of tissue transplants present on the territory. The research intends to assess the knowledge, the values, the attitude and the willingness to donate their corneas of adults, residents in the Province of Barletta - Andria - Trani (BT). METHOD: The sample was composed of 815 adults aged between 18 and 70 years and it was selected with simple random sampling among population residents in the Province of Barletta - Andria - Trani. All participants were interviewed by means of a questionnaire formulated and sent via Google modules. Their knowledge, values and attitudes were evaluated to deter- mine their willingness to donate their corneas. RESULTS: The participation rate was 64.4% (525/815). 68.4% (359/525) of participants would agree to donate their corneas. 89% (467/525) of participants know the theme of dona- tion. Asking specific questions to the participants on the donation path, the correct answers are on average 80%. This percentage increases to 86.2% considering only those who are willing to donate. Greater knowledge and an increase in altruistic values can be associated with an increase in willingness to donate. CONCLUSION: A good percentage of participants, about at 68,4% (359/525), is willing to donate their corneas. The awareness in this regard turns out to be very high, but the specific knowledge of the entire process should be further increased anyway.

A qualitative study using semi-structured interviews of palliative care patients' views on corneal donation and the timing of its discussion.

BACKGROUND: Corneal transplantation can lead to sight restoration, but globally there is a donor shortage. Many palliative care patients can donate their corneas but think they are ineligible due to comorbidities. Healthcare professionals are reluctant to broach the topic, but studies have shown that relatives would be upset if they were not offered this chance. There is no existing research involving patients. AIM: To understand the views and feelings of patients in palliative care settings towards corneal donation and explore their opinions regarding the timing of its discussion. DESIGN: This is an exploratory study based at one UK palliative care unit. A census sampling method was used. Nine participants took part in semi-structured interviews and thematic analysis was undertaken. RESULTS: Themes found included altruistic motivation and the value of sight. Family views were important, but the influence on final decisions varied. The timing of discussion relative to the illness trajectory was important; patients want to be able to engage fully in conversations and had concerns about not being able to think clearly when closer to death. Participants also associated discussion of donation as an indication of a poor prognosis. Patients prefer face-to-face discussions with someone whom they had a close rapport. Many had misconceptions about eligibility. CONCLUSION: This is the first study to engage directly with palliative care patients and to establish their views on the timing of corneal donation discussions. Patients are willing to discuss donation, and further exploration of patient views in this area should be undertaken.

Awareness Regarding Eye Donation in an Urban Slum Population: A Community-Based Survey.

OBJECTIVES: Our objective was to assess the awareness of eye donation in an urban slum population and willingness to donate eyes after death. MATERIALS AND METHODS: A cross-sectional, population-based study was undertaken in 20 urban slum clusters of the Indian capital, New Delhi. A total of 2004 individuals aged 18 years and older were recruited. After written, informed consent was obtained, knowledge regarding eye donation was assessed through a predesigned close-ended questionnaire. The questionnaire was framed so as to understand the sociodemographic factors influencing the willingness to donate and the awareness of eye donation in this distinct population. RESULTS: The mean age of the recruited individuals was 36.53 ± 13.68 years. Age did not have any significant effect on awareness regarding eye donation. We observed that 34.3% of the study population had no knowledge of eye donation and that 7.78% of the study population had excellent knowledge. Education seemed to be an important determining factor regarding knowledge of eye donation. Multivariable logistic regression demonstrated better awareness among the Hindu population (81.1%) and those belonging to a higher caste (P < .05). The younger age group (those 18-30 years old) showed significant willingness to donate their eyes versus older age groups (P < .001). In our study population, male participants (P = .006), those classified as literate (P < .001), and those classified as Hindu (P < .001) were more willing to pledge their eyes for donation. CONCLUSIONS: Although there is substantial awareness about eye donation, willingness to pledge eyes was very low in the urban slum population. Additional efforts are needed to translate this awareness into actual eye donation in the urban poor population.

Measurement of visual function among patients undergoing corneal transplantation using the VF-14 index in Morocco.

OBJECTIVE: To validate the Moroccan version of the VF-14 in candidates for keratoplasty and to assess their quality of life using this tool before and after transplantation. METHODS: This is a longitudinal prospective study that assessed 57 patients who underwent penetrating keratoplasty, recruited in the ophthalmology service in Marrakech over 5 years. The original VF-14 questionnaire was adapted into Moroccan dialect. The questionnaire was administered before and 2 years after transplantation. The VF-12 questionnaire was also used, deleting the last two items. Data analysis was performed using SPSS 16.0 software. Comparisons of VF-14 scores before and after transplantation used the Wilcoxon test for paired samples. RESULTS: In total, 57 patients participated in the study. The most frequent indication for surgery was keratoconus (44%). All patients underwent penetrating keratoplasty. Chronbach's alpha value was 0.989 for VF-14 and 0.990 for VF-12. The two scores were negatively correlated with logMAR visual acuity. The strongest correlation was found with VA in the fellow eye. The average best-corrected visual acuity of the eye scheduled for keratoplasty was 1.1±0.16 logMAR. The average of VF-14 was 53±3. After keratoplasty, the average best-corrected visual acuity of operated eye was 0.34±0.31. The average postoperative astigmatism was 3 D. After keratoplasty, an increase in VF-14 score was observed from 53.5 to 81.92 (P<0.001). In postoperative follow-up, graft rejection was noted in two patients and maculopathy in a single patient. DISCUSSION: Graft transparency, absence of complications, minimal astigmatism, and good visual acuity have long been indicators of a successful corneal transplant. However, this does not provide information on visual quality and its impact on everyday life. It is in this sense that the VF-14 was adapted into several languages, as reliable, valid and sensitive as the original Anglo-American version, to assess objectively and subjectively the quality of life of patients after keratoplasty. CONCLUSION: With advances in techniques and availability of better materials, surgical success in performing keratoplasty is increasing. At the same time, vision-related quality of life of corneal graft recipients deserves more attention from ophthalmologists.

Estudio comparativo en queratoplastia para queratocono entre las técnicas lamelar profunda de Anwar (big bubble) y penetrante procedente de conversión / Comparative study of keratoconus between Anwar's deep anterior lamellar keratoplasty versus converted penetrating keratoplasty

OBJETIVO: El propósito de este grupo de estudio fue comparar los resultados entre los procedimientos de queratoplastia lamelar profunda anterior (deep anterior lamellar keratoplasty [DALK]) y queratoplastia penetrante (penetrating keratoplasty [PK]) en pacientes con queratocono. DISEÑO: Estudio de cohorte retrospectivo. MÉTODO: Se analizaron los resultados de 90 DALK y 49 PK procedentes de reconversión en pacientes con queratocono. Todos los procedimientos fueron realizados por el mismo cirujano (R.D.) desde 2006 hasta 2011. Entre ambos grupos se comparó la agudeza visual a distancia corregida (AVCC), el astigmatismo, el tiempo de la primera refracción, la paquimetría, el recuento de células endoteliales y las complicaciones postoperatorias. RESULTADOS: La media de edad fue de 28,2 años para DALK y de 31,7 años para PK (p = 0,17). El seguimiento medio fue de 14,7 meses para DALK y 19,4 meses para PK (p = 0,13). No hubo diferencia significativa alguna entre los grupos de PK y DALK en la media postoperatoria de AVCC (LogMAR) (0,17 frente a 0,17; p = 0,59), astigmatismo refractivo (-3,19 frente a -3,01 dioptrías; p = 0,65) ni en el tiempo de la primera refracción subjetiva (60,5 frente a 68 días; p = 0,50). Las principales complicaciones postoperatorias fueron 8% de rechazo endotelial en el grupo PK y 10% de vascularización de la interfaz en el grupo DALK. CONCLUSIONES: La única diferencia entre ambos grupos fue la neovascularización estromal profunda en DALK y el rechazo endotelial en PK, por lo que el procedimiento DALK debe ser considerado como primera opción en el tratamiento de pacientes con queratocono

OBJECTIVE: To compare outcomes between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. DESIGN: Retrospective cohort study. METHODS: Data of 90 DALK and 49 procedures from conversion to PK, performed by a single surgeon (R.D.) from 2006 to 2011 were analysed. Outcomes on corrected distance visual acuity (BCVA), astigmatism, time to first refraction, pachymetry, endothelial count cell, and postoperative complications were compared between these groups. RESULTS: The mean age of the patients who underwent DALK and PK was 28.2 and 31.7 years, respectively (P=.17). The mean follow up for DALK and for the PK group was 14.7 and 19.4 months, respectively (P=.13). There was no significant difference between PK and DALK groups in the mean postoperative for: BCVA (LogMAR) (0.17 vs. 0.17; P=.59); refractive astigmatism (-3.19 vs.-3.01 diopters; P=.65), and time for the first subjective refraction (60.5 versus 68 days; P=.50). Main postoperative complications were 8% of endothelial rejection in PK group and 10% of deep stromal vascularization in DALK group. CONCLUSIONS: The only differences in postoperative results between groups were stromal neovascularization in DALK group and endothelial rejection in PK group. DALK should be considered as the first option when keratoplasty is indicated in keratoconus

Knowledge and attitudes regarding eye donation and corneal transplant: medical versus nonmedical university students in a developing country in Africa.

OBJECTIVES: We sought to assess the knowledge and attitudes of medical and nonmedical University students regarding eye donation and corneal transplant. MATERIALS AND METHODS: The study was a comparative, questionnaire-based, cross-sectional survey of fourth-year medical and environmental science students at the University of Nigeria conducted in October 2012. Participants' demographics, knowledge, and attitudes on eye donation and corneal transplant were analyzed using descriptive and comparative statistics. Values for P less than .05 were considered statistically significant. RESULTS: The participants (107 medical students, 75 environmental science students) were 117 men and 65 women aged 22.3 ± 2.2 years (range, 18-32 y). There were no significant intergroup differences regarding awareness of eye donation (OR 1.71; 95% CI: 0.92-3.17; P = .0924) and willingness to donate their own (OR 0.76; 95% CI: 0.33-1.76; P = .5260) or their relatives ' eyes (OR 0.76; 95% CI: 0.29-1.98; P = .6274). Significantly more medical students than environmental science students knew that donation consent is given by the donor while alive (OR 2.93; 95% CI: 1.56-5.4; P = .0005) and had good knowledge of donor eye preservation (OR 2.43; 95% CI: 1.27-4.68; P = .007). CONCLUSIONS: Among medical and nonmedical undergraduate students, there are crucial deficits in knowledge and attitudes on eye donation and corneal transplant. Tailored donation awareness campaigns and introduction of undergraduate course work on eye donation may reverse the trend.

Vision-related quality of life before and after keratoplasty for Fuchs' endothelial dystrophy.

PURPOSE: To assess vision-related quality of life in Fuchs' dystrophy and changes in vision-related quality of life after 3 types of keratoplasty (penetrating keratoplasty [PK], deep lamellar endothelial keratoplasty [DLEK], and Descemet stripping endothelial keratoplasty [DSEK]). DESIGN: Prospective, observational case series. PARTICIPANTS: Sixty-three subjects with Fuchs' endothelial dystrophy: 12 subjects (12 eyes) received PK, 11 subjects (11 eyes) received DLEK, and 40 subjects (40 eyes) received DSEK. METHODS: Subjects were examined before keratoplasty and at regular intervals through 3 years after keratoplasty. At each examination, vision-related quality of life was assessed using the 25-item National Eye Institute Visual Functioning Questionnaire; best spectacle-corrected and uncorrected visual acuities were measured by using the electronic Early Treatment of Diabetic Retinopathy Study protocol; keratometric cylinder was measured by a manual keratometer. Disability glare was measured with a straylight meter. MAIN OUTCOME MEASURES: Vision-related quality of life composite score. RESULTS: Vision-related quality of life composite score for all eyes with Fuchs' dystrophy before keratoplasty was 72 ± 11 (n = 63) and did not differ between groups (P = 0.88). Vision-related quality of life improved by 6 months (PK, P = 0.008; DLEK, P = 0.03; DSEK, P < 0.001), with continued improvement between 6 months and 3 years after PK (P = 0.01) and DSEK (P = 0.004). At 6 months, the composite score was higher after DSEK than after PK (P = 0.006). At 3 years, there were no differences in composite scores between the 3 treatments (P = 0.33; mean minimum detectable difference, 8 [α = 0.05; ß = 0.20]). After keratoplasty, quality of life was correlated with uncorrected visual acuity at 1 year (r = -0.38; P = 0.001) and at 3 years (r = -0.36; P = 0.02), with disability glare at 3 years (r = -0.41; P = 0.02), and with best-corrected visual acuity at 6 months (r = -0.34; P = 0.03), but not thereafter. CONCLUSIONS: Vision-related quality of life in patients with Fuchs' endothelial dystrophy is significantly impaired but improves after keratoplasty, irrespective of the technique. The improvement is faster after DSEK than after PK, and this might be explained in part by rapid improvement in uncorrected visual acuity after DSEK. This study affirms an advantage of endothelial keratoplasty over PK with respect to patient-reported outcomes.

Understanding selective refusal of eye donation. Identity, beauty, and interpersonal relationships.

Corneal transplantation is the most common form of organ transplantation performed globally. However, of all organs, eyes have the highest rate of refusal of donation. This study explored the reasons why individuals decide whether or not to donate corneas. Twenty-one individuals were interviewed who had made a donation decision (13 refused corneal donation and eight consented). Analysis was performed using Grounded Theory. Refusal of corneal donation was related to concerns about disfigurement and the role of eyes in memory and communication. The request for donation therefore raised concerns about a potential adverse change in the ongoing relationship with the deceased, even in death. For those who refused donation, these concerns overshadowed awareness of need or benefit of transplantation. Adjusting the donation message to be more congruent with the real, lived experience of corneal donation may to some extent "prepare" individuals when the donation question is raised.

Patient and family attitudes about an eye donation registry for research.

PURPOSE: There is a shortage of human eye tissue available for scientists, and it is unknown how willing ophthalmic patients are to donate their eyes for research. Therefore, we assessed eye patient and family member attitudes regarding the establishment of an eye donation registry for research purposes. MATERIALS AND METHODS: Surveys were distributed to consecutive patients attending the clinics of an academic ophthalmology practice over a period of 8 days. This survey consisted of questions about demographic information of the participant, attitudes regarding eye donation and attitudes regarding a registry for research-specific eye donation. An additional nested survey was administered to family members who accompanied survey participants. RESULTS: A total of 207 patients and 76 accompanying family members returned their respective surveys. Of the patients, 55% indicated that they would consider joining a proposed eye donation registry for research, 30% were undecided and 15% would not consider joining (n = 193). Over 95% of family members indicated that they would support their relative's decision to enroll in the registry (n = 74). Of the potential donors, 41% indicated they would most prefer to learn about the registry from their eye doctor and 37% from a pamphlet (n = 180). CONCLUSIONS: A majority of patients with eye disease and their family members support the idea of establishing an advance-directive eye donation registry for research. This registry for research donors could be incorporated into the current eye donation registry. Such an addendum would bridge the current disconnect between ophthalmic patients who want to donate their eyes for research on their disease (and are ineligible to donate for corneal transplantation) and scientists who need more human eye tissue for experimentation.

Perception of transplant coordinator regarding relatives' attitude toward tissue donation request.

INTRODUCTION: Family denials for tissue donation are higher than denials obtained after organ donation. OBJECTIVES: To find out families' perception toward tissue request as well as its relation with the degree of acceptance or denial. MATERIALS AND METHODS: Following the request for tissue donation (corneas or different tissues), a five closed-question survey was designed and immediately answered by the Transplant Coordinator. The main aim was to find out whether the request determined surprise, disapproval, understanding, knowledge, and immediacy in the decision-making process, as well as its relation with the decision to donate. RESULTS: Of 1751 surveys, 991 were answered and collected from 2009 to 2011, which represents a 56% from the total. Data collected relate to families 510 who donated and 481 who did not (P = NS). The fact of requesting corneas only or different tissues did not influence the answers. Surprise and disapproval variables significantly predicted refusal to donation (P = .000). CONCLUSIONS: Regardless the request type (corneas or multitissue) variables influencing the decision making when approaching families are expression of surprise and disapproval. Neither understanding the application nor existence of a prior approach to donation has any influence whatsoever in the decision-making process.

Anything but the eyes: culture, identity, and the selective refusal of corneal donation.

At the time that a patient is diagnosed as brain dead, a substantial proportion of families who give consent to heart and kidney donation specifically refuse eye donation. This in part may relate to the failure of those involved in transplantation medicine and public education to fully appreciate the different meanings attached to the body of a recently deceased person. Medicine and science have long understood the body as a "machine." This view has fitted with medical notions of transplantation, with donors being a source of biologic "goods." However, even a cursory glance at the rituals surrounding death makes it apparent that there is more to a dead body than simply its biologic parts; in death, bodies continue as the physical substrate of relationships. Of all the organs, it is the eyes that are identified as the site of sentience, and there is a long tradition of visual primacy and visual symbolism in virtually all aspects of culture. It therefore seems likely that of all the body parts, it is the eyes that are most central to social relationships. A request to donate the eyes therefore is unlikely to be heard simply in medical terms as a request to donate a "superfluous" body part for the benefit of another. That the eyes are not simply biologic provides one explanation for both the lower rates of corneal donation, compared with that of other organs, and the lack of adequate corneal donation to meet demand.

Public opinion concerning corneal donation and transplant: a survey from Izmir, Turkey.

OBJECTIVES: As the deceased-donor organ shortage has become a common problem, we sought to investigate the attitudes of people in Izmir, Turkey, concerning corneal donation and transplant. MATERIALS AND METHODS: A questionnaire designed to collect demographic data and determine attitudes concerning corneal donation and transplant, based on 9 questions, was prepared and administered to 1000 people that presented to our outpatient clinics in 2009. RESULTS: Among the respondents, 54.7% were willing to donate their corneas, while 84.3% were willing to receive corneas, and 15.4% were opposed corneal transplant. Attitudes toward corneal donation were significantly more positive in those with more education than in those with less education. Among participants, the ratio of a positive attitude toward donation significantly increased with decreasing age (P < .001), with a maximum of 66.7% among participants aged 18-24 years and 46.2% among those aged > 65 years. The positive attitude increased with increasing level of education. The donor parameters reported to be of the most importance were religion, nationality, country, ethnicity, and sex (31.3%, 25.1%, 23.5%, 22.8%, and 20.8%). CONCLUSIONS: The primary factor associated with negative attitudes toward organ/tissue donation and receipt is low education. This result suggests that educating and motivating the public might help increase the rate of consent for organ and tissue donation and transplant.

[Evaluation of the need for communication training of ophthalmologists for gaining telephone consent for cornea donation]. / Bitte um Einverständnis in eine Hornhautspende: Bedarfsanalyse für ein Kommunikationstraining mit Augenärzten in der Spendenakquise.

INTRODUCTION: Because of the gap between the high need for cornea tissue for transplantation and the current lower numbers of donors, there is high pressure to succeed in telephone calls to relatives of deceased for obtaining consent. Besides the attempt to increase the rate of donors, these telephone calls should be gentle for relatives and not overstrain professionals. This study assesses the need and expectations of physicians towards communication training in preparation for their task. METHODS: In September-October 2009 a needs assessment for communication training among physicians who currently work or have worked for the eye bank took place. Personal data were recorded and their estimate of the perceived burden as well as needs and potential benefits from a specific communication training for obtaining consent for cornea donation by telephone were assessed using numeric rating scales between 1 (minimum) and 10 (maximum). Results were expressed as mean and range. RESULTS: The participants felt only moderately prepared for the task regarding information content, their emotions and personal convictions. They considered a specific training to be highly meaningful, necessary and helpful. Their highest burden during telephone calls previously experienced was documented as 8.4 and the average burden as 6.3. Accordingly, their willingness to continue working at an eye bank after their rotation was moderate. DISCUSSION: Physicians involved in obtaining consent for cornea donation by telephone feel highly stressed and only moderately prepared for fulfilling the task both for the information content and on the emotional level. Accordingly, specific communication training is perceived as highly meaningful, necessary and helpful. An educational program was developed to meet the needs and expectations of physicians.