BBC News Magazine

Page last updated at 16:18 GMT, Tuesday, 13 April 2010 17:18 UK

Why do donors tick the opt-out box for eyes?

The Magazine answers...

Of the hundreds of thousands of organ donors who may have had their wishes wrongly recorded, many chose not to donate their eyes. Why are some people so reluctant to give them up in death?

Eye close-up
More than a million donors explicitly opt out of giving their eyes

An independent review has been ordered after organ donors had their preferences wrongly recorded about which body parts they were prepared to donate.

The NHS has confirmed 21 cases in which the wrong organs may have been taken from donors. A further 800,000 people on the UK donor register may have had their specific requests incorrectly noted.

While many of Britain's 17 million registered body part donors give consent for all their organs and tissues to be used for transplant after their death, more than 10% have chosen to with-hold consent for certain parts - by far the most common being eyes.

Some people feel an emotional attachment to their eyes
Fears a corpse will be disfigured
Lack of understanding how corneas are harvested

According to figures for the donor register, 55% of those who go for the pick-and-choose option - some 1.2 million people - specify it's their eyes they do not want transplanted. Why?

People often view the eyes with more emotion and see them as more symbolic than other parts of the body, says Prof John Wallwork, chair of the Transplant Trust.

Historically, they have held cultural and spiritual significance. Referred to as "windows to the soul" by Roman philosopher Cicero, the eye is also often regarded as symbolising knowledge. In Hinduism and Buddhism, the third eye is a symbol of enlightenment.

"Eyes are something people can feel differently about compared to other parts of the body," says Prof Wallwork. They can be regarded as being "symbolic of [a] personal view of the world".


Many people have a similar perception of the heart, he adds. After the eyes, it is the next most common part of the body people say they do not want to donate. Figures show 40% of people who withhold consent specify the heart.

Another fear among potential donors who opt out of giving their eyes is of disfigurement, especially if mourners will be viewing the body, says Prof Wallwork.

Of the eight body parts one can choose from - kidneys, heart, liver, small bowel, eyes, lungs, pancreas and tissue (skin, bone and heart valves) - eyes are the only explicitly external part. And it's been noted that people are often more squeamish about donating their eyes than other body parts.

But eye experts say eye donation does not affect the appearance of the donor. The cornea is the part that is used and this is just the thin, clear tissue covering the front of the eye.

This lack of understanding about organ donations is also a key issue when it comes to why people don't want to donate their eyes and other parts of their body, says the Organ Donation Campaign.

Question mark floor plan of BBC Television Centre
A regular part of the BBC News Magazine, Who, What, Why? aims to answer some of the questions behind the headlines

"People do not understand the harvesting process for corneas and there is a lack of awareness about donations in general," says a spokeswoman. "Some people are worried about disfigurement when there is no need to be."

Vision is dramatically reduced if the cornea becomes cloudy from disease, injury or infection. Last year 2,711 people had their sight restored by corneas supplied through the donor register, says the NHS Blood and Transplant (NHSBT), which is in charge of the register. But there is still a shortage each year of approximately 500 corneas.

Most cornea transplants are done on the over 65s, but anyone may need one. The youngest person in the UK to have one was just a few days old, the oldest was 104.

The sooner the eye is retrieved the better and they are stored in eye banks, says the NHSBT. Recipients are matched with similar aged donor.

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