HC Deb 06 May 1968 vol 764 cc37-43

Dr. David Kerr (by Private Notice) asked the Minister of Health if he will make a statement on the heart transplant operation.

The Minister of Health (Mr. Kenneth Robinson)

I welcome the opportunity to make a statement about the operation to transplant a human heart performed at the National Heart Hospital on Friday, 3rd May.

I should like to congratulate the entire hospital team on this outstanding surgical achievement. The patient's condition, I understand, is satisfactory, and is taking a normal post-operative course.

I gave the House on 25th March, in an Answer to my hon. Friend the Member for South Shields (Mr. Blenkinsop), the first conclusions of a conference convened by the Secretary of State for Scotland and myself to consider the problems arising from the transplantation of vital organs in man.

The conference recognised the public uneasiness about the possibility of premature removal of organs and agreed that vital organs should not be removed until spontaneous vital functions had ceased and two doctors, each independent of the transplantation team and one of them being at least five years qualified, had certified that this condition was irreversible. I understand that in this case confirmation of the death of the donor was given by more than two doctors of very considerable standing at the hospital to which he had been admitted after his accident.

The requirements of the Human Tissue Act, 1961, in regard to the removal of the donor's heart were fully complied with. The brother of the dead man gave permission acting for the family as the widow was herself in hospital unable to be consulted because of her own serious condition.

My Department recently issued advice to hospitals to guide them as to the demand for news coverage because of the press and public interest in advanced surgery. I wished, among other things, to protect the interests of the patient and his relatives and those of the donor, and to ensure that no names should be disclosed without the free consent of those concerned.

The National Heart Hospital acted in accordance with my advice, but names were revealed to the Press from sources other than the hospitals concerned. No observers were present at the operation and only the normal clinical photographs were taken, which will not be released.

Dr. Kerr

The House is grateful to my right hon. Friend for that very full Answer and the reassurances which it contained. I wish to put three questions.

First, will he acknowledge our great sympathy and admiration for the bearing of the donor's widow and couple with that our concern for the rapid recovery of Mr. West?

Secondly, while I am in no way behind my right hon. Friend in his admiration for the technical achievements of this magnificent operation, may I ask him to seize a tactful opportunity to bring to the attention of those concerned that medicine, and particularly this aspect, is an international activity which is perhaps not well served by flag-waving in a particular context?

Thirdly, in view of his assurances about the work of his conference on this subject, can he now say, in the light of the experience gained in this operation, whether he will seek to establish the conference on a permanent basis and invite those who undertake transplant operations of vital organs to refer constantly to the advice offered by the conference?

Mr. Robinson

I am grateful to my hon. Friend for what he has said.

First, I associate myself and, I am sure, the whole House, with his expressions of sympathy with the donor's widow and also with his good wishes to Mr. West.

Secondly, there is bound to be some conflict between the very natural desire of the Press to get the maximum information and detail about an event of this kind and the traditional reticence of the medical profession. I think that how this conflict is resolved is very much a matter of personal taste and, speaking purely personally, I must confess to the House that there are some aspects of the publicity associated with this which I regret.

I will certainly consider my hon. Friend's suggestion on the third point. I think that we do need a body, or are likely to do so, sitting permanently to deal with these very fundamental problems associated with organ transplantations.

Lord Balniel

I join in the congratulations to the medical team on the outstanding technical achievement and also in the expressions of sympathy with the donor's widow and of good wishes to Mr. West during this very difficult and important post-operation phase.

Would not the right hon. Gentleman agree that this operation brings into relief the unsatisfactory state of the existing law and also the fact that there is no legal definition of death? Would not he also agree that, in spite of the views of the conference which he convened last month, this is not a matter which can be left solely to the opinions of surgeons but that it must be laid down in a framework of law?

Is the right hon. Gentleman quite sure that where the wishes of the donor are not known in advance there is a clear and defined procedure for ascertaining the wishes of the next-of-kin?

Mr. Robinson

The House should be quite clear that, in this instance, the provisions of the Human Tissue Act were no barrier to the performance of the operation. The conference advised me that there should be no legal definition of death, but it gave guidance, which I have repeated to the House, on this subject. Certainly, I can confirm that there is a clear procedure under existing legislation as to the processes which need to be gone through and that these are well understood by the medical profession.

Dr. John Dunwoody

Will my right hon. Friend confirm that this operation was performed under the National Health Service? Can he assure the House that we shall not see, following the operation, the sort of commercialisation that we have seen following similiar operations in other countries?

Mr. Robinson

I understand that this operation was carried out under the National Health Service, and I whole-heartedly echo the hopes expressed by my hon. Friend in the latter part of his supplementary question.

Sir G. Nabarro

Having regard to the sensational and dramatic events of this weekend—not only the transplant of a human heart, but also the case of the transplant of a human liver—can the right hon. Gentleman say what his policy will be towards the Renal Transplantation Bill, which fundamentally deals with this matter and is due to go into Standing Committee upstairs during the course of the next few weeks?

Mr. Robinson

I am glad the hon. Gentleman referred to the liver transplant at Addenbrooke's Hospital, Cambridge, because this is another piece of remarkable surgical achievement which has been somewhat overshadowed by the heart transplant. Here too, the House will be glad to know that the patient's progress has been entirely satisfactory, although it is too early in the postoperative course to assess the eventual prognosis.

As to his own Private Member's Bill, I have told him, and the House, that I shall not be in a position to express the Government's definitive view on the contents of the Bill until after I have received the further conclusions of the Conference on Organ Transplantation, which will be reconvened in a few weeks time.

Mr. Heffer

Would my right hon. Friend agree that this particular case raises a certain number of rather disturbing questions? Could he give us an assurance that the House will have the opportunity of discussing this whole question fully? I feel that this matter ought not to be rushed. I ask him to give the House the opportunity to go into all aspects of it before we go too far.

Mr. Robinson

I certainly agree with my hon. Friend that these are profound issues. Obviously no one should come to rushed conclusions. There was recently an opportunity to discuss these issues on the Second Reading of the Bill brought forward by the hon. Member for Worcestershire, South (Sir G. Nabarro). Further time for debate is not a matter for me, but for the Leader of the House, and I am sure that my right hon. Friend will have heard what my hon. Friend has said.

Mr. Shinwell

Is my right hon. Friend aware that a Question cannot be placed on the Order Paper, or even a Private Member's Question asked, unless the Minister has responsibility? Does he accept responsibility, and if he does, then when a person is described as dead, and, therefore, suitable for a transplant operation, should not his Chief Medical Officer be brought into consultation?

Mr. Robinson

I have statutory responsibility for everything done in National Health Service hospitals. The fact of death is a clinical matter. It would not be appropriate to bring my Chief Medical Officer into this matter, which is one for those concerned with the care and treatment of the patient. In this instance death was confirmed by several experienced doctors at King's College Hospital before the donor's body was transferred to the National Heart Hospital, and again by several consultants at that hospital, not associated with the transplant team.

Mr. Maurice Macmillan

May I, first, assure the Minister that I share the sentiments expressed in the opening remarks of my hon. Friend? May I ask whether he would consider, not only the problem of transplants from dead donors, but also those from live donors and the whole question of experimental surgery, which is developing so fast and producing moral, ethical, legal—and I suggest in the future—problems of medical and research priorities?

Would he consider not only having a conference to which these matters could be referred, but a conference or a similar body with terms of reference to go into particular juridical and legal aspects, and report to him? He could then consider putting the matter before the House so that we can debate at length the extremely weighty and grave implications in the whole of these technical advances?

Mr. Robinson

I agree with the general line of the hon. Gentleman's supplementary. The matters to which he refers are not outside the remit of the existing conference. There are profound issues which will need long consideration, and I would rather reserve my position as to the precise way in which we shall arrange for consideration; but I give him the assurance that it will be given.

Mr. Cronin

Will my right hon. Friend consider what means should be taken to relieve hospital doctors of the invidious task of approaching relatives of the donor for permission to make the transfer? Bearing in mind that there will be a tremendous demand for replacement surgery of this type in future, out of all proportion to the present resources, would he consider what action might be taken to put increased resources at the disposal of the National Health Service, so that it can continue this work?

Mr. Robinson

I entirely agree that surgery of this kind makes fantastic demands on resources, which are inevitably—and which always will be—limited. Naturally, I want to put as many resources at the disposal of the National Health Service as the economy can afford.

As to my hon. Friend's first point, this is one of the particular matters to which the conference I referred to has been giving consideration. It is this aspect as much as any which has led to requests for an amendment of the Human Tissue Act. I hope that I shall be receiving guidance on that very soon.

Mr. Monro

Can the Minister say something about the excellent cardiac team in Edinburgh? Has it all the special equipment it requires, should it be necessary to perform this operation?

Mr. Robinson

I must ask the hon. Member to put that question down for answer by my right hon. Friend the Secretary of State for Scotland.

Several Hon. Members rose——

Mr. Speaker

Order. Private Notice Question to the Postmaster-General.