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Organ donation still taboo

Since the establishment of the eye bank in 2010, there has been no cornea donated by indigenous Kenyans

Evelyn Makena @evemake_g

month ago, Nelson Mwangi* passed by his parents’ home on his way from work with a big announcement. Nelson, an IT specialist at one of the country’s eye hospitals, had made up his mind to donate his cornea on his death.

“Seeing many patients suffer with poor sight since they could not access a cornea transplant moved me to make the decision,” says the 32-year-old. Getting his parents’ consent was necessary for him to successfully sign up as a cornea donor.

Kenyan Asian donors

While it was easy convincing his dad, his mum was against the idea arguing that in case he died it was her wish that he is buried ‘whole’. Uncomfortable with the idea, she asked the son to give her time to pray about it. His father, a retired reverend who drafted his own eulogy five years ago, did not have qualms backing his son’s decision.

After a day of informing them of his decision they gave him a green light and gave their written consent.Mwangi is one of the few indigenous Kenyans who have signed up to donate their cornea to an eye bank at Lion’s Eye Hospital.

All donations received by the eye bank since it was set up in 2010 have been made by Kenyans of Asian origin. While the hospital receives at least 30 cornea donations from Kenyan Asians, indigenous Kenyans still shy away from the procedure because of cultural and religious beliefs that makes death and deceased organ donation a taboo topic. Besides the culture challenge, families and relatives have also been an obstacle to organ donation.

Culutre a huge obstacle

A few indigenous Kenyan donors have pledged their corneas, but upon death, their relatives stood on the way of the process by refusing to have the cornea extracted. Ideally, cornea should be harvested from the donor within six hours of death in a procedure that takes about 20 minutes and does not require the removal of the whole eye.

“Some potential donors shy aware since they believe that by giving [their cornea] away, they will be blind in the next life,” says Dr Pushparaj Singh, ophthalmologist, Lions SightFIrst Eye Hospital.

Singh says that low number of donations cannot match the high demand for cornea transplants, especially for patients of keratoconus, a degenerative eye disorder that’s prevalent in Kenya. It is estimated that one in every 500 people in the global population suffers from the disorder. The disease causes poor vision due to change of shape of the cornea and can lead to blindness.

Dr Geoffrey Wango, a psychologist at the University of Nairobi, says that cultural beliefs, especially those that relate to death make Africans hesitant to donate organs.

“Signing up to become an organ donor upon death is an admission that death is a reality you must confront someday. But traditional beliefs make people hesitant to talk about anything related to death,” he says. He reckons that donating organs to save another person’s life is a noble act and can give one the satisfaction of knowing that even after death, they will continue living in another person.

Mwangi admits to initially having reservations towards discussing death, let alone donating his organs. But his family’s open-mindedness about the topic inspired him to make the decision.

When his father, a retired reverend announced to the family that he had written his eulogy five years ago, they all panicked. “We thought that he was going to die soon. But he is still alive and healthy. He has changed how I perceive the subject and made me more accepting of the fact that it will one day happen anyway,” he says.

Demand for other organs

There is even a higher demand of other organs for patients with kidney, heart and liver diseases. It is estimated that four million Kenyans suffer from chronic kidney disease.

At least 10 per cent of the patients progress to chronic kidney failure requiring dialysis or a transplant. But despite the high demand for kidney transplants in the country, Kenyatta National Hospital, the largest referral hospital has only carried 90 kidney transplants in the last five years (15-30 per year).

“There is a legal framework that allows for living kidney donations from living relatives. But many tend to be ineligible due to hereditary diseases such as diabetes. Embracing deceased donor donations and getting organs from people not related to the recipients will increase the uptake of kidney transplants,” says Dr John Ngigi, Head of Renal Unit, Kenyatta National Hospital.

The proposed Kenya National Blood Transfusion and Organ Transplantation Services bill seeks to create a proper legal framework to allow for deceased organ donations. The law, under the Health Act of 2017 allows Kenyans to donate their organs upon death through a will or oral statement made in presence of two competent witnesses.

In the absence of a will, the spouse or spouses, elder child, parent, guardian, eldest brother or sister in the specific order mentioned upon that person’s death may donate the body or specific tissue to a person or institution. Despite there being a law to allow for organ donations, there is a gap in proper facilities such as organ banks needed to facilitate the process.

Organ donation in Kenya is altruistic and one is not paid any money, as experts believe selling may promote organ trafficking. “Dozens of Kenyans want to sell their organs for money. At KNH we have over 200 people that are willing to sell their kidneys. Most are young people below 25 years who say they want to get school fees, but the hospital cannot accept that,” says Ngigi.

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