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Dr Yao and his mission
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Song Yingwen
CORNEA donation is becoming standard practice in Shenzhen, thanks in large part to Xiang Chunmei, Duan Guosheng and many other pioneer donors in Shenzhen. But while the stories of these generous souls have received a great deal of attention in the press, there is another name which should not be neglected: the doctor who carried out the last wishes of the dying, and saw the donated corneas to their new hosts. He plays a key role behind the scenes as well, helping spread the word about the importance of cornea donation. His name is Yao Xiaoming.
Dr Yao is in charge of the Shenzhen Eye Bank and is director of the Corneal Department of the Shenzhen Hospital of Ophthalmology. With all the publicity surrounding cornea donation, he finds himself becoming something of a celebrity in the city.
He is, indeed, an outstanding specialist in his field, both in clinical experience and in academic research. Being the first doctor of medicine in keratopathy in Shenzhen, he not only performed the first cornea transplant in the city, but also the first successful cornea transplant from a living donor in China. And he is one of the chief compilers of the first monograph on eye banks in China, and, to top it off, is now a supervisor of PhD candidates.
But Dr Yao has not found local fame just from this impressive resume.
Young and energetic, he has a reputation as an enthusiastic advocate of creating new laws on cornea donation in Shenzhen in addition to his role as an eye specialist. His image as a devoted, high-profile publicist for cornea donation is probably more familiar to most ordinary citizens than his role as a
doctor. And by looking after the donors before and after their deaths, he has become a trusted friend of the families of the deceased.
Yao is, without any doubt, proud of all his roles: "I do all I can to encourage the idea of donating corneas and organs after death."
His efforts are paying off, as he says he has received more and more calls for donation. In the first month of 2001 alone he procured four corneas from two donors, the first time this has happened since the Shenzhen Eye Bank was founded in May 1999.
Yet despite this achievement, his face betrays anxiety: "For all our efforts, we are still facing a severe shortage of corneal tissue," Yao says.
Background
Cornea damage is one of the most common causes of blindness. Each year thousands of people lose their sight from corneal damage caused by disease, injury, or infection.
But with the help of cornea transplantation, an operation in which the damaged cornea is removed and replaced by a healthy one, these people can often have their eyesight restored.
China has an estimated three million people suffering blindness from corneal damage, but every year only 4000 of them are lucky enough to undergo transplant surgery because of the poor supply of corneas.
Shenzhen, according to Yao, is leading the country in terms of the quantity of donated corneas. From June 1999, when the first donation was made to the end of January 2001, there have been altogether 10 donors and 22 beneficiaries in the city. "This is a record in the country up to now," says Yao with a smile.
It was a proud yet bitter smile, for the figures show the supply of donated transplantable tissues still falls far short of demand.
"We had 138 corneas transplanted last year and there are still a lot of people waiting in line for the operation," Yao said. And out of all the tissues consumed in the surgeries on cornea transplantation last year, only 13 of them were from volunteered donors in the city, and Yao must count on eye banks in other cities for the rest needed, a worrisome state of affairs.
Yao has every reason to be worried. Though technology has developed where corneas can be replaced with new materials such as amniotic membrane and keratoprothesis, corneal tissue is still regarded as the safest and the most cost-effective material for transplantation because it is natural and is available in potentially huge numbers. But the cruel fact in Shenzhen as well as in many other cities in China is that the shortage continues, even though the techniques and hardware for procurement and storage of tissues are well developed. "A lot of patients are losing their best time for treatment because of the shortage," Yao says.
Problems and solutions
Turning the critical situation around is a tall order for Yao and his colleagues.
The main reasons their work is still such a struggle, according to Yao, are traditional views on treatment of the dead, and the absence of a presumed consent law, as well as laws that protect physicians against lawsuits filed by donors' relatives.
Although everyone knows that eventually we all turn to dust after we die, most people still belive that the body should not be mutilated after death but that it should be returned whole. A survey carried out by Yao a year ago indicated that in Shenzhen only 9.67 per cent of the 3,742 people interviewed were willing to have their corneas donated after death. Some of the people refusing included well-educated professionals.
But Yao believes that public awareness can be raised through publicity campaigns, literature and person-to-person contact after death of a relative or friend.
"Shenzhen is the best example of this. Following Xiang Chunmei, more and more people signed up to be donors after death, a direct result of the publicity," Yao says.
Publicity to Yao means encouraging the spirit of donating organs, calling for the concern of society and paying tribute and respect to the donors and their family.
"Making a donation is a noble act and the donors and their families deserve every respect," Yao states.
That's why he spares no effort in raising funds for donors in difficult financial situations and does all he can to help in medical treatment before their death.
That's why he attended the funerals of every donor and maintains regular contact with their families. And that's why he and his colleagues came up with the idea of sending a big thank-you note to the city's first donors in the newspaper on New Year's eve last year. "It's my way of paying my heartfelt tribute to them, and it's my way of calling for society to be grateful of them," Yao smiles.
But without the protection of law, all the efforts may be in vain. This is the greatest concern of Dr Yao.
The story of Hong Dingan, one of the cornea donors, gives us a picture of his concern.
Had it not been for Yao Xiaoming, Hong would be another volunteer who passed away in sorrow because his wish to donate his eyes was refused by several hospitals before he came to Yao. The reason was obvious: there is no specific law in China which spells out all the regulations on receiving donated organs. As a result, hospitals are unsure of when and how to accept the donated tissues and from whom. As a result, rather than risk lawsuits, they choose to turn down donation offers from patients.
"The absence of laws on the matter puts the hospitals in an awkward position. On one hand we are in desperate need for tissues, but on the other hand people with the intention to donate organs are confused, not knowing where and whom to turn to. Who knows how many Hong Dingans we have missed," Yao asks.
As a doctor who has spent so much time studying the experiences of other countries in which organ donation is well received and performed, Yao is in strong favour of the passage of laws on donation.
"The open attitude towards death and organ donation in many foreign countries is a reason for their high development in organ donation, but a sound and effective law system on donation is definitely the most important reason for their success. In the United States organ donation and procurement are protected by federal legislation. In some states, under the Drivers' Licence Laws, your driver's licence includes your will on organ donation on the back. It is the legal document for legal procurement of tissues after death. These enacted laws have made organ donation an easy and orderly procedure. It would make my job much easier if there were strict laws to follow here in dealing with donation," Yao continued.
Reportedly, a proposal for legislation on cornea and organ donation was made to the Municipal People's Congress in 1999 under the appeal of Yao Xiaoming and is now being drafted.
"My wish in the new century is that Shenzhen will become a city with its own legislation on organ donation. If there are enacted laws and strong public awareness on organ donation, donating cornea after death would become as popular as the idea of donating blood," Yao says with a confident smile.
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