Potentiality of Crematorium based Corneal retrieval program as Hospital Corneal Retrieval Programs: Donor Profiles, Tissue Quality for corneal transplantation surgeries at a Tertiary Eye Care Center in Nepal

In many parts of the world, a damaged cornea—the clear, window-like front layer of the eye—is the only barrier standing between a person and permanent blindness. When this window becomes scarred or cloudy, the only way to restore sight is to replace it with a healthy one from a donor. This process relies entirely on the generosity of people who choose to give their eyes after death, but the journey of that tissue from the donor to the recipient is fraught with logistical challenges. In countries with limited medical infrastructure, the time between death and the preservation of the eye is critical; if too much time passes, the cells in the cornea die, and the tissue becomes useless for transplantation. Furthermore, the location where the eyes are retrieved matters. Traditionally, medical teams have rushed to hospitals to collect eyes from patients who died under medical care, a method known as hospital-based retrieval. However, in places like Nepal, where cremation is a common cultural practice, a different approach has emerged: teams go directly to crematoriums to retrieve eyes shortly after a body is prepared for burning. This alternative method, called crematorium-based retrieval, offers a way to access a large number of potential donors, but for decades, eye banks have wondered if tissue collected in this hurried, outdoor setting is truly as good as tissue collected in a sterile hospital room.

Researchers at the Tilganga Institute of Ophthalmology in Nepal set out to answer this question by looking back at the records of nearly seven hundred eye donors from 2020 and 2021. They compared the eyes collected from hospitals against those collected from the crematoriums at the Pashupatinath temple, a major religious site in Kathmandu. The team examined the people who donated their eyes, looking at their ages, genders, and the causes of their deaths to see if the two groups were different. They also measured the most important factors for a successful surgery: how long it took to preserve the tissue after death, whether the tissue was healthy enough to be used for sight restoration, and the density of the living cells on the surface of the cornea. The goal was not just to count the eyes, but to determine if the crematorium method, which is often seen as a last resort, could actually stand shoulder-to-shoulder with the hospital method in terms of quality.

The study revealed that the two groups of donors were remarkably similar. The average age of donors in both groups hovered around fifty years, and the mix of men and women was nearly identical. The causes of death also followed the same patterns, with suicide by hanging, heart disease, and respiratory issues being the most common reasons for death in both the hospital and crematorium groups. This similarity in the donor pool meant that the researchers were comparing apples to apples, ensuring that any differences in tissue quality would be due to the retrieval method itself rather than the people who donated. When the team looked at the actual eyes, they found that the vast majority of tissue from both sources was suitable for surgery. About eighty-six percent of the crematorium eyes and eighty-eight percent of the hospital eyes passed the strict medical tests required for transplantation. Of those that were suitable, the vast majority were used for optical purposes, meaning they were clear enough to replace a damaged window and restore vision, while a smaller portion was used for therapeutic purposes to treat painful, non-seeing eyes.

The reasons why some eyes were rejected were also consistent across both methods. The most common cause for rejection was the presence of multiple scars on the cornea, followed by positive blood tests for infectious diseases or the presence of foreign objects. Interestingly, the time it took to preserve the tissue after death was almost the same for both groups. In the crematorium group, the average time from death to preservation was just over six and a half hours, while the hospital group averaged just under six and a half hours. This small difference was not statistically significant, suggesting that the crematorium teams are able to reach donors and begin the preservation process just as quickly as hospital teams. The only measurable difference the researchers found was in the number of living cells on the surface of the cornea. The eyes retrieved from hospitals had a slightly higher count of these cells compared to those from the crematorium, but both groups still possessed enough healthy cells to be considered excellent candidates for surgery.

The findings suggest that the crematorium-based retrieval program is a viable and high-quality method for collecting donor eyes. The study challenges the notion that tissue collected outside of a hospital is inherently inferior. By demonstrating that the quality of the tissue, the time it takes to preserve it, and the suitability for surgery are nearly identical between the two methods, the research provides strong evidence that eye banks can safely expand their networks to include crematoriums. This is particularly vital in Nepal, where the tradition of cremation offers a vast, untapped resource of potential donors. The study concludes that with structured programs and rigorous screening, the crematorium method can ensure a steady supply of high-quality tissue, helping to reduce the burden of corneal blindness in the region. The work confirms that the location of retrieval does not dictate the quality of the gift; rather, it is the speed, care, and screening of the retrieval team that matters most.