In Aotearoa New Zealand, the demand for corneal transplants continues to outpace local supply, leaving hundreds waiting for sight-restoring procedures each year. With around 350 corneal transplants performed annually to address conditions like end-stage keratoconus—a thinning of the cornea that severely impairs vision—the country relies heavily on imported tissue. Since the COVID-19 pandemic, more than half of these corneas have come from overseas, highlighting a critical gap in domestic eye donation rates that have been steadily declining. This shortfall not only strains healthcare resources but also underscores the urgent need for research into why New Zealanders are not donating their eyes at higher rates, despite strong surgical capacity within institutions like the University of Auckland's Department of Ophthalmology.

Recent investigations led by researchers at the University of Auckland have shed new light on this issue, revealing a complex interplay of factors beyond simple logistics. These studies emphasize the role of public attitudes, cultural nuances, and systemic shortcomings, providing a roadmap for universities and health organizations to foster greater participation in eye donation.

University of Auckland's Pioneering Qualitative Exploration

The University of Auckland's Faculty of Medical and Health Sciences has taken a leading role in dissecting these challenges through innovative qualitative research. Published in the New Zealand Medical Journal on March 27, 2026, the study titled "Barriers to eye donation in Aotearoa New Zealand: a novel qualitative analysis" marks the first in-depth examination of public perceptions in the country. Led by Dr. Natalie Allen, a PhD candidate in the Department of Ophthalmology, alongside supervisors Associate Professor Rachael Niederer, Associate Professor Jie Zhang, Dr. Micah Rapata, Dr. Akilesh Gokul, and Professor Charles McGhee, the work draws from ten semi-structured focus groups involving 44 diverse participants.

Participants ranged from patients with eye conditions and palliative care recipients to healthcare professionals like donor link nurses and ophthalmologists, as well as members of the general public. Ages spanned 18 to 84 years, with a mix of genders and ethnicities, including significant representation from Māori and Pacific communities—groups historically underrepresented in donation statistics. Conducted between March and December 2024, the sessions were held in person at hospitals, hospices, and homes, or via Zoom, ensuring broad accessibility. Transcripts were analyzed using NVivo software for thematic saturation and sentiment, uncovering overwhelmingly positive views toward eye donation (90.9% support) tempered by substantial hurdles.

This approach highlights the University of Auckland's commitment to community-engaged research, blending rigorous academic methods with real-world voices to inform policy. By prioritizing qualitative depth, the study complements quantitative data, offering nuanced insights that quantitative surveys alone cannot capture.

Decoding the Methods: Capturing Authentic Voices

The methodology's strength lies in its purposive recruitment and flexible framework. With no prior New Zealand-specific data, researchers designed ten open-ended questions to probe awareness, perceptions, willingness, and barriers. Ethics approval from the Auckland Health Research Ethics Committee ensured participant safety, with informed consent and verbatim transcription (manually corrected for te reo Māori and accents).

Groups averaged 4.2 participants, fostering intimate discussions that revealed layered sentiments. Sentiment analysis classified language as positive, negative, or neutral, while iterative coding until no new themes emerged confirmed saturation. Demographics reflected New Zealand's diversity: mostly female (70%), aged 30-64, with NZ European, Māori, Pacific, and Asian representation. Health professionals provided insider views, while public participants offered grassroots perspectives, enriching the dataset.

• Diverse Recruitment: From university staff and charities to hospice visitors, ensuring socioeconomic and ethnic breadth.
• Hybrid Format: In-person for cultural depth, Zoom for remote inclusion.
• Analytical Rigor: NVivo thematic coding, cross-verified for reliability.

This participant-centered design exemplifies how Auckland's ophthalmology team translates lived experiences into actionable evidence, setting a model for health research at New Zealand universities.

Core Barriers Identified: Awareness Tops the List

The study's findings pinpoint four interconnected barriers, with lack of awareness emerging as the most pervasive—affecting 96% of participants (42 out of 44). Only 31.8% knew about eye donation specifically, dropping to 8.7% among non-healthcare public members, despite universal organ donation familiarity. Misconceptions abounded: many believed driver's license markings served as a formal registry (they do not), or that prior surgeries like cataracts disqualified donors.

Cultural considerations ranked second (93%, n=41), particularly resonant among Māori and Pacific participants. Eyes hold spiritual significance—the "window to the soul"—and death rituals emphasize tapu (sacredness), restricting body interference. Without established tikanga (customs), families defer to elders, stifling decisions. Disgust factored for 52% (n=23), with visceral reactions to eyes being "cut out," exceeding aversions to other organs. Religious beliefs influenced 30% (n=13), often overlapping with culture, such as Catholic burial preferences among Pacific groups.

These barriers explain declining trends: from 1991-2024, the New Zealand National Eye Bank facilitated 5,128 donations for 8,561 transplants, yet current annual needs hover at 350 amid rising keratoconus cases. Post-2020, imports exceed 50%, underscoring self-sufficiency potential untapped.

Cultural Nuances: Māori and Pacific Insights

A standout contribution is the cultural lens, vital in multicultural Aotearoa. Māori and Pacific participants (36% of groups) described eyes guiding the afterlife, rendering donation a profound loss. Family whānau dynamics prioritize collective consent, with youth hesitant to challenge kaumātua (elders). Quotes illuminate: "Our eyes are our vision; they help guide the way in the afterlife. Why would I give those away?" (71-year-old Māori male patient).

Tapu protocols demand family-only handling, complicating hospital processes. Pacific views echoed: Tongan customs view post-death bodies as sacred, interfering as disrespect. Yet, sentiment remained positive, suggesting tailored approaches—like culturally matched coordinators—could bridge gaps. This aligns with lower donation rates among these groups in quantitative data, urging universities to champion equity-focused research.

The University of Auckland's emphasis on te reo Māori transcription and diverse recruitment models inclusive scholarship, fostering trust and relevance.

Quantitative Context: Multi-Organ Donor Trends

Complementing qualitative insights, a parallel University of Auckland study in Scientific Reports (2025) analyzed 638 multi-organ donors from 2013-2022 via Organ Donation New Zealand data. Only 40.4% also donated eyes, with 59.6% not—widening from 57.9% gap in 2013 to 65.3% in 2022. Older donors (OR 1.021 per year) were more likely; Asian ethnicity less (OR 0.483 vs. NZ European); no gender difference.

This reveals untapped potential: eye donation could match organ rates with better pathways. For full details, see the study.

Proposed Solutions: From Education to Infrastructure

Participants offered constructive paths: education campaigns (30%), infrastructure upgrades (30%), advertising (23%), personal stories (18%), and a national registry (16%). Culturally safe family discussions by matched ethnicity coordinators garnered 90% support. Health professionals advocated specialist eye donor nurses beyond ICUs and automatic referrals.

• Public campaigns highlighting keratoconus impacts and success stories.
• Online registry to pre-register intent, easing family burden.
• Medical curriculum integration for broader clinician awareness.
• Māori/Pacific-specific frameworks respecting tikanga.

UoA researchers stress system changes for self-sufficiency, positioning the university as a catalyst for policy reform.

UoA's Ophthalmology Excellence and Broader Impact

The Department of Ophthalmology at the University of Auckland, home to the Aotearoa New Zealand National Eye Centre, exemplifies translational research. Professor Charles McGhee's leadership has elevated global profiles, with studies like this informing Donate Life and Eye Bank initiatives. PhD candidate Natalie Allen's work underscores how student-led projects drive national health advances.

This research extends to inequities: higher keratoconus in Pacific peoples demands culturally attuned solutions. By partnering with iwi and communities, UoA bridges academia and practice.

Implications for New Zealand Higher Education and Health

For higher education, such studies highlight interdisciplinary value—ophthalmology intersecting public health, Māori studies, and bioethics. Universities like Auckland train future leaders via hands-on projects, fostering careers in research and policy. Explore opportunities at NZ university jobs.

Health-wise, addressing barriers could eliminate imports, saving costs and reducing wait times. With 180,000 vision-impaired Kiwis projected to rise, proactive donation boosts equity.

Future Directions: Research and Advocacy Ahead

Upcoming UoA work may quantify interventions, partnering with Eye Bank for trials. Policymakers should prioritize registries and culturally safe training. Individuals: discuss wishes with whānau; register intent via Donate Life.

For the full NZMJ study, visit here. The New Zealand National Eye Bank site details donation processes.

As Aotearoa advances, University of Auckland's insights pave the way for a sighted future, blending research excellence with compassionate action.

Photo by Adrien Olichon on Unsplash