Comments: Pendleton's Ideas, Concerns and Expectations model for improving outcomes through eye donation counseling.

Dear Editor,

We enjoyed reading the work by Thulasiraj et al.[1] focusing on eye donation in India which clearly showed education and counseling of the loved ones of potential donors is fundamental to improving donor numbers. However, we felt that the study did not fully explore barriers to donation that are unrelated to lack of knowledge. Reluctance may not stem from absence of understanding, but instead from personal worries not raised by the questionnaire or considered by counselors. This includes apprehension over lack of transparency relating to misuse of corneas[2]; in a country where organ trafficking is rife[3] this is not an unreasonable basis for refusal. Additionally, as a prominent feature of one‘s visage, eyes are ‘intrinsically associated with […] identity‘[4] and removal can be seen to destroy an individual‘s ‘self‘ cosmetically and spiritually.

These specific concerns could be successfully addressed through the addition of the ‘Ideas, Concerns & Expectations‘ (ICE) Healthcare Consultation Model[5] to counseling sessions. The ICE model, taught in UK medical schools as a template for patient-centered primary care, allows patients to be involved with their healthcare plans and increases compliance. Patients are given a voice to express understanding of their presenting complaint (‘ideas‘), worries they may have (‘concerns‘) and outcomes they hope to achieve from the consulting (‘expectations‘). This model can give clinicians greater insight into a patient‘s condition and treatment plans. Shaping this template for use in eye donation counseling may allow barriers preventing consent to be discussed and dispelled in a manner that is sensitive in its approach toward grieving family members.

COVID-19 has only widened the already gaping mismatch between the availability and demand for donor corneas meaning communicating effectively with relatives for a common goal has never been more important.

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