/ 2 June 2009

SA lacks foresight to donate corneas

A government policy change has resulted in a severe shortage of corneal transplants in South Africa.

A government policy change has resulted in a severe shortage of corneal transplants in South Africa, leaving thousands of near-blind patients on years-long waiting lists and highlighting the need for a national organ donation programme.

The country’s eye banks, responsible for harvesting and distributing all corneas in the country, have experienced a shortage of donors since mortuaries changed hands from the South African Police Service (SAPS) to the Department of Health in 2006.

Under the SAPS, mortuaries gave eye banks contact information about families of dead people who could be approached for donations. Under the department, however, mortuaries do not release this information because of patient confidentiality.

While this policy protects patient identity it adversely affects the number of corneas available for donation. ”Mortuaries are now not in a position to pass on any information to us and that was the largest source of potential donors,” said Sharon Munnik, director of the Cape Town Eye Bank. ”We’re not in the position to call hospitals because medical records are confidential and so we don’t have any donations.”

Munnik estimates that nationwide 3000 patients are waiting for corneal transplants. According to Hill, the number of corneas available is 5% of those previously available.

”The waiting list used to be three or four months, now it’s three or four years,” said Hill, adding that the official waiting lists did not reflect the actual number of patients in need of transplants. ”Because we know that there are no corneas we don’t put people on the waiting list until they’re really desperate.”

Each corneal transplant takes about 40 minutes and costs R15 000. ”It’s sad, the number of people waiting for a small, simple operation. Obviously the benefits of a corneal transplant are huge for someone who can’t see,” said Hill.

Tanya White (41) waited four years for a corneal transplant. ”I couldn’t see anything out of my eye. I had a lot of pain and sleepless nights, but the only thing I could do was use eyedrops.”

Corneas can be imported from the United States for R25 000 each, but White could not afford the fee. ”I spoke to other doctors and there was just nothing they could do.”

”If you’re on a medical aid, [importing corneas] is fine, but if you look at your poorer communities they don’t have access to this,” said Munnik, who believes that due to financial constraints ”most of the 3 000 on the waiting list are not eligible for imported corneas”.

Eye banks are desperate for a change in what Munnik refers to as South Africa’s ”culture of organ donation”.

Although other countries, particularly those in Europe and North America, have national registries monitored by health departments and organ donation identity cards, no such policy has been instituted in South Africa.

Instead, organ donations take place on a voluntary basis, with consent required either from the patient or a family member in the case of death.

Fiona McCurdie, transplant coordinator at Groote Schuur hospital in Cape Town, said that most patients do not discuss organ donation with their families. ”Donating blood or bone marrow is a whole lot more user-friendly. People are willing to talk about it, but when it comes to ‘when I die —’ people like to think that they’re not going to die, that they’re going to be immortal.”

Because few patients discuss organ donation before they die, family members must make the decision immediately on hearing of a relative’s death. ”We’re asking for something that’s really tough at a difficult time,” said McCurdie.

Corneas must be harvested within 12 hours after death, leaving a small window period for consent. ”Giving your family members’ corneas when you’ve just found out that they’ve died is not a priority.”

Because of the high number of patients who die in public hospitals in South Africa, having patients register for an organ donation on admission to hospital has been discussed and ”would be ideal”, McCurdie said.

But the policy has yet to be implemented and there is scepticism about its feasibility. ”There are cultural, educational and situational issues that make it more complicated than in a first world country,” said McCurdie.

Government support for such an initiative is also lacking. According to a public sector ophthalmologist, who asked to remain anonymous: ”The government hasn’t come to the party in terms of organ donation, they haven’t understood the need for us to have a better transplant system. The funding is never going to be there, there are other priorities.”