A corneal transplant is a highly successful procedure but even so most people suffering
from corneal disease don’t have their eyesight restored. That’s because most corneas
end up in the trash as a result of a new government policy on organ transplants
By Elise-Marie Tancred
Five years ago Sharon van
Mechelen (38) was the
ultimate water baby.
This sports-mad young
mother lived an active life,
skiing, swimming and
diving regularly. She loved every minute of it.
Fortunately, her soft contact lenses for
short-sightedness made life easy. Or so
But in early 2003, just 10 months after the
birth of her second child, Sharon’s sight began
“Eventually I could only distinguish
between light and dark,” she says. Within
a year she was practically blind and completely
dependent on those around her.
Fortunately, in 2004, a simple operation
restored her sight and independence. Donor
corneas replaced her severely damaged ones
and a day after the procedure she could see.
“Everything was so clear – it was like
a miracle,” says Sharon, who hails from
Durbanville but now lives in New Zealand.
“The last time I’d seen my baby he was
10 months old – and he’d changed so
much. When I was blind he avoided me
and wouldn’t let me hold him. After the
transplant I could look into his eyes and
cuddle him again.”
This kind of transplant is necessary when
the cornea – the transparent covering of
the eye through which light penetrates – is
irreversibly damaged. Impairment can be
caused by congenital corneal defects, illness,
viruses or – as in Sharon’s case – infection.
Single-celled organisms that live in rivers
and dams – Acanthamoeba – nested in the
hollows behind her contact lenses, causing
small abscesses that destroyed her corneas.
Fortunately for Sharon, the transplant
turned things around.
Many other South Africans have similar
stories of escaping the blight of blindness.
That’s what makes the corneal transplant one
of medical science’s greatest achievements.
It’s regarded as the most successful transplant
procedure, with a success rate of over
92 per cent.
In a small percentage of cases
the donor cornea may be rejected by the
body or the stitches may come loose so
that the operation has to be repeated. The
transplant is also an inexpensive procedure,
costing less than R5 000 per local
cornea used. The total cost of the operation
is roughly R40 000.
But the future is bleak for the thousands
of South Africans who are waiting to have
the operation. The dire shortage of donor
corneas means they might never see again,
thanks to short-sighted government policy.
Ironically, in a country where people
die every day – in road accidents, through
violent crime or ill health – there should
be more than enough donor corneas.
But recent legislation laid down by
the Department of Health has made it
extremely difficult for surgeons to get the
corneas they need.
“It’s an absolute tragedy,” says Dr Harold
König, president of the Ophthalmological
Society of South Africa.
König says about six years ago, ophthalmologists
could get up to 80 corneas a
month from eye banks. Two years ago that
number dropped to 40 a month. By June
2008 there were only three corneas available
– one of which was older than
14 days and couldn’t be used. The following
month there were none.
There are about 4 000 patients on official
waiting lists at South Africa’s five eye banks.
But most government hospitals no longer
even add potential cornea recipients to the
list as there’s no point.
“We could save these patients’ sight if we
could get hold of corneas,” König says. “It’s
a very serious problem and the Department
of Health is doing practically nothing. We
hope that now, with the appointment of a
new minister, progress can be made.”
The crisis began when it emerged that staff
at some government morgues were dealing
illegally in body parts. The then Minister
of Health, Dr Manto Tshabalala-Msimang,
responded by transferring the morgues
previously under the jurisdiction of the
South African Police Services to that of the
Department of Health.
An embargo was
placed on information, thereby preventing
government morgues and hospitals from
notifying tissue and organ banks, including
eye banks, when organs were available.
As a result, eye banks cannot contact
relatives of the deceased to ask for the
donation of their corneas and hundreds of
corneas that could restore the sight of many
patients are being buried or destroyed daily.
This year, the Cape Eye Bank hasn’t
received a single cornea from the Salt River
government morgue, the same morgue that
provided up to 90 per cent of the hospital’s
corneas in the past.
Dr Hubrecht Brody, ophthalmologist and
founding member of the Eye Bank Foundation
of South Africa, says doctors understand
the reasons behind the legislation,
but regard the lumping together of all tissue
banks as ill-advised.
“We made several representations to
Dr Tshabalala-Msimang, but we never
received an answer,” Brody says. The lack
of donor corneas has other, far-reaching
“We’re forced to allow young ophthalmologists
to complete their studies without
having done a single corneal transplant,”
“Our young doctors are
simply leaving the country – not because
of crime but because they’re not given the
opportunity to complete their training
properly. This damages South Africa’s
medical image overseas.”
To get the corneas they so desperately
need, patients can import them from the
United States at a cost of R22 000 each.
Some medical aids will pay for imported
corneas, others won’t.
This means a transplant
which should be a relatively inexpensive
procedure becomes an exorbitantly
expensive undertaking. The result: the rich
have their sight restored while the poor remain
To complicate matters the best corneas are
kept for use in America, where about 80 000
corneal transplants are performed annually.
Sharon van Mechelen was fortunate
enough to experience the miracle of
a corneal transplant.
But before the
operation, the invisible organism had
damaged her eyes to such an extent that
she couldn’t look after her children. Her
weight dropped to 46 kg and she was in so
much pain she had to be hospitalised and
treated with intravenous
Yet, only a few days after the transplant
she could see her son blow out the two
candles on his birthday cake. “Thanks to
a cornea donation, I got my life back,” she
says. “That’s why all the members of my
family have now registered as donors.”
Brody agrees that becoming a donor is the ultimate gift. “By donating your corneas
you can give someone a new lease on life,”
Two years ago, Brody’s brother-in-law
Bernard Kloppers was shot dead during
a crime-related incident at his Vanderbijl
Park home. “My sister Marie is comforted
by the fact that two blind people can see
because she donated Bernard’s corneas,”
“But it’s still a huge frustration. We could
do so much. The resources are available
but the will of the government is lacking,”
“That’s why we appeal to all South
Africans to consider the seriousness of the
situation. Perhaps you
or a relative will need new corneas one
day . . . ‘new’ eyes and the ability to see are
of the greatest gifts you can give your fellow
Contact Dr Brody on 021-948-5650
Blind no more
Thomas Strauss (21),
student, has had
serious bilateral keratoconus
(a thinning and distortion of
the cornea in both eyes) since he was a child.
As a teenager he had to wear two sets of
contact lenses – hard and soft – and carried
a little black bag of lenses, eye drops, painkillers
and antibiotics wherever he went.
Eventually the lenses tore his corneas and
two years ago he was led into an eye specialist’s
surgery, blind. Today, following two corneal
transplants, he’s completed his first year at
university and is independent.
“I used to be
a prisoner of my eyes,” Thomas says. “Now it
feels as if someone’s set me free.”
Three years ago Jeannine Nestel (39), a single parent of two daughters, was diagnosed with the corneal disease keratoconus. A corneal transplant was her only hope.
was fantastic –
I got my life back,”
times and during the past two
years Jeanine has had three
painful procedures to reattach
“When I remember how
dependent I was – I always had
to ask someone to lead me or
take me somewhere – I know
the operation was worthwhile.”
Today Jeannine is a financial
consultant who travels the
length and breadth of the
Western Cape to visit clients.
Become a donor
If you don’t have HIV or hepatitis B, call the
Eye Bank Foundation of South Africa on
021-447-5151 and sign up now. The staff at
eye banks know exactly how traumatic it is for
families when a loved one dies.
That’s why you
should tell your family if you want to become
a cornea donor – it’ll make things easier for
them when you pass away.
Corneal transplant. Cape Eye
Hospital, 9 September 2008.
10:10 Andries Pepler (81) of Franschhoek
just before he is given anaesthetic. His
left eye is almost blind.
10:56 The area around the eye has been
sterilised. A disc will be cut out of the
10:57 The disc – 0,6 mm in diameter and
2 mm thick – is carefully lifted out. An
arrow indicates the corneal disc.
11:00 A rare moment: the patient without
a cornea. The doctor looks through a
microscope, enlarging the eye 16 times.
12:01 The new cornea has been attached
using the finest nylon, which is only a
quarter of the thickness of a strand of hair.
12:03 Antibiotics and cortisone are
applied to the eye to prevent infection