Source: BBC

To restore sight to damaged eyes, doctors often need to transplant the cornea – the transparent covering of the iris and the pupil – from a donor’s dead body. There is a worldwide shortage, but one country, Sri Lanka, is doing its best to satisfy demand, without seeking any reward – at least in this life.

Bandages cover Paramon Malingam’s right eye. A tear appears in the left one. It is the relief of a very lucky man. “I thought I was going to live the rest of my life with one eye,” he says.

Thirteen years ago, Malingam, a shop owner from central Sri Lanka, cut his eye with steel wire. Last year, he injured the same eye with a piece of wood. After both accidents, a new cornea from a donor saved his sight.

The cornea is the clear front part of the eye, which lets in light and helps focus images on the retina.

When it’s damaged, as a result of injury or disease, a person’s sight deteriorates, sometimes to the point of blindness.

Often the only solution is a transplant, but in many countries donated corneas are in short supply – a situation aggravated by the fact that they have a brief shelf-life.

Harvesting of the eye must happen within a few hours of death and the cornea itself must be used on a patient within about four weeks, depending on the storage method.

Malingam waited four days for his new cornea and is recovering at Sri Lanka’s main eye hospital in the capital, Colombo.

“After the surgery, I was reborn to the world,” he says.

A few doors down from his ward, Viswani Pasadi, a student, is preparing for a different kind of rebirth, by filling out a form at the National Eye Bank pledging her eyes when she dies.

Like most Sinhalese – who make up 75% of Sri Lanka’s population – Pasadi is Buddhist. She believes in a cycle of birth, death and rebirth, and sees this donation as a sound investment in her future.

“If I donate my eyes in this life,” she says, “I’ll have better vision in my next life.”

Another who has taken this step is bookkeeper Preethi Kahlewatte.

“Whatever good things we do in this birth, that will take into the next birth,” she explains. “When the person needs something, we like to donate. Without hands, we can work. Without legs, we can work. Without eyes, what can we do?”

According to the Eye Donation Society – a non-profit organisation founded by a young doctor, Hudson Silva, in 1961 – one in five Sri Lankans have pledged to donate their corneas. This does not include those, like Pasadi, who have signed up with the National Eye Bank, a separate institution which opened five years ago.

“It seems like I’ve signed a certificate for every human being in Sri Lanka,” says the Eye Donation Society’s medical director, Dr Siri Cassim, whose job includes adding his name to the decorative papers given to donors’ families.

The eagerness of Sri Lankans to offer their corneas to others means that the country has long harvested more than it needs and has been able to send the surplus to other countries.

The late Hudson Silva began this process in 1964, by packing a few eyes into an ice-filled thermos flask normally used for tea, and having them carried by hand on a flight to Singapore.

In 2014, his Society exported 2,551 corneas, including 1,000 to China, 850 to Pakistan, 250 to Thailand, and 50 to Japan.

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