Embracing Cornea Donation in Nigeria

Contributed By Bibiana A. Adeniji

INTRODUCTION

Cornea damage or disease is one of the most common causes of blindness universally.^[1] In Nigeria, for instance, corneal blindness accounted for 9.6% and 20.4% of bilateral and unilateral blindness, according to a 2014 survey,^[2] and continues to contribute to the growing rate of blindness in Nigeria.^[3] This is despite the continued advocacy for the donation of cornea to eye banks in order to assist patients to recover their sight having suffered blindness from the damage of their cornea.^[4]

The cornea is a transparent outer layer of the eyeball which helps the eye to focus on light thereby aiding vision.^[5] It is an important visual agent as it is responsible for handling more than two-thirds of the focusing power and function of the eye.^[6] Thus a damaged cornea translates to a nonfunctional eyesight, i.e., blindness of varying degrees depending on the extent of the damage.^[7]

The Corneal Grafting Act was enacted in 1973 as a result of the need to have a legal framework to encourage the donation of cornea in combating blindness in the nation.^[8] However, efforts towards combatting cornea blindness through cornea grafting have been disconcerted as a result of several factors including the attitude of Nigerians towards the subject. This article will appraise the provisions of the Corneal Grafting Act Cap C29 LFN 2004 as well as its impact on cornea donation in Nigeria.

AN OVERVIEW OF THE PROVISIONS OF THE CORNEAL GRAFTING ACT CAP C29 LFN 2004

Enacted on the 5^th of May, 1973, the Act provides for the use of a deceased person’s eyes for therapeutic purposes.^[9] The Act has, among other medical legislations, since regulated the donation and usage of a deceased’s organ, to wit, the eyes for medical purposes in order to prevent the illegal usage or transfer of same. Thus, where a person expresses his desire in unequivocal terms, either in writing or orally in the presence of at least two witnesses during his last illness, to donate his eyes to be used for therapeutic purposes after his death, then a person in lawful possession of his body after death, may authorise that such deceased’s eyes be removed accordingly unless he has sufficient reasons to believe that such desire or request by the deceased was withdrawn before his death.^[10]

By section 1 (2) of the Act, a person in lawful possession of a deceased person’s body may consent to the removal of the deceased’s eyes in accordance with the earlier expressed request of the deceased except if he has reasons to believe that the deceased has objected to same or the surviving spouse or relative of the deceased objects to such removal.^[11] It is expedient to note that once an authority is confirmed on the existence of such request by a deceased person before his death, no further confirmation or authority shall be necessary.^[12] However, such authorised removal for the purposes specified cannot be carried out except by a registered medical practitioner^[13] who is duty-bound to examine the deceased’s body personally and be certain that the body is indeed lifeless.^[14]

Furthermore, where a person having the power to authorise the removal of the deceased’s eyes has reasons to believe that a coroner’s inquest is likely to be required and conducted on a deceased person’s body, he cannot give authority for the removal of the deceased eyes.^[15] Also where a deceased’s body is entrusted to a person by another person for the purposes of burial or cremation, such person entrusted with the body cannot give consent or authority for the removal of the deceased’s eyes.^[16] However, where a body is in the hospital, consent or authority required under the Act may be given on behalf of the person having control of the body or the authority, by an officer or person so designated.^[17] The Act however does not apply to such lawful dealings with a deceased body parts as may be in existence prior to the enactment of the Act.^[18]

IMPACT OF THE ACT ON CORNEA DONATION IN NIGERIA

The Act, designed to provide a legal basis for the removal of the cornea of a deceased who has willingly donated same to the Cornea bank, has regrettably not had much impact on cornea donation in Nigeria. Although it is agreed by medical experts and ophthalmologists that the statistics of people living with Cornea blindness in Nigeria is high and same can be corrected through a surgical procedure known as corneal grafting,^[19] the lack of awareness as well as the belief system prevalent among Nigerians has made corneal grafting rather difficult in spite of the fact that a lawful basis exists for the procedure.

Speaking at the 47^th Annual Conference of the Ophthalmological Society of Nigeria, themed “Improving Access to Quality Eye Care” and sub-themed “Sustainable School Eye Health Corneal Donation and Eye Banking” the President of the Society, Dr Abiola Oyeleye, while discussing the reluctance of Nigerians to donate their corneas based on ‘traditional and cultural reasons’ stated as follows:

“We have a cornea bank in Nigeria that has been established for about 30 years, yet it is the only bank that is empty, so we need to encourage people to donate their corneas upon their death or that of their relatives…

“What we are trying to do is be able to preach the gospel (of cornea donation) and stop winking in the dark. We need to be able to wink where people will see us…

“We have to make people who have benefited from cornea donation visible, and we need to let people know that cornea donation has nothing to do with reincarnation; this would encourage people to want to donate willingly. If you donate your cornea, it can give at least two people who are blind their vision back.”^[20]

It was also observed that because of the lack of corneas in the bank, Nigerians have resorted to procuring same from outside the country which makes it costly owing to the expiration period of same,^[21] as it needs preservation before use.^[22] Moreover, the sourcing of cornea from abroad has also been facilitated by some stakeholders in order to convince the Nigerian public of the viability of cornea donation but same has not had much impact.^[23] Furthermore, Nigeria’s eye bank faces several other challenges such as space, shortage of staff, non-registration of an eye bank with the relevant association, non-notification of the eye bank on the death of potential donors, etc.^[24]

There has thus been a call for increased awareness of the success rate of corneal grafting in restoring sight of persons affected by corneal blindness, in order to occasion a mindset shift for Nigeria, provision of the necessary facilities for the practice of corneal grafting in Nigeria, increased public-private partnership in fostering cornea donation, etc.^[25]

CONCLUSION

The Corneal Grafting Act came into existence as a result of the need to provide a legal basis for the donation of cornea in order to address cornea blindness in Nigeria. However, the law seems not to have had so much impact on the practice in Nigeria as a result of several factors including cultural and traditional beliefs, lack of awareness, inadequate facilities, etc. There has nonetheless been a call to address these challenges as cornea blindness, which can be easily addressed through corneal grafting and transplant, continues to be a common cause of blindness lacking adequate attention in Nigeria.

1. Ifedayo Ogunyemi, “Blindness from Diseased Cornea is Reversible but Nigerians need to embrace Corneal Donation- Ophthalmologist” Nigerian Tribune (June 23, 2022) available at https://tribuneonlineng.com/blindness-from-diseased-cornea-is-reversible-but-nigerians-need-to-embrace-cornea-donation-ophthalmologist/ accessed on the 14^th of October, 2023 ↑
2. Mukaila A. Seidu, Boluwatife A. Olusanya and Ayobade O. Ogundipe, “Prevalence and Determinants of Corneal Blindness in a Semi-Urban Population of Southwest Nigeria” Nigerian Journal of Ophthalmology, 2017; 25; 18-27 available at https://www.ajol.info/index.php/njo/article/view/159409/148971 accessed on the 14th of October, 2023. ↑
3. Lara Adejoro, “Over One Million Nigerians Blind, Ophthalmologists inadequate- Experts” PUNCH (24^TH August 2023) available at https://punchng.com/over-one-million-nigerians-blind-ophthalmologists-inadequate-experts/ accessed on the 14^th of October 2023. ↑
4. Ifedayo Ogunyemi, op cit. (fn. 1) ↑
5. See Aruj K. Khurana, “Comprehensive Ophthalmology. Diseases of the Cornea”. 4th ed. New Delhi: New Age International (P) Limited, Publishers; 2007. p. 89-90 ↑
6. Mulita Musa, et al., “An Overview of Corneal Transplantation in the Past Decade” Clinics and Practice, 2023; 13; 264-279, available at https://www.mdpi.com/2039-7283/13/1/24 accessed on the 14th of October 2023. ↑
7. Ibid. ↑
8. Nkechi Ibeneme, “Cornea Transplant: How a Blind Nigerian Teenager Regained Sight” THISDAY (2017) available at https://www.thisdaylive.com/index.php/2018/02/17/cornea-transplanthow-a-blind-nigerian-teenager-regained-sight accessed on the 14th of October, 2023. ↑
9. See the Long Title to the Act. ↑
10. Section 1 (1) of the Act. ↑
11. Ibid. Section 1 (2). ↑
12. Section 1 (3) of the Act. ↑
13. Duly registered under the Medical and Dental Practitioners Act. See the Interpretation Section of the Act. ↑
14. Ibid. ↑
15. Section 1 (4) ↑
16. Section 1 (5) ↑
17. Section 1 (6) ↑
18. See Section 1 (7) ↑
19. Sola Ogundipe, ‘VISION RESTORATION: Pledge to Donate Your Corneas, Ophthalmologists Charge Nigerians’ (VANGUARD, September 5, 2023) available at https://www.vanguardngr.com/2023/09/vision-restoration-pledge-to-donate-your-corneas-ophthalmologists-charge-nigerians/ accessed on the 23^rd of October 2023. ↑
20. Ibid. ↑
21. Ibid. ↑
22. Nkechi Ibeneme, op cit. (fn. 8) ↑
23. Ibid. ↑
24. Ibid. ↑
25. Ibid. ↑