'When I die take all my organs'

A cold chilly morning. Half past seven. Hundreds of patients wearing sullen faces are queueing at Lions SightFirst Eye Hospital in Nairobi hoping to regain their sight.  

But one patient, high in hopes to get his eye complication sorted, sighs when Healthy Nation greets him. He looks deep in thought and then gives a curious gesture as more patients join the queue.

“I have decided to donate all my body organs, bones, basically everything to science and research or whoever needs them when I die,” Mr Philip Ogolla, a Nairobi-based digital media practitioner, whispers as he moves his left palm to his heart. That’s a message everyone needed to hear.

The father of two urgently needs a cornea transplant to salvage his failing right eye but for that to happen, 951 other Kenyans who come before him on the recipients list need to be served first. 

It breaks his heart that only Kenyans of Indian descent are willing and ready to donate the required parts as Dr Priyanka Bhuyar, an ophthalmologist and the lead cornea and refractive surgery specialist at the facility who is treating him, discloses. 

“Last month only four people from the Asian community donated their corneas to the facility upon their demise,” he says.  

Dr Bhuyar explains that a cornea transplant is most often used to restore vision to a person with a damaged cornea and can also relieve pain or other signs and symptoms associated with cornea diseases.

Scientific research shows that after someone dies, it takes six to eight hours for cornea cells to die and so harvesting of the cornea needs to happen in between that timeframe.

According to the expert, a number of conditions can be treated with a cornea transplant. They include, a cornea that bulges outward (keratoconus), Fuchs’ dystrophy, which is a hereditary condition, thinning or tearing of the cornea, cornea scarring usually caused by infection or injury, swelling of the cornea, corneal ulcers not responding to medical treatment and complications caused by a previous eye surgery.

“In Kenya as per what I have observed, most of my patients have keratoconus and they form the majority of the transplantations we do here. We only harvest the cornea, the transparent part of the eye, from dead people and do not do live donors or animals like sheep —  that has been a misconception,” the ophthalmologist highlights while explaining that the genetic compatibility of animals and humans is very different. 

Ms Rizwana Peerbhoy, the general manager at the eye hospital,  notes that they have treated many children’s eyes who rub their eyes when they play in dusty environments. The resulting constant irritation tends to make their cornea thin. 

“When you are driving and your windscreen gets shattered, that’s it, your visibility is gone, the cornea is the windscreen of the eye, it is actually a very clear tissue, “she adds while pointing out that it costs Sh250,000 for a cornea transplant at their facility,” says 

Being on the frontline for the past decade at the Kenya Redcross Society as a first responder to disasters including Dusit and Westgate opened Mr Ogola’s eyes to the reality of Kenya’s dilapidated state of organ and tissue transplant mechanisms. Many people, he realised, are suffering because there’s no one to donate organs when they die yet the organs “are going to rot in the ground.” 

That has disturbed him for a very long time because such conversations  never happen yet thousands of people in dire need of blood and body organs die everyday.

He has been to accident scenes with mass casualties where 67 or even 100 people have lost their lives. “Can we have a mechanism whereby we can harvest body organs from these incidents and store them for whoever needs them? Once you are dead, you are just dead and gone,” he observes.

Mr Ogolla reveals that reality hit him hard upon visiting the facility’s eye bank.  “It is sad when you find that their fridges are empty because there are no donors. This is why I want to lead the way as an example by donating all my organs when I die so that someone else benefits.”

He urges everyone to take lessons from Covid-19 pandemic. For him, Covid-19 was a very big lesson because religion was disrupted. “If churches can be closed because of a health issue and we listen to science and medical experts for once, can we listen to them on this? Can we separate our religious beliefs and culture from health issues that are a matter of life and death?” 

The cornea transplant forms the bulk of all transplants done in the world as eye transplants have a very high success rate. As for Mr Ogolla, he has keratoconus in both eyes, it is quite advanced which is why he needs urgent transplantation even after he had intacs placed in them in India.

Intacs is the trademark name for micro-thin prescription inserts which were previously used as a form of refractive surgery in the treatment of low levels of myopia or nearsightedness but received the Food and Drug Administration approval for the treatment of keratoconus. 

According to Dr Bhuyar, the procedure involves placing the plastic inserts just beneath the surface of the eye in the periphery of the cornea. 

It takes approximately 15 to 20 minutes after which anaesthetic drops are used to numb the eye and a clamp is used to hold the eye open throughout the procedure to prevent blinking.

When inserted, they flatten the cornea, changing the shape and location of the cone which means the placement of intacs remodels and reinforces the cornea thus eliminating some or all of the irregularities caused by keratoconus in order to provide improved vision. 

This can improve uncorrected vision though depending on the severity of the keratoconus, glasses or contact lenses may still be needed for functional vision.

Mr Patrick Wambugha, the ambulance driver and the cornea retrieval assistant at the eye hospital, tells Healthy Nation that he is now used to visiting the morgue even at odd hours of the night whenever a call is made. 

“This is my seventh year working here and at first I used to be afraid of dealing with dead bodies but thanks to the training I have received so that I am able to assist the specialists who I drive to different locations to harvest the cornea whenever a call is made that someone has passed on. I am used to the job because to me this is all about giving hope to someone else who is in dire need,” he says.  He, however, points out a huge challenge he feels those who transport organs from donors to recipients face in the country. 

“Nairobi has endless traffic jams which pose a huge challenge when it comes to collection of the donated cornea because I have to rush and bring it before six hours elapse yet sometimes the donors are far away. All ambulances need to be fitted with sirens too as drivers have to endlessly hoot, which annoys many road users. 

“I have seen the management book flights, for example the other day when a donor from Kitale passed on.”

The driver further discloses that they have to sometimes deal with ‘unfriendly relatives’ of the deceased who has made the donation. 

“Due to culture and various beliefs, some people do not entertain the idea of their loved ones donating organs to someone else and so you might find that the donor even pledged and consented to the cornea being harvested but his or her family does not see the bigger picture and so we have to be very patient with them and take a lot of time convincing them because we know that someone else’s life and a second chance at full sight is depending on this.”

“There is a religion that believes their loved ones upon death will go somewhere where they will be offered seven virgins. There is a family that once asked us to explain to them how we expect their loved one to see the seven beautiful virgins he is going to see in the afterlife if we ‘take away’ his eyesight. People need to understand that an eye donation does not imply that we harvest the entire eye out if its sockets, we only take the corneas and infact, no one will notice they aren’t there,” Mr Christopher Mwangala, a cornea retrieval specialist at the hospital, notes. 

He is incharge of the eye bank where harvested corneas are stored.  

“We don’t rule out any corneas save for those from donors who have battled chronic infections such as HIV/AIDS, Syphilis and Hepatitis because if you transfer tissues from them,  healthy recipients will get infected. Local Kenyans usually pledge but they never donate,” the retrieval expert explains while noting that they conduct endless tests before adding a harvested cornea to their bank. 

Mr Mwangala has pledged to donate his cornea when he dies.

“I would urge people to pledge and donate, we will all die someday that’s a given and so this should not be a big issue as it won’t affect you in any way.” 

Ms Peerbhoy reveals that due to high demand yet little to no cornea donations from Kenyans, they resorted to importing from Europe and the US.

“We are members in almost all the eye banks globally and they usually alert us when they have them but it is too expensive and so we have been talking to religious and community leaders so that we get Kenyans to change their perspectives on this but more needs to be done, “she says. 

On August 4 this year, President Uhuru Kenyatta okayed the birth of a new authority mandated to oversee tissue and organ transplants in the country in a gazette notice. 

The gazette notice explained that  the Kenya Tissue and Transplant Authority will succeed the department of the National Blood Transfusion, Tissue and Human Organ Transplant Services existing at the Ministry of Health with an objective of ensuring  access to safe and ethical use of human cells, tissues and organs and the safety, biosafety and wellbeing of donors and recipients in medical services relating to human derived medical products through the establishment and maintenance of systems that comply with safety and legal requirements.

“The authority shall maintain a registry of transplant service providers, donors and recipients and establish an equitable mechanism for matching and allocation of cells, tissue and organs,” President Kenyatta said while highlighting that the authority shall also mobilise, educate and sensitise members of the public to foster voluntary donations of cells, tissues and organs.

It will inspect hospitals periodically for examination of the quality of transplantation and the follow-up medical care to persons who have undergone transplantation and persons from whom organs are removed. The authority has further been given the power to enter, search and inspect any place suspected of indulging in unauthorised removal, procurement or transplantation of human cells, organs or tissues.

In an official response to queries fielded by Healthy Nation, Health CS Mutahi Kagwe lauded President Kenyatta in his efforts towards reforming the country’s healthcare system.

“The President is so passionate about making health affordable to everyone and this has been his top priority as enshrined in the Big Four Agenda that explains his desire to make Universal Health Coverage a success in the country.

“This authority is a huge step and will help millions of Kenyans who have been suffering due to the lack of a national well-coordinated transplants and organ donation structure as well as blood transfusion services.

Our goal as a government has always been to provide the best quality healthcare services and we are thankful that the president has renewed our vigour,” Mr Kagwe said while adding that more needs to be done in terms of training and implementation so as to ensure the new authority runs smoothly and is well coordinated to sub county level and grassroots.   

In an exclusive telephone interview with Healthy Nation, Mr Alfred Obengo, the director of the newly constituted board,  asked Kenyans to give them time to settle in. 

“We are developing institutional capacity as there have been major gaps in policy and legal framework. Kenyans need to give us time because we understand the task ahead of us but for sure we will prioritise civic education on organ, blood and tissue donation and transplantation, which is where misconceptions, religious and cultural beliefs fall,” he assured. 

As Mr Ogola patiently waits in line for a cornea transplant, he says he has chosen a new path which involves creating lots of awareness. 

“Imagine if we as a country decided to have a digital system linked to a database accessed by all hospitals, one where our identification cards or driving licences captures our blood groups as well as whether we have pledged to donate our organs. 

“Wouldn’t it make it easier for those working at emergency response centres or police officers to access patient details, get consent and deliver organs to the recipients waiting in line when one dies in an accident so that a person in need gets it on time? 

“The National Hospital Insurance Fund has already paid Sh250,000 for my surgery, my fingers are now crossed.”  

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