18 - 24 October 2001
Issue No.556
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Al-Ahram Weekly Online 18 - 24 October 2001 Issue No.556 |
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A clear view
For most of the estimated 120,000 people who will never see again without a cornea transplant, new legislation is their only hope
As little as five years ago, people suffering from corneal blindness could undergo a simple procedure in governmental hospitals for a fairly low cost and regain their sight. All this came to an abrupt end in 1996, however, when it was discovered by the family of a deceased man during his funeral that his cornea had been removed at the public hospital where he died. The director of the eye bank that obtained the cornea and the head of the morgue were both questioned and shortly afterwards, the nation's eye banks at Ain Shams, Cairo, and Tanta were shut.
Since then, doctors, legislators and religious specialists have clashed over one of the more difficult questions facing Egypt's medical establishment today: transplants. The question of whether cornea transplants are organ transplants is a delicate one, and doctors have grown extraordinarily nervous about performing the procedure.
Medhat Mokhtar, general manager of the Ophthalmic Department at the Ministry of Health (MOH) admits that the department is aware of "thousands" of people in need of cornea transplants, "but doctors who used to perform these operations now fear legal prosecution," he explained. "You can't blame the doctors for refusing to perform the operation -- it's pretty difficult for them to feel safe."
"Once bitten, twice shy," suggests Taha Labib, head of the Research Institute of Ophthalmology in Giza. "Doctors went through so much trouble because of the eye banks," says Labib, pointing out that the law that governs cornea transplants offers little protection to doctors. "We were fiercely attacked by the media, so what can be expected from us?"
According to Law No. 103 for the year 1962, the cornea can be removed from a deceased person only with the written approval of the donor or his family. The only exceptions are the bodies of people who either died in accidents and remained unidentified or underwent an autopsy.
Those who can afford it travel abroad to undergo the operation, as the need to see is worth almost any cost. Others try to import corneas from foreign sources. "I have been offered LE25,000 to perform the operation, but of course I have refused, since I neither know the origin of the cornea, nor whether it has been subjected to necessary tests," a doctor at the Research Institute told Al-Ahram Weekly on condition of anonymity. The World Eye Bank has tried to donate corneas to Egypt when it can, but Labib notes that not all of the donations are good enough to be used.
In the meantime, doctors see a lucrative business being taken over by Israel, where a basically simple operation costs less than in Europe or the United States. The MOH is being faced with an increasing number of requests to fly patients abroad to perform the operation. "The closure of the eye banks has put an additional burden on the ministry, as many patients wish to have cornea transplant operations done abroad," says the ministry's Mokhtar. "However, that is difficult to achieve."
Patients who cannot afford to travel abroad have no option but to wait for the eye banks to reopen. This all hinges on the passing of a controversial new law that will cover all aspects of the donation process. The consent of the donor is the most debatable article in the current draft law, which allows government hospitals to remove the cornea from deceased patients as long as the patient does not explicitly state that he does not want this done. In other words, failure to make this statement is assumed to be implicit consent.
"This is fraud," fumes Maher Mahran, head of the health committee at the Shura Council, where the draft law is currently being discussed. "Illiteracy is still a significant factor. Many people would not know about this law, which means they would be donating out of ignorance," he argued, saying that passing the law with the article in question would be "cheating the people". Mahran backs the method of organ donation used in most countries, in which people indicate on their identity cards whether they want to donate any of their organs. "That would be fair enough for everyone," said Mahran.
Another point of contention in the draft law is a provision saying that the minister of health will specify certain government hospitals for cornea transplants. Mahran suggests that one way to circumvent the kind of corruption that formerly plagued the eye banks would be to create a special centre for cornea transplants, where the operation would be offered for free.
Mahran says that it will likely be four or five months "maximum" before the draft law goes back to People's Assembly to be re-discussed. "If agreed upon, it will be issued as law," says Mahran.
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