The cornea is a transparent, avascular tissue that protects the eye and contributes two-thirds of the refractive power of the eye ( Sridhar, 2018). Corneal diseases are among the leading cause of global blindness, accounting for the fourth-most common cause of blindness worldwide (5.1%), after cataract, glaucoma and age-related macular degeneration. In cases where corneal opacity disrupts vision and results in corneal blindness ( Oliva, Schottman & Gulati, 2012) or a severe corneal dystrophy or degeneration impedes vision, or a non-resolving corneal infection or corneal injury threatens the integrity of the eye, a cornea transplant is recommended ( Krysik et al., 2018). Cornea transplantation is a surgical procedure that replaces all (penetrating keratoplasty) or part of a diseased cornea tissue (lamellar keratoplasty) with healthy donor corneal tissue, and in the absence of complications, leads to vision improvement after a sufficient period of healing ( Tan et al., 2012). This surgical procedure is one of the most common and successful forms of allogenic tissue transplantation ( Gaum et al., 2012). Unlike other types of organ transplant, in corneal transplantation surgery, major histocompatibility complex matching between the donor and the host is rarely used, and the value of such matching in cases of high-risk corneal transplant (such as in immunosuppressed patients) is still debatable ( CCTS Research Group, 1992). The collaborative corneal transplantation studies (CCTS) showed that human leukocyte antigen (HLA-A, HLA-B and HLA-DR) antigen matching did not reduce the likelihood of graft failure nor did a positive donor-recipient cross match significantly increase the risk of corneal graft failure ( CCTS Research Group, 1992). The procedure from the donor to the recipient is to harvest the eyes within 24 hours of death, ideally within 6 h of death, and place the tissue in a storage medium. The tissue is subjected to a procurement process, and measures are taken to ensure that the tissues are viable and healthy for surgery, excluding medical donor contraindications ( Sousa, Júlio de Faria & de Faria e Sousa, 2018). Indications for corneal transplantation vary in different countries. In a global survey of corneal transplantation and systematic review, the authors reported Fuch’s Dystrophy to be the most common indication for corneal transplantation in developed countries, whereas infectious keratitis and corneal scarring following trauma remain the leading causes in developing countries ( Gain et al., 2016).

The socio-demographic characteristics of the study participants provide important contextual information and insights into the composition of the sample.

Participants in this study were female, which is consistent with previous research showing that women are more likely to express willingness to participate in eye donation studies and health- related interventions ( Gesesse et al., 2021; Soqia et al., 2023; Yew et al., 2005). This gender imbalance may reflect differences in health-seeking behaviors and engagement in healthcare matters. According to this study, females had a significantly higher likelihood of awareness compared to males (odds ratio = 1.537, p = 0.004), approximately 53.7% more likely. This result varies with other studies ( Siminoff et al., 2006; McGlade & Pierscionek, 2013). This might be due to the variation in socio-demographic characteristics and study setting of the participants.

Age had an association with the of awareness and knowledge of eye donation: in this study younger age groups showed higher levels of awareness and knowledge of eye donation. This agrees with the previous study. Studies have shown that younger age groups exhibit higher levels of awareness and knowledge about organ donation, including eye donation ( Parija et al., 2023; Alghamdi et al., 2023). This might be due to younger individuals being more open to new ideas and more likely to engage in altruistic behaviors such as eye donation ( Mithra et al., 2013) than other age groups and, indicating their potential receptiveness to altruistic behaviors ( Mithra et al., 2013; Parija et al., 2023). Also, there are mixed findings regarding the association between age and eye donation awareness ( Siminoff et al., 2006; Tong et al., 2021). Some studies have even reported higher levels of awareness among older individuals who may have had more exposure to healthcare systems and information over time ( McGlade et al., 2013; Yew et al., 2005).

Education level is a significant socio-demographic characteristic that has been consistently associated with awareness and knowledge levels regarding eye donation. The high proportion of university and postgraduate students in this study aligns with previous research demonstrating a positive association between education level and awareness of eye donation ( Alghamdi et al., 2023; Acharya et al., 2018). Higher education provides individuals with opportunities for information exposure and critical thinking skills, which can contribute to greater awareness and knowledge. In contrast, some studies have found no significant association between education level and awareness of eye donation ( Siminoff et al., 2006; McGlade et al., 2013).

Religious beliefs and practices can influence individuals’ views on organ donation. The majority of participants in this study identified as Christians, Hindus, and Muslims. Some religions promote and encourage donation, whereas others have reservations or restrictions ( Ríos et al., 2013; Blake, 2015; Hameed & Jadidy, 2015). Previous studies have shown differences in eye donation attitudes and practices among individuals from different religious backgrounds ( Rady, McGregor, & Verheijde, 2011; Siminoff et al., 2006). Some studies have reported higher rates of eye donation among certain religious groups ( Rady, McGregor, & Verheijde, 2011; Parija et al., 2023), whereas others have found variations in attitudes toward eye donation even within the same religious affiliation ( Siminoff et al., 2006; Blake, 2015). Furthermore, cultural and religious factors can significantly influence perceptions and attitudes towards eye donation. For instance, a study by Panigrahi et al. (2022) revealed that religious beliefs and rituals can pose challenges to eye donation acceptance among certain communities (7.8% cited religious disbelief as a barrier). Some individuals may hold religious beliefs that discourage or prohibit the donation of organs, including eyes ( Raza & Neuberger, 2022). Another study in Iran found that Shia Muslims were more likely to donate their eyes than Sunni Muslims ( Khoshravesh, 2022; Ghotbi, 2013). These findings highlight the need for culturally sensitive approaches to eye donation programs that consider the unique beliefs and attitudes of different religious groups. The ethnic composition of participant was Indo-Trinidadians, mixed background, and Afro-Trinidadians. Ethnicity can influence health-related beliefs and behaviors, including attitudes toward organ donation ( Gesesse et al., 2021; Morgan et al., 2016).

Additionally, this study’s findings show that, none of the ethnic groups showed significant differences in awareness compared to Indo-Trinidadians, including Afro-Trinidadians, Caucasians, and individuals of Chinese ethnicity. Previous studies also supported our findings: divergent findings regarding the relationship between ethnicity and eye donation attitudes, with some studies finding no significant associations ( Siminoff et al., 2006; McGlade et al., 2013).

The findings of this study indicate that a significant proportion of participants demonstrated awareness of eye donation and corneal transplantation. Over half of the participants (54.3%) were aware that the cornea can be donated, which highlights a positive level of knowledge within the study population; however, there is still a significant proportion of individuals who lack knowledge about eye donation. This finding is consistent with previous research that has reported varying levels of awareness of eye donation in different populations ( Parija et al., 2023; Alghamdi et al., 2023). Recent evidence shows that awareness and willingness to donate eyes can differ markedly even within healthcare-adjacent populations. A survey of ambulance drivers in central India revealed that although 63.3 % had heard of eye donation, only one in four were willing to pledge their eyes, with key barriers including lack of reliable information, uncertainty about religious permissibility, and confusion over the donation process ( Joshi et al., 2023). Khan et al. (2015) similarly reported a high level of awareness (above 70%) among patients attending a tertiary hospital in India, supporting the role of clinical settings in spreading awareness. These findings underscore the need for tailored educational strategies that address the occupational and sociocultural factors influencing donation decisions. Additionally, their study highlighted the role of community-based organizations and local healthcare providers as key sources of information for eye donation. The primary sources of information for those who were aware of eye donation were the internet and television, This aligns with the increasing accessibility of online resources and media platforms, which play a crucial role in disseminating health-related information ( Sufrate-Sorzano et al., 2024; Van De Belt et al., 2013). Furthermore, the internet and television were identified as the primary sources of information in this study.

It is encouraging to note that a substantial proportion of participants recognized the need for prompt retrieval of eyes after death, with 42.5% expressing the belief that the eye should be retrieved as soon as possible. This awareness is crucial because the , timely retrieval of corneas is vital for successful transplantation. According to Williams and Muir (2018), early enucleation significantly influences graft quality and transplant outcomes, emphasizing the importance of sustained public education on the urgency of post-mortem eye donation.

However, it is worth noting that only a small percentage of participants (14.6%) demonstrated knowledge of the optimal time for retrieval. This highlights the need for targeted educational efforts to enhance understanding of the time-sensitive nature of eye donation. The finding that the majority of participants believed that the eye should be retrieved as soon as possible after death is consistent with previous studies that have shown the importance of timely retrieval of corneas for successful transplantation ( Gupta et al., 2018) small proportion of participants were aware of the optimal time for retrieval of eyes after death, indicating the need for education on this topic. A significant proportion of participants (42.5%) in this study recognized the importance of prompt retrieval of eyes after death, highlighting the significance of timely corneal retrieval for successful transplantation ( Williams & Muir, 2018). Several studies have reported varying levels of awareness and knowledge regarding the optimal time for eye retrieval. For instance, a cross-sectional survey in Ghana found that only 17.8 % of respondents correctly identified the six-hour window for corneal retrieval, while more than half admitted they did not know the timeframe ( Ackuaku-Dogbe & Abaidoo, 2014).

Similarly, Chowdhury et al. (2021) demonstrated limited knowledge among participants regarding the time-sensitive nature of eye donation and the need for prompt retrieval.

The perceptions of participants regarding cornea transplantation revealed varying attitudes toward eye donation. A significant proportion (42.7%) considered it a pleasure and noble act to help a blind person through cornea transplant, indicating a positive perception of the procedure and its potential impact on improving someone’s quality of life. This finding aligns with studies that have reported similar positive attitudes towards organ donation and transplantation ( Gupta et al., 2018; Mithra et al., 2013). On the other hand, a notable portion (32.7%) believed that eyes are not useful to someone after death and should be given to someone else. This perception reflects the recognition of the potential benefit of eye donation in contributing to the well-being of others even after one’s passing ( Gupta et al., 2018; Yew et al., 2005). These individuals may hold a more utilitarian perspective, prioritizing the positive impact of eye donation over personal concerns about post-mortem eye preservation. Studies have identified various barriers and misconceptions that may hinder individuals’ willingness to donate their eyes. For example, Lawlor et al. (2010) found that concerns about disfigurement were the dominant reason for refusing corneal donation even among respondents who were otherwise supportive of organ donation. This fear may contribute to the belief that eyes are not useful to someone after death, as individuals may prioritize their own appearance and preservation of their body.

The attitudes towards cornea transplant revealed a range of perspectives among the participants. A notable proportion (35.2%) expressed their willingness to donate their eyes, reflecting a positive attitude toward eye donation and the potential impact it can have on improving the lives of others ( Gupta et al., 2018; Patil et al., 2015; Marathe et al., 2014). This finding aligns with previous research that has reported a similar willingness among individuals to donate their organs after death ( Alghalyini et al., 2024; Tong et al., 2021). On the other hand, a significant percentage (36.4%) indicated that they need more information to make a decision regarding eye donation after death ( Gupta et al., 2018; Acharya et al., 2019; Maiya et al., 2018). This suggests that there is a lack of awareness or understanding about the process and implications of eye donation. Providing comprehensive and accessible information about eye donation, including its benefits and procedures, can address the information gap and empower individuals to make informed decisions ( Agrawal et al., 2017; Swathi et al., 2017). A noteworthy proportion of participants (14.3%) expressed a desire for their body to remain intact after death ( Gupta et al., 2018; Acharya et al., 2019; Maiya et al., 2018). This preference may stem from personal beliefs, cultural norms, or religious considerations. While most of participants in this study expressed a desire for their body to remain intact after death, it is worth noting that some individuals may hold different views. For instance, a study by Raza and Neuberger (2022) reported that a small proportion of participants believed that organ donation is a way to extend their own lives even after death, and therefore, they were more inclined to donate their eyes. These differing perspectives on bodily integrity and personal beliefs highlight the complexity and diversity of attitudes toward eye donation Religious beliefs can significantly influence attitudes toward eye donation, as highlighted in this study. Religious beliefs emerged as another influencing factor in participants’ attitudes towards eye donation. A small number of individuals (2.5%) stated that it was against their religion to donate their eyes ( Gupta et al., 2018; Acharya et al., 2019; Raza & Neuberger, 2022). However, contrasting studies have reported varying perspectives among different religious groups. Research by Siminoff et al. (2020) found that religious affiliation significantly influenced attitudes toward organ donation, with some Asian American groups, particularly those identifying with Buddhism and other Eastern religions, exhibiting more reluctance toward deceased organ donation due to cultural and familial considerations. A few participants (1.3%) cited their age as a barrier to eye donation, perceiving themselves as too old to donate ( Gupta et al., 2018; Acharya et al., 2019; Patil et al., 2015). However, these studies have shown mixed results. While some individuals may perceive themselves as too old to donate, other research has found that older individuals may actually express higher levels of willingness to donate their eyes ( Gupta et al., 2018; Acharya et al., 2019; Patil et al., 2015).

The analysis revealed significant associations with sex and education level with knowledge of eye donation. Females exhibited higher levels of knowledge, with an odds ratio (OR) of 1.80, indicating that females were 1.80 times more likely to possess knowledge about eye donation than males. This finding is consistent with previous research that has shown that females are more knowledgeable about health-related topics and more proactive in seeking healthcare information ( Gesesse et al., 2021; Bertakis et al., 2000). This may be due to females easily sorrows for sadness and accepts the health information provided as essential. However, some studies have reported no significant difference in knowledge levels between males and females ( Bhandary et al., 2011). Moreover, while individuals with a lower level of education were found to have a lower likelihood of possessing knowledge about eye donation, with an OR of 0.44, some studies have reported no significant association between education level and knowledge about eye donation ( Basnet et al., 2019; Farooqui et al., 2019). This is due to the education level being key for health information application and exercise.

Interestingly, no significant association was found between any variables and participants’ perception of eye donation. This indicates that the factors examined in this study, sex, education, and religion, may not have a significant impact on individuals’ overall perception of eye donation. However, some studies have reported significant associations between the perception of eye donation and factors such as knowledge, attitude, and awareness ( Bhandary et al., 2011; Williams & Muir, 2018; Krieglstein et al., 2002). This might be due to the perception of organ donation being more related to experiential phenomena than to demographic characteristics.

The study showed that more than half of the participants had good level of awareness regarding corneal transplantation and eye donation, and these were mostly females and educated people. More than half of the participants had low awareness of eye donation and the number of the study participants had negative perception toward eye donation and corneal transplantation was is substantially high. Additional sex, education level, and religion was associated with knowledge and perception of eye donation respectively. Therefore there is need for education and awareness programs cannot be overstated, as it will help to increase the level of knowledge and understanding among the general public. This will lead to an increase in the number of eye donors and a reduction in the waiting list for transplants. In order to increase the level of knowledge, educational programs and campaigns can be conducted in schools, colleges, and community centers. These programs can provide information about eye donation, its benefits, and the process of donation. This will help to clear any misconceptions and fears that people may have about eye donation. Furthermore, the healthcare profession, including medical and optometry students, can play a significant role in promoting eye donation. They can educate their patients, families, and communities about the importance of eye donation and the benefits it brings to others.

Kingsley K. Ekemiri (KKE) conceptualized the study with guidance from Godwin Ovenseri-Ogbomo (GOO), Ngozika E. Ezinne (NEE), and Uchechukwu L. Osuagwu (ULO). KKE, Megan Seebalack (MS), and Sarita Dean (SD) coordinated data collection and survey administration. Obinwanne Chukwuemeka Junior (OCJ) and Chioma C. Ekemiri (CCE) contributed to data entry, preliminary screening, and quality checks. KKE performed the statistical analysis with input from ULO. NEE, MS, and SD contributed to interpretation of the findings and manuscript drafting. GOO, ULO, and KEA provided critical intellectual input, methodological guidance, and substantive manuscript revisions. All authors reviewed the manuscript, approved the final version for submission, and agree to be accountable for the integrity of the work.