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Al-Ahram Weekly 8 - 14 July 1999 Issue No. 437 
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Published in Cairo by AL-AHRAM established in 1875 |
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Al-Ahram Weekly 8 - 14 July 1999 Issue No. 437
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| Published in Cairo by AL-AHRAM established in 1875 |
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Egypt Region International Economy Opinion Culture Profile Features Focus Books Travel Living Sports Time Out Chronicles People Cartoons Letters Second sight
By Fatemah FaragWhat seemed to be a piece of shattering news has been given publicity by the Arabic-language press: a dead man's cornea was removed at the Kasr Al-Aini hospital, without the consent of his family, to restore a blind man's sight. As a result, the sole operational eye bank was temporarily shut down until investigation of the incident was completed, while approximately 4,000 patients suffering corneal blindness remained on a mushrooming waiting list.
On the surface, the incident can be viewed as a case of violating the sanctity of a poor man's body. But, in fact, there is a strong argument in its favour.
The incident is reminiscent of a similar incident which took place in February 1996 when the press reported that a cornea was removed from a corpse without family permission. As a result, a laboratory technician was arrested and the Ain Shams University eye bank shut down. Prominent ophthalmologists described the press campaign as unfair and called for legal protection. Moreover, the Kasr Al-Aini eye bank was forced to shut down in 1997 for one year, becoming operational once again in February 1998. The result was that the black market in corneas flourished, with the press reporting that the cost of the operation soared from LE1,000 to LE6,000. But more importantly, those who suffer corneal blindness, and they are many, were denied access to light. The affluent travelled abroad, where the operation costs an average of $30,000.
Loss of sight mostly afflicts the nationals of developing countries. According to World Health Organisation (WHO) figures, nine out of 10 of the world's 180 million blind hail from the developing world. And 80 per cent of them have conditions that could be cured -- but only through cornea replacement operations. Many of the afflicted, however, cannot afford the cost. Hence the reliance on public subsidies.
At government-run hospitals, two thirds of the corneas are provided for free. According to eye bank specialists, there was difficulty keeping up with the demand, even while working at full capacity. "Every day I get people who are desperate for a cornea. I now have a waiting list of thousands of people who need this operation and we do it for free," said Dr Moataz El-Sherbini, dean of the Kasr Al-Aini Faculty of Medicine.
The importance of eye banks is further highlighted by specialists who explain that the operation in government-run hospitals is safer because corneas are tested for hepatitis, syphilis and AIDS -- a service that is not available on the black market.
The practice is not new to Egyptian medicine. In fact, cornea replacements have been taking place in Egypt for years, and they are not considered organ transplants. Dr Mahmoud Ibrahim of the Ain Shams eye bank explained that "only the cornea is taken, and only from dead people. We do not mutilate the body."
In 1962, Law 103 was passed, allowing eye banks to operate and licensed specialists to remove the cornea, provided they submit an official report and gain the written approval of the donor or his family. The exceptions are the bodies of unidentified people or those who underwent an autopsy. Doctors have complained, however, that the law is not impartial because corpses from government morgues are used at all faculties of medicine without the written approval of families. Furthermore, time is of the essence because the cornea must be replaced within six hours.
After the 1996 shutdown, the prosecutor general issued a statement in May of the same year instructing district attorneys that licensed specialists are allowed to remove the corneas of people who die in accidents. In fear of a possible backlash, the statement was not announced publicly. At the instructions of Health Minister Ismail Salam, the Higher Council for Eye Banks stipulated that cornea removal should be done within two hours after the death of persons involved in accidents or those who die in university and public hospitals. And, in all cases, a written order from the head of the department is required and it must be notarised by the hospital director.
In 1998, Sheikh Mohamed Sayed Tantawi of Al-Azhar issued a fatwa, stating that it was not against Islam to remove the cornea after death. Last March, he went further, announcing he would donate his own cornea following his demise.
In response to possible complaints by the families of the dead, Farouk Ismail, president of Cairo University, pointed out that "it does not hurt the dead person in any way to have something like the cornea removed, but it gives another person, who is alive, the eye-sight he has lost. If a member of the complaining family suffered an accident and needed a cornea, he would go to the Kasr Al-Aini hospital and get one from the body of a dead person. People should put themselves in the place of others."
In the meantime, the government has pledged to honour a WHO drive to eradicate blindness by the year 2002. It is obvious that finding a solution to the moral/legal dilemma of cornea replacement is crucial for attaining this aim.
