From Transnational Corneal Donations to Expanding Surgical Infrastructure: The Impact of the Zafar & Mir Foundation in Pakistan and Afghanistan
Simran R. Sarin, Noor-Us-Sabah Ahmad, Muhammad Sultan, Huma Saigol, Fawad Zafar, Erin M. Shriver, Kanwal S. MatharuPurpose:
This study analyzed the perceived impact of a free, transnational corneal donation program in Pakistan and Afghanistan and evaluated current, local, corneal procurement efforts. The Zafar and Mir Foundation (ZMF), a nonprofit organization that procures corneal tissue from US eye banks, provides tissue to surgeons in Pakistan and Afghanistan on the condition that the surgeons do not charge patients for surgery.
Methods:
This cross-sectional, mixed-methods study involved 2 online surveys distributed to all ophthalmologists in Pakistan and Afghanistan using ZMF donor tissue. Questions were multiple choice and free response. Qualitative responses underwent thematic content analysis.
Results:
A total of 60 unique responses were collected in Survey #1, and 54 in Survey #2 from the 76 ophthalmologists receiving communications from ZMF. Keratoconus was the leading indication for keratoplasty among respondents (28/60, 46.7%). The most common response regarding the impact of ZMF was improved access to care (28/50, 51.9%); respondents also described expansion of corneal departments and increased surgical volume. Top reported barriers to local procurement were perceived cultural/religious beliefs (40/54, 74.1%), awareness (33/54, 61.1%), and funding (24/54, 44.4%). Despite these barriers, 1 group established a self-sustaining eye bank. Respondents emphasized a need for further support in training opportunities (5/19, 26.3%), establishing local procurement (5/19, 26.3%), and increased tissue supply (5/19, 26.3%).
Conclusions:
ZMF's transnational corneal donation program has increased access to corneal transplantation in Pakistan and Afghanistan while supporting hospital-wide growth, expanding access to care, and increasing training capabilities. Sustainable local procurement remains limited because of systemic and cultural barriers.