Last year, Ghana saw its first ever sets of successful corneal transplants in two major facilities, which saved the sights of at least 14 citizens, on the verge of blindness, marking a significant milestone in the optometry and ophthalmology fields of the health sector.

The surgeries, performed free of charge, were done in collaboration with the Himalayan Cataract Project (Cure Blindness), a United States-based health Foundation working to end the scourge of blindness.

The first set was performed in February in Accra at the Korle Bu Teaching Hospital (KBTH) where six people underwent the procedure, while the next was done at the Cape Coast Teaching Hospital (CCTH), in August, to restore the sight of eight others.

Corneal Transplant

Corneal transplant is an operation to remove all or part of a damaged cornea (the transparent part of the eye that covers the iris and the pupil and allows light to enter the eye) and replaced with healthy new tissues from a donor (a recently dead person).

The procedure is used to treat conditions like corneal ulcer, corneal dystrophy (inherited eye diseases), Keratoconus (thinning disorder in the cornea) and complications from cataract surgeries.

Unlike cataract surgery, corneal transplant is a bit uncomfortable until the body tissues heal completely and patients are able to see clearly, mostly after one month.

With a success rate of about 90 per cent, corneal transplant is the best of all forms of surgeries, experts say.

Rejection of the new tissues by the patient’s immune system and a drop in tissue quality, resulting from transportation, are some phenomena accounting for the procedure not having a 100 per cent success rate.

Three doctors from the US and three cornea surgeons from the Korle Bu Teaching Hospital and the Komfo Anokye Teaching Hospital (KATH), trained by Cure Blindness, took an average of one hour to operate on each patient.

The Need for Eye Bank

Interestingly, however, the corneas were donated by eye banks in America after Cure Blindness, which funds research leading to the cure of eye diseases, had placed a request to enable them to undertake the surgeries.

This is because Ghana does not have an eye bank, a specialist facility that harvests, medically examines and distributes cornea tissues for transplant, research and education.

For such a delicate medical procedure, experts say it is neither advisable nor sustainable for Ghana to depend on the benevolence of foreign countries and their facilities.

The high numbers of persons with corneal conditions in Ghana, coupled with a raft of other factors, create a desperate situation for an eye bank in the country, Dr Kwadwo Amoah, a corneal specialist and Ashanti Regional Ophthalmologist, had said.

Beyond the fact that the country is not guaranteed a constant supply from benefactors, transporting cornea over long distances could affect the health and optimal function of the tissues, he added.

Indeed, another set of corneal transplants for some lucky patients in Ghana scheduled for the early part of this year was thwarted by severe weather conditions, which affected eye banks in the USA, the Ghana News Agency (GNA) reported in February, 2023.

Dr Geoffery Tabin, the Chairman and Co-Founder of Cure Blindness, told the GNA that: “We had a record spell of cold weather and there was a huge storm in America, which made it difficult for the eye banking team to collect the tissues.”

He said with a backlog of more than a thousand Ghanaians needing corneal transplants, it was important to establish an eye bank in Ghana within the next 10 years.

Religious and Cultural Implications

There are frantic efforts by major stakeholders, including Cure Blindness and some specialists in Ghana, to build an eye bank, but like many African countries, it was difficult to get the corneas due to some cultural and religious beliefs, Dr Tabin said.

People did not want to have the bodies of their loved ones tampered with before they were buried, he said.

“There is high reverence for the dead in Ghana as well as a strong belief in the hereafter and, therefore, it is considered abominable to cause ‘disability’ or ‘deformity’ in the dead.”

These beliefs, coupled with the lack of a legal framework to regulate the harvesting of human tissues are major impediments to the quest to save people from blindness, Dr Tabin said.

“With the advancements in science and technology, which are making medical procedures like heart and kidney transplants possible, are there still good reasons to hold on to the age-old beliefs? Or maybe it is time to make sacrifices to enable the ‘dead’ save lives and give comfort to the living” he said.

The Singaporean Story

Dr Tabin, also a Professor of Ophthalmology in Global Medicine, Stanford University, said there was only one eye bank functioning in Sub-Saharan Africa, situated in Ethiopia, which barely supplied enough tissues for surgeries.

Worthy of note is the fact that a “very successful” eye bank has been established in Singapore through its religious leaders, he said.

“We had Buddhist, Monks and Hindu priests saying you are not going to be sending your loved ones blind into reincarnation,” Dr Tabin said.

“You are going to give them a better reincarnation because this last act of kindness is going to help another human being and that will help them achieve higher state in the reincarnation.”

And, instead of doctors asking for the donation, the Buddhist and Hindu priests lead the cause.

The Himalayan Cataract Project, thus, intends to take a similar approach to rally traditional and religious authorities in Ghana to support the mission.

“I’m hoping that we can have some cultural leaders like the Ashanti King and maybe some well-known actors and people who can support the idea of cornea donation.”

Christian Perspective

When the GNA sought the view of Rev Philip Nana Owusu of the Wesley Methodist Cathedral in Cape Coast on the subject, he expressed his support for the idea, describing it as worthy.

He notes that some of the religious beliefs, particularly those against medical procedures such as blood transfusion and organ transplant, are “misconceptions some people hold”.

Some are fueled by the lack of understanding, which requires deliberate education.

Rev Owusu acknowledged the differences in religious beliefs but, as a Christian, he thought that the human body was only flesh and blood and, therefore, it could not go into the Kingdom of God physically.

“If somebody is involved in an accident and the person cannot even be identified, does it mean the person is going to heaven with a burnt body? That is not true.”

As Jesus preached love, Christians should see the donation of certain parts of their bodies as a social responsibility to save lives, he said.

“It can be a means of evangelism because if I donate an organ of my dead relative to somebody, the person sees it as a demonstration of love.”

“The bible is not against any of these things. As a religious leader, I wholly embrace such a move.”

He proposed a joint and multifaceted stakeholder engagement to tackle the issue holistically “else it will always be distorted with half-truths.”

Islamic Perspective

Alhaji Alhassan Kofi Ansu of the Cape Coast Circuit of the Ahmadiyya Muslim Mission, encouraged citizens to donate tissues if they could, for the sake of Allah.

Citing the Quran, he said: “Allah says that whoever gives life to a soul gives life to the entirety of mankind and vice versa.”

“Islam believes that Science comes from the Quran, and therefore it would be a service to mankind and Allah if a qualified person, through a scientific procedure, donates a tissue to save another life.”

However, he advocated proper procedure to avoid abuse.

Varying Opinions

Some Ghanaians expressed varying opinions on the donation of cornea tissues in separate interactions with the GNA.

Isahak Abubakar, a carpenter, said he would consult his religious leaders before taking any such decision, pointing out how his religion treats the dead with reverence.

“In Islam, the laws are put on hold in certain emergencies but if I have to do a gesture like that, I will first ask my leader,” he said.

Madam Emelia Nketsia, a sales attendant, noted that aside from her Christian beliefs, she personally rejects the idea of cornea donation.

Like blood, she is concerned that cornea tissues would be sold to patients and so she would not advise anybody to donate at all.

Legal Framework

Stakeholders have initiated a myriad of activities to enact a legal framework to make the donation of tissues and organs such as heart and kidney lawful and also to regulate the space.

In furtherance of that, the Ophthalmological Society of Ghana, with support from Cure Blindness, organised the first-ever inaugural cornea transplant summit in Ghana, in March this year, on the theme: “Paving the Way to Cure Cornea Blindness in Ghana.”

At the summit, Dr Anthony Nsiah-Asare, the Presidential Advisor on Health, implored legislators to expedite the legislation for corneal and other organ transplantation to help save lives, citing the social and economic impacts of blindness.

“This is the missing component of the puzzle. Many go blind every day because we do not have the requisite legislation in place to guide human organ and tissue donation, counselling, storage, and distribution for necessary transplants to take place,” he noted.

Need for Training

Dr Amoah, one of the only four ophthalmologists qualified to perform corneal transplants in Ghana, reiterated the limitation to their work due to absence of a law.

Even though no law banned people from giving out their organs, such donations could be abused if the space is not properly regulated.

“We need to train people but how can we train them when there are no tissues and other organs. We need to have the law passed and have the national eye bank built,” he said among other concerns.

“There is every reason to have an eye bank to harvest tissues. If you are a black person and you are given the body part of a white man, a lot can go wrong.”

Way Forward

A Ghana Blindness and Visual Impairment study in 2015, conducted by the Ghana Health Service and its partners, showed that 11.2 per cent of the blind population in the country suffered the defects as a result of corneal scars.

This meant that about 25,000 of Ghanaians who were blind then had corneal problems.

The figure has probably increased significantly and may keep rising if stakeholders fail to expedite action to get a law passed, build an eye bank and educate the citizenry on the need to donate tissues.

The overreliance on foreign countries for every pressing need must eventually cease.

The conduct of corneal transplants by Ghanaians, with tissues from Ghanaians from a Ghanaian eye bank must be the way to go.

And like Nelson Mandela said: “It always seems impossible until it is done”.

This, however, does not seem impossible and it must be prioritised and established in no time to save the ‘eyes’ of the country.

Source: Ghana News Agency