World Journal of Surgery

, Volume 42, Issue 11, pp 3482–3492 | Cite as

Microeconomic Benefit of Corneal Transplantation in a Developing Country via Public–Private Partnership Model

  • Rahul M. JindalEmail author
  • Stephen G. Waller
  • Shailendra Sugrim
  • Jan Pasternak
  • Joseph Pasternak
Original Scientific Report



We measured the microeconomic benefit, QOL, DALYs averted and clinical outcomes of corneal transplant surgery via a public–private partnership in Guyana. Corneas were obtained, ex gratia, from US eye banks, and the work was done at no cost to the patient or the Governments of USA or Guyana.


We obtained qualitative data using a “semi-structured interview technique” to question 60 recent recipients of corneal transplants in Guyana. Our questions covered schooling in children, training for job, and type and income of job, both before and after surgery. We also discussed improvement in family income and quality of life (QOL) using a Likert scale of 1 lowest to 5 highest.


Our data came from five humanitarian missions from July 2014 to July 2017. All school-going children (n = 6) were able to return to school and participate in educational activities. Young adults (n = 13), were able to acquire new jobs (50%) or training positions (50%) with higher income. Patients in the middle-age adult group (n = 20) re-acquired their employment positions (25%) or found new work (75%). Elderly patients (n = 21) after transplant were able to perform odd jobs to increase the family income. A consistent theme across all age groups was a dramatic improvement in the QOL. Two hundred and sixty DALYs (4.3 per patient) were averted. In this cohort of 62 surgery cases, mean preoperative visual acuity was 0.03 and postoperative mean visual acuity was 0.20.


We have shown microeconomic benefits and improved QOL of corneal transplantation in a low-income country.



Public–private partnership


Low- and middle-income countries


Renal replacement therapy


Cleft lip/cleft palate


Disability-adjusted life years


Quality of life



The late Mr George Subraj, philanthropist and President of Zara Realty, Queens, New York, supported us since inception; thanks are due to the Government of Guyana for providing the use of their public hospital and medications and the staff of the local hospital where the transplants and related surgeries are performed.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • Rahul M. Jindal
    • 1
    Email author
  • Stephen G. Waller
    • 2
  • Shailendra Sugrim
    • 3
  • Jan Pasternak
    • 4
  • Joseph Pasternak
    • 5
  1. 1.USU-Walter Reed Department of SurgeryUniformed Services University of the Health SciencesBethesdaUSA
  2. 2.Department of Preventive Medicine and BiostatisticsUniformed Services UniversityBethesdaUSA
  3. 3.Department of OpthalmologyGeorgetown Public Hospital CorporationGeorgetownGuyana
  4. 4.University of MarylandBethesdaUSA
  5. 5.Uniformed Services UniversityBethesdaUSA

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