Samuel Kumba
22 September 2007
Nairobi — Kenyan hospitals are making arrangements to open up eye banks.
But it will take Kenyans of goodwill and some changes in law to make this happen. People will pledge their eyes at death so that others suffering from corneal blindness may regain their sight.
These transplants are rarely done in Kenya because donor tissue is not readily available.
Dr Fayaz Khan, the chief ophthalmologist, Lions Sight First Eye Hospital, says plans are at an advanced stage to develop an eye bank.
The hospital is in the process of getting the right equipment, usually highly specialised, to preserve the corneas.
"This will ensure that the corneas obtained are stored for about two weeks awaiting use," Dr Khan says.
At the hospital, more than 200 patients are in the queue, waiting for cornea transplants, some for both eyes. It is only last year, according to Dr Khan, when the hospital carried out cornea transplants - but the donations came in from Italy.
Kikuyu, another hospital dealing with eye treatment, has not carried out cornea transplant for a long time. The hospital has about 75 eye unit beds.
According to a recent study, Kikuyu is said to have performed more than 3,300 eye operations, treated 60,000 outpatients and 16,000 more on mobile eye safaris. Its ophthalmology unit offers all aspects of eye care, from prevention through primary care, mobile clinics and surgery.
And Dr Walter Owen, the head of department of the Eye Unit at the Kenyatta National Hospital, told the Saturday Nation that his unit had been lobbying for an eye bank.
"However, this has to go through the whole process of the law. First the Human Tissues Act has to be amended to facilitate the process. So far, we have gathered the experts' opinion and our recommendations are with the Attorney-General whom, we believe, will soon introduce a Bill in Parliament to amend the 1967 Act.
"We have since established a team that is working specifically on that," explained Dr Owen.
According to him, every country should have its eye bank.
"We can't afford to go harvesting corneas from other countries to benefit our citizens. In the past, on a friendly basis, India has been donating to us corneas for free," says Dr Owen.
But Dr Khan said if all went according to plan, by November this year, the hospital should be ready to receive cornea donations. Usually before a cornea is accepted for use, the doctor has to ensure that it is fit. "It has to be from a healthy donor and have the required number of cells.
The donor must not have any communicable disease, including Aids, other sexually transmitted diseases, or others that can be transferred through tissues," he explained.
The venture is expensive, he said. For instance, one machine used to detect the number of cells present in a cornea costs about Sh1.4 million.
Normally the cornea should be obtained within six hours of the donor's death.
If the donor is far, ice is put in the eyes to keep the cornea cool. It is later preserved in special liquids.
One bottle of such a liquid, Dr Khan said, costs about Sh3,350.
Their legal basis for the establishment of the eye bank is in The Human Tissues Act.
The Act's Chapter 252 2 (1) states thus: "If any person, either in writing at any time or orally in the presence of two or more witnesses during his last illness, has expressed a request that his body or any specified part of his body be used after his death for therapeutic purposes of medical education or research, the person lawfully in possession of his body after his death may, unless he has reason to believe that the request was subsequently withdrawn, authorise the removal from the body of any part or, as the case may be, the specified part, for use in accordance with the request."
In Kenya, keratoconus, a non-inflammatory thinning and bulging of the cornea, is the second most common cause of blindness. Keratoconus results in distortion of the cornea, and an associated reduction in visual acuity.
Causes include infection, trauma, lack of vitamin A, measles in children and trachoma.
If established, the bank will supply other hospitals throughout country and only after the local demand has been satisfied would they export to the neighbouring countries.
In Africa, eye banks are few, but are in South Africa, Egypt and Ethiopia, among others. To get one cornea from the US costs Sh67,000.
Since the cornea has no blood supply, it is seldom subject to the rejections that plague other organ transplants.
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