From Compliance to Capability: Making Corneal Transplant Rules Work
Efficacy of relaxed equipment norms will depend on accountability and ethical tissue allocation
A background note can be accessed here: India Simplifies Rules for Corneal Transplants
Dr. Nishmita R.: Consultant Physician, SPARSH Hospital
SDG 3: Good Health and Well-being | SDG 10: Reduced Inequalities
Ministry of Health and Family Welfare
The amendment removes the mandatory requirement for Clinical Specular Microscopy equipment in corneal transplantation centres to ease infrastructure barriers. How might this trade-off between simplified equipment requirements and procedural rigour affect both access to services and the quality/safety of transplants, especially in rural or semi-urban settings?
Relaxing the requirement for mandatory Clinical Specular Microscopy – equipment used to assess the endothelial health of donor corneas – can make transplantation more accessible outside major cities. Many district hospitals and semi-urban centres cannot afford this machine or the specialists needed to operate it, so the amendment meaningfully lowers the barrier to offering the procedure.
The trade-off is real. Specular microscopy is central to predicting whether a graft will survive; without it, the risk of uneven tissue quality or avoidable graft failure increases, particularly in facilities with limited ophthalmic expertise.
A practical middle path is to decouple where surgeries are performed from where tissue evaluation takes place. Smaller hospitals can perform the transplant while relying on accredited eye banks or reference centres – public, private, or charitable – to assess donor tissue using specular microscopy. As long as the rules make this outsourcing explicit, and hospitals maintain clear documentation and accountability, rural patients can gain broader access without compromising the safety or predictability of their surgery.
By reducing equipment-related compliance burdens, the reform aims to enable smaller hospitals and eye-banks to participate more effectively in the cornea-donation and transplant ecosystem. What institutional, operational, or supply-chain challenges, such as donor-tissue logistics, technician training, or accreditation, must be addressed to make this decentralised expansion meaningful and sustainable?
Easing equipment-related compliance helps smaller hospitals and eye banks join the cornea transplant ecosystem, but meaningful expansion depends on addressing several ground-level challenges.
First is trained manpower: technicians who handle donor tissue need specialised skills in preservation, quality checks, and sterile transport.
The second is logistics. Donor corneas have short viability windows, making reliable cold-chain movement from retrieval points to surgeons critical. Breaks in temperature control or transport delays can render tissue unusable, especially in districts with limited ambulance or courier infrastructure.
Third is accreditation. Smaller facilities need simple but firm standards so that tissue handling, waiting lists, and allocation remain ethical and transparent. Remote mentoring, tele-supervision, and periodic audits by larger centres can help maintain consistency without burdening smaller hospitals.
State-level networks can also coordinate retrieval and distribution so that tissue does not get wasted in one region while shortages persist in another. If these institutional and operational gaps are addressed, the reform can genuinely broaden participation rather than simply reducing paperwork.
Corneal blindness disproportionately affects underserved regions with limited surgical capacity. How can the amended rules be leveraged to reduce regional and socio-economic disparities in access to corneal transplantation, and what additional measures might be needed to prevent new gaps from emerging as compliance is simplified?
The amended rules create a real opportunity to bring corneal transplantation closer to patients in underserved regions, where surgical capacity and specialist equipment are scarce. Allowing smaller hospitals to participate means that rural or tribal communities may no longer need to travel long distances or depend on limited slots in metropolitan centres.
But to ensure this expansion reduces disparities rather than creating new ones, it must be paired with supportive measures. Insurance schemes, public or private, should cover the full cycle of care, including follow-up visits that are essential to preventing graft rejection. Transparent tissue-matching and allocation systems can ensure that better-resourced hospitals do not absorb most of the supply.
Mobile follow-up units or tele-ophthalmology services can help patients who cannot return frequently for check-ups. States could also develop regional “hub-and-spoke” models where high-volume eye banks handle evaluation and quality control, while nearby district hospitals focus on surgery and aftercare.
With these safeguards, the simplified rules can expand access without weakening safety or eroding public confidence in corneal transplantation.
Author:
Dr. Nishmita R. is a Consultant Physician at SPARSH Hospital.
Views are personal.