HC Deb 31 January 1969 vol 776 cc1787-801

Order for Second Reading read.

3.15 p.m.

Sir Gerald Nabarro (Worcestershire, South)

I beg to move, That the Bill be now read a Second time.

My Bill has 12 sponsors, of which five are members of the Government party, six are Tories and one is a Liberal. It is, therefore, an all-party Measure. Moreover, it is supported by six medical doctors in the House of all three parties and six laymen. It could not, therefore, be a more comprehensive Bill in character, both in a party-political sense and in a medical sense.

Of course, the Bill is exactly the same Measure as emerged from Committee in June, 1968. The House will recall that last Session I brought in the Renal Transplantation Bill under the difficulties confronting the Redundancy Fund at present which must, clearly, be taken into account on the other side of the picture, but I undertake that, if the House approves the Bill, we will consider it carefully, and no doubt some of the points to which both the hon. Member and I have referred will be considered in Committee.

Question put, That the Bill be now read a Second time:—

Ten-Minute Rule, on 13th March, 1968. The House gave permission for it to be brought in and it was given a First Reading on that date, following a Division. The results of that Division after a fairly full vote for a Bill brought in under the Ten-Minute Rule, were 155 for the Bill and 40 against, whereupon the Bill proceeded to a Second Reading on 5th April.

After considerable debate the Bill received the assent of the House, without a Division, and went into Committee upstairs, from which it emerged on 26th June. It then fell during the last Session, because of the refusal of the Government to allow any additional time for Report and Third Reading.

It may be claimed that the Bill made substantial progress last Session. It is not a party-political Measure in any sense. Due to the shortage of time this afternoon, and the fact that I did not really expect the Bill to be reached, I do not propose to canvass in detail all the arguments related on 13th March, 15th April and again on 26th June, 1968, as the Measure was comprehensively examined, notably in Committee.

It is noteworthy that the Government did not oppose the Bill; they damned it with faint praise. They said that they would do nothing to obstruct the Bill, but they remained to the end utterly neutral and did nothing to help it. They were deeply concerned by the ethical considerations involved, not—I repeat "not"—the medical, the surgical or the physiological considerations. They were concerned most largely with the ethical questions, as, I think, the whole of civilised humanity today is concerned with the ethical questions associated with the transplanting of human organs.

This is, of course, a highly personal matter. Every human being has these organs. Every human being, I hope, respects his own organs, loves his own organs, and, in the event of failure of any one of his major organs, he would like to feel that an alternative spare-part organ was available from another human being to graft into his own body in order to keep him alive.

Most people regard life as precious. They wish to see the happy day arrive when organs may freely be available in healthy condition for transplant into men and women who are sick so as to save their lives. Unfortunately, the transplanting of hearts is at present in only an embryonic state of progress. There are few human beings alive with hearts transplanted into them.

I say that the state of progress is embryonic because so few recipients of transplanted hearts have survived. No recipient of a transplanted liver has survived. No recipient of a transplanted bowel has survived. No attempt has been made to transplant a testicle, an ovary or any other major human organ, and in respect of only one human organ which is blood-fed has any great measure of success been achieved. I refer to the cadaver kidney.

I hope that no hon. Member will wish to correct me here and refer to corneal grafting. The grafting of the cornea involves non-blood-fed organs. It was the present Mr. Speaker who was responsible for the pioneering legislation nearly 20 years ago in the matter of corneal grafting, which legislation was later absorbed into the Human Tissues Act, 1961. However, as I say, whereas corneal grafting involves a non-blood-fed organ, the only blood-fed organ of the human body with which great success has been achieved is the kidney.

During the passage of my first Renal Transplantation Bill, last Session, I had always said that 3,000 human beings died in Britain each year due to kidney ailments and diseases. I am able to tell the Parliamentary Secretary to the Ministry of Health that I grossly underestimated the figure. I did not exaggerate. The planning unit of the British Medical Association has now revealed that 7,000 human beings die every year due to kidney ailments and diseases.

Broadly, these men, women and children can be kept alive in two ways. First, provided that the disease is serious enough—and if they are likely to die it is serious enough—by a very expensive method of dialysis involving, roughly, one kidney machine per kidney patient. We have now reached the stage when kidney machines can be installed in people's homes, but it remains an enormously expensive treatment.

In the Vale of Evesham, in my constituency, I was very impressed by the tremendous public efforts being made by men and women of public spirit who were rushing around raising money for a kidney machine. After a great deal of effort, they raised £2,000, which bought one kidney machine, which, broadly, would keep one patient alive. Perhaps in certain circumstances it could be used for more than one patient. It depends on the condition of the patient, the environment, and all sorts of other things. But it is a very expensive way of doing it.

Compare that with the second alternative method, which is transplanting cadaver kidneys. I shall not relate all the statistics which I gave during the proceedings on my Bill last Session. Suffice it to say that scores and scores of successful cadaver kidney transplants have now been undertaken in the United Kingdom by various surgical units, notably the unit at the University of Cambridge headed by Professor Roy Calne. Scores and scores of men and women who are the recipients of those cadaver kidneys are alive today up to seven years after the date of the transplant, so we are getting on.

Taking the position in the United States, France and Germany, it may be said that there are now thousands of men and women all over the world alive because cadaver kidneys have been transplanted into their bodies, by recent techniques of great surgical and physiological skill and with improved methods of typing. That does not mean manual typing, as on a typewriter. It means matching. The blood of the human being has to be matched. The constitutional idiosyncrasies of the human being must be attuned. Thus the permutations and combinations which may be established to find a kidney which will suit the recipient are diverse and almost as difficult—I am not indulging in levity—as finding the winning formula for a football pool.

This was so with human blood 30 years ago. The reason blood transfusion was so difficult in its early stages was simply because of the typing of blood extracted from one human being and used in another—I wish the Whip would go and get that piece and paper from the lady in the Official Box. It is irritating me being waved at me.

The House divided: Ayes 9, Noes 43.

Division No. 54.] AYES [3.06 p.m.
Bell, Ronald Rawlinson, Rt. Hn. Sir Peter TELLERS FOR THE AYES:
Eyre, Reginald Russell, Sir Ronald Sir Gerald Nabarro and
Grimond, Rt. Hn. J. Thorpe, Rt. Hn. Jeremy Mr. Bruce Campbell.
Iremonger, T. L. Vaughan-Morgan, Rt. Hn. Sir John
Jennings, J. C. (Burton)
Atkinson, Norman (Tottenham) Jackson, Peter M. (High Peak) Sheldon, Robert
Barnes, Michael Jones, Rt. Hn. Sir Elwyn (W. Ham, S.) Silkin, Rt. Hn. John (Deptford)
Booth, Albert Kerr, Russell (Feltham) Skeffington, Arthur
Boston, Terence Luard, Evan Snow, Julian
Brown, R. W. (Shoreditch & F'bury) MacColl, James Swingler, Stephen
Coe, Denis Macdonald, A. H. Walker, Harold (Doncaster)
Davies, Dr. Ernest (Stretford) Mackie, John Watkins, David (Consett)
Davies, Harold (Leek) Mackintosh, John P. Wells, William (Walsall, N.)
Dewar, Donald Mallalieu, E. L. (Brigg) White, Mrs. Eirene
Driberg, Tom Mikardo, Ian Whitlock, William
English, Michael Miller, Dr. M. S. Winnick, David
Evans, loan L. (Birm'h'm, Yardley) Molloy, William
Fletcher, Rt. Hn. Sir Eric (lslington, E.) Moyle, Roland TELLERS FOR THE NOES:
Foot, Rt. Hn. Sir Dingle (Ipswich) Perry, Ernest G. (Battersea, S.) Mr. George Wallace and
Foot, Michael (Ebbw Vale) Rankin, John Mr. Arnold Shaw.
Heffer, Eric S. Reynolds, Rt. Hn. G. w.
The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

I will fetch it.

Sir G. Nabarro

I thank the Under-Secretary. I give him leave of absence to fetch it. It will improve his reply, so I am grateful to him.

Blood transfusion has been perfected because of the establishment of blood banks. Men and women of strong constitution and sound health have been appealed to to give their blood. Countless types of blood have been established by doctors and surgeons. These are all stored in good condition; and when grave accidents occur life is saved, as after operations, by blood transfusions.

I am aiming at a kidney bank with tens of thousands of kidneys, all refrigerated in bottles, all ready for instant use, so that when a man, woman or child is found to be suffering from acute kidney disease and the type of kidney required is ascertained by the doctors, a new kidney—a spare-part cadaver kidney—may be extracted from the bank, rushed to the patient and, with a relatively minor operation, the patient is incised, the kidney is inserted and attached, and the evidence points to a high measure of success.

I come to the purpose of my Bill. Why cannot we do this now? The condition of the law prohibits our doing it now. The governing Statute is the Human Tissues Act, 1961, and I want to say what the operative part of that Act contains. I quote from Section 1(2): If any person, either in writing at any time or orally in the presence of two or more witneses … has expressed a request that his body or any specified part of his body be used after his death for therapeutic purposes or for purposes of medical education or research, the person lawfully in possession of his body after his death may … authorise the removal from the body of any part or, as the case may be, the specified part, for use in accordance with the request. Subsection (2) says: … the person lawfully in possession of the body … may authorise the removal of any part from the body … if, having made such reasonable enquiry as may be practicable, he has no reason to believe—

  1. (a) that the deceased had expressed an objection to his body being so dealt with … or
  2. (b) that the surviving spouse or any surviving relative of the deceased objects to the body being so dealt with."
Effectively, therefore, if one wants to get the cadaver kidneys out of a dead body, the permission of the next-of-kin has got to be obtained before they can be removed. But here is the head-on collision with the doctors. The doctors and the surgeons cannot use those kidneys unless they are removed within an hour of death. This is incontrovertible. Any doctor or surgeon will confirm it. The sort of cadaver kidneys we want are the good, healthy kidneys from one of the silly young men who kill themselves in a motor accident on the Ml by driving too fast in the fog, or through some other similar cause, are taken into hospital and die—hundreds of them during the course of a year.

As the law stands today, before those kidneys may be removed the hospital has to telephone the next-of-kin and ask permission to take them. It is inconceivable that any hospital official could act in such an inhumane fashion as to reach for the telephone after the patient had died from his motor smash, ring up Mrs. Snooks and say, "I deeply regret having to inform you that your son Johnnie has just been killed in a motor smash on the Ml and is lying in our mortuary here in the South Blank-shire hospital. He left this life 20 minutes ago. Please may we 'pinch' his kidneys within 40 minutes?"

I am utterly serious. These things are inconceivable. I am not behaving with levity. I am trying to paint a picture which the House can understand. I deeply regret that anybody is ever killed in a car smash or by any means before his due time to go aloft, or wherever people go at the end of this life. What I am concerned about is that we have to get good healthy kidneys to enable transplants to save life, and we cannot get them in the existing state of the law.

This Bill reverses matters. In simple parlance, once a certificate of death has been signed by two doctors, a further doctor, other than the two doctors who signed the certificate of death, may remove the kidneys of the dead person, provided that there is no evidence carried on the dead person—normally in the case of a motorist it would be attached to the driving licence—to the effect that the dead person in his or her lifetime had expressly stated that he or she did not wish his or her kidneys to be removed.

In addition, the Bill provides that there shall be a central registry of objectors so that if I, Gerald Nabarro, wanted to record that my kidneys should not be removed in the event of my premature death, precipitating a by-election in South Worcestershire, I would ensure that the central registry had my name and address and my request, which would probably say, "I hereby record that I do not wish any of my organs to be taken after death for transplant purposes". [Interruption.] If the hon. Member for Ebbw Vale (Mr. Michael Foot) wishes to interrupt my speech he should take his seat and not interrupt from below the Bar of the House in such an unseemly fashion.

As I was saying, my request would be recorded and every hospital would have a central registry to which to apply. This would be done by computer—it is an easy matter, as the scientists will confirm—and every hospital would be prevented from taking my kidneys for the purpose, after my death, of saving the life of a sick man, woman, or child.

I wish to make it clear, however, that I take exactly the contrary view because once I have expired, and once two doctors have certified that fact, anybody may take any part of my body that is considered desirable, including my larynx, for transplant purposes. [Interruption.] Now that the hon. Member for Ebbw Vale has taken his seat, he should not treat this matter with levity. Of the six doctors who support the Bill, three are members of his party.

I aver that anybody can take any part of my body to save a sick person. There is nothing particularly magnanimous about that. Fifty years ago cremation in this country was almost unknown. Today, nearly two-thirds of people opt to be cremated. In other words, they take the view that once the doctors have certified that they are dead their spirit has gone aloft, or to wherever it may go, and the human remains, inanimate and worthless, should be burnt.

I do not want mine to be burnt. The ultimate residual remains may be burnt, but while I have healthy organs in my body, including my eyes, bowels and lungs, which are all very good, as well as my heart, which is quite good, and my larynx, I want them to be used to save lives. I will not talk further about my organs. Anybody may have them to save a sick person; and the remaining bric-a-brac and debris can be consigned to the crematorium.

I have made out a reasonable case for the Bill. Before the Under-Secretary of State replies—I am grateful to him for being in attendance so promptly to deal with the matter—it might help if I explain the Measure. Clause 1 deals with exclusions; that is, the exclusion of cadaver kidneys from the Human Tissue Act, 1961. Clause 2 is the authoritative part of the Bill covering the removal of cadaver kidneys after death for the purpose of organ transplant.

Clause 3 delineates the exceptions to Clause 2, excepting persons who are

  1. "(a) mentally insane, or
  2. (b) mentally handicapped, or
  3. (c) below the age of 18, or
  4. (d) 65 years old or more than that age, or
  5. (e) deprived of his liberty by the conviction and judgment of a court, or
  6. (f) a permanent resident of a hostel, home or institution for the aged, the disabled, or the handicapped."
Clause 4 is really important and was included in last Session's Bill to meet very legitimate objections pointed out to me to the effect that two medical practitioners should certify death, in addition to the doctor actually carrying out the transplant.

Clause 5 deals with the qualification of doctors who would be carrying out a transplant. Clause 6 deals with conscientious objection.

Clause 7 covers the establishment, as I have said, of a Central Renal Registry so that an objector to the transplant of his kidneys may duly register his objection in a form to be decided by the Minister. In that Clause there is also denial of any expenditure in this regard falling on public funds.

Clause 8 deals with the commencement of the Bill—three calendar months from the date on which it receives the Royal Assent. Clause 9 is the Short Title.

With those few words I commend the Bill. I will end by indicating the professional support which I now have and the new information which has come to us since the last Bill fell at the end of the 1968 Session. This is of paramount importance, and I hope that any Member of the House who entertains any dubiety about the ethics of the Bill will now be guided by the advice of the British Medical Association.

In the Financial Times of 10th January, 1969, that is, only just three weeks ago, the Planning Unit of the British Medical Association is reported as saying—I paraphrase—"We are not ready to proceed on a large scale with heart transplants, which are enormously expensive, as are transplants of other major organs." The Financial Times report of the Unit's statement proceeded thus: In the case of kidney transplants, the Unit found the figure far more promising. That is, the figure of survivals: Of the 7,000 who die in Britain each year from kidney disease, about 1,000 are between 15 and 44 and"— quoting the Planning Unit— 'many of these might be saved by transplants from 600 donors'. The operation is expensive—about £6,000 per patient, the Unit estimates—but far cheaper none the less than a heart graft. 'Many patients with chronic renal failure are the parents of young families, and the expansion of our present renal trans- plant programme is a matter of urgency from the humane as well as the economic point of view,' says the statement. Success with the grafting of kidneys, said Professor Miller, was now 'almost as good as any other surgery for a very serious condition.' That is an absolutely revolutionary statement. What the British Medical Association is now saying is that kidneys can be transplanted as effectively and efficiently as carrying out an operation for appendicitis.

In those circumstances, I confess I am very disappointed with the Secretary of State for Social Services. I put to him that I had made out an absolutely incontrovertible case for proceeding with amending legislation unilaterally for cadaver kidneys. He has replied that he does not propose to proceed with amending legislation until he can deal with all human organs. That time is years and years away. If we wait for that we shall have to wait to deal with hearts, livers and bowels, and all the other major organs where, and I quote my earlier words, the progress of transplantation is in an embryonic condition.

I therefore appeal to the Minister to reconsider his views about this matter and to proceed unilaterally with this Bill, the sole purpose of which is to establish facilities whereby a large number of the 7,000 lives per annum presently lost through kidney ailments and diseases may be saved through the establishment of a sufficient number of reserve or spare-pan kidneys in good condition in banks, properly typed, and with all the computer facilities available for transplant to needy people.

3.46 p.m.

The Under-Secretary of State for the Department of Health and Social Security (Mr. Julian Snow)

It would be a great pity if it were to be inferred from what the hon. Member for Worcestershire, South (Sir G. Nabarro) has said, or what he suspects, or what I may say now, that in my Ministry there is any attempt to obstruct legislation on this matter. The hon. Gentleman has deployed a very reasonable case in very moderate terms, and I am not at all worried by his histrionic attitude—sometimes, indeed, I find it rather endearing. However, I am afraid that my Minister cannot accept the Bill, and I will explain why.

The main proposition is that the Human Tissue Act, 1961, should no longer apply to renal transplantation so that it would no longer be necessary to consult relatives before removing the kidneys from the body of a suitable donor. Instead, it would be open to those who object to record their objections in advance with a central register which the hospital would have to consult.

We think that it would be a pity to take kidney transplants in isolation. We have reason to feel that, first, public opinion has not progressed far enough in this matter and, secondly, there are factors common to the use of other organs which make it a doubtful proposition whether we should legislate in the matter of one single type of organ.

I think that the hon. Gentleman was not quite accurate in saying that it was technically possible to establish banks for kidneys. My advice is that at the moment refrigeration of this type is yet far from perfection.

The hon. Gentleman referred also to the great expense of the intermittent haemodialysis as an alternative. It is expensive, but I should add that the public, in raising money for this type of machine, fails frequently to understand that not only the cost of the machine has to be met but the cost of the supporting staff. For example, a hospital type of dialysis machine needs between 20 and 25 skilled people to operate and maintain it. Too often these well-meaning people would do better to consult hospitals before they start raising money for a machine which may be not so necessary as other machines. We do not agree, therefore that we should legislate for one organ alone.

The hon. Gentleman asked me not to come back with the old case of corneal grafting, but there are other organs, some of which he mentioned this afternoon.

We do not entirely accept the hon. Member's understanding of the technical position which has been reached in the matter of renal transplantation. When he read the reports which have been made by other doctors who have been concerned in the matter, the hon. Member gave me the impression—although he did not precisely say this—that the science of kidney transplantation had achieved such a degree of efficiency that it could be taken in isolation from the transplantation of other organs. He used the words, very carefully, "The great success that has been achieved in this matter". That is quite right.

But an opposite and contrary view was printed in the edition of the Lancet on 4th January. I am fully aware of the dangers of laymen such as myself reading out an extract from a technical paper on such a matter as this. But I read from page 4 the report of a survey: Of the 33 patients who died, 23 died in the first three months after transplantation and nine in the ensuing three months but there was only one death after six months. The article went on to give the causation of the various deaths. I do not want to make too much of that, but the House is entitled to know that from the professional viewpoint there is not quite the feeling that the case is proven as might appear from certain reports mentioned by the hon. Member. The advice which we have received from our advisory committee on renal transplantation is that we ought to progress rather slowly, and we feel that we ought to accept that advice.

We hear a great deal about opting out. I shall have a subsidiary criticism to make of this Clause of the Bill, but the registry would involve people opting out of a general permission to remove kidneys from their bodies after death on the assumption that they know what the law is on the subject. But I need not tell the House that there are many pieces of legislation providing that kind of opting-out which are not necessarily known to the public at large. I do not believe that a registry such as is proposed would be effective, fair or equitable. We doubt whether such a registry instantly available to hospitals throughout the country, would be practicable, and certainly it would not be without cost to public funds. Clause 7(3) refers to charges and costs not falling on public funds; yet Clause 7(1), dealing with the provision of a registry, must of itself mean public expenditure.

Sir G. Nabarro

The hon. Member must not misunderstand me. I do not want to argue with him a technical detail of administration, but he knows that, within a year or two, every Ministry will have a computer to deal with work of this kind, notably the Ministry of Health. Keeping a central registry in the computer would cost nothing more in the hands of the Ministry of Health than all the other administrative services which the Ministry has to provide.

Mr. Snow

I wish that I had as much faith in computers as has the hon. Member. Judging by some bank statements which I have received, perfection in that science has not yet been reached.

We feel that a registry is not a proposition if it depends for its efficiency on people knowing what the law is and on people knowing that they could opt out if they had objections.

The hon. Gentleman must know that there have been objections to the proposition that he is putting forward from certain religious bodies in this country. For these reasons and others, not excluding that it is not in consonance with the Northern Ireland legislation, we feel at this stage that we cannot accept the Bill as proposed.

I have watched the hon. Gentleman's activities in this House for a long time now. It is an easy compliment to pay in this House, but I must compliment him on his persistence. In this case, I feel entitled to say that, from my layman's examination of his case over a long time, I know that he does his homework and takes advice from very good professional sources. Having said that, I must appeal to the House not to accept the Bill, but to allow matters to progress a little further.

Sir G. Nabarro

With the leave of the House—

Mr. Speaker

Order. It is unusual for an hon. Member to get permission to address the House a second time on Second Reading, but if the House gives permission it gives it.

3.56 p.m.

Mr. Bruce Campbell (Oldham, West)

This is not a subject on which I am an expert. I did not come into the Chamber this afternoon to speak upon the Bill, but, having listened to its merits being

discussed, I am completely persuaded that it certainly ought to receive the commendation of this House and should have a Second Reading.

Often people give directions in their wills about the disposal of their organs after death. The trouble about that is that most of them leave their wills in the vaults of banks. If a person dies on a Saturday, there is no way of finding out what is in his or her will until Monday, by which time it is too late to extract these vital organs. While it may always be possible to obtain permission from the next-of-kin to remove a vital organ from the body of that dead person, the next-of-kin may not be available.

Married people have as next-of-kin the wife or the husband, as the case may be. But they may be living apart at the time that one spouse dies and no one may know where the other is to be found. Even if they are not living apart on any permanent basis, one spouse may be abroad and it may be impossible to obtain his or her approval to the proposals.

It seems, therefore, that it is a very inadequate arrangement to leave it to the consent of the next-of-kin. Added to that, there is the very distressing business of asking the next-of-kin at this awful time of tragedy. What a distressing thing to say to a wife, "Now that your husband is dead, may we please take from him his kidney?"

Mr. Robert Sheldon (Ashton-under-Lyne)

On a point of order. I do not know whether the hon. Gentleman realises that in talking the Bill out he is preventing it coming to a vote?

Mr. Speaker

That is not a point of order.

Mr. Campbell

I may not have been in this House very long, but I have been a Member long enough to discover the fact of which the hon. Gentleman has just informed the House.

I commend the Bill to the House.

Question put, That the Bill be now read a Second time:—

The House divided: Ayes 8, Noes 38.

Division No. 55.] AYES [3.57 p.m.
Dunwoody, Dr. John (F'th&C'b'e) More, Jasper
Errington, Sir Eric Morgan, Geraint (Denbigh) TELLERS FORTTHE AYES:
Eyre, Reginald Russell, Sir Ronald Sir Gerald Nabarro and
Gresham Cooke, R. Thorpe, Rt. Hn. Jeremy Mr. Bruce Campbell.
Atkinson, Norman (Tottenham) Luard, Evan Silkin, Rt. Hn. John (Deptford)
Bell, Ronald MacColl, James Skeffington, Arthur
Booth, Albert MacDermot, Niall Snow, Julian
Boston, Terence Mackie, John Swingler, Stephen
Brown, R. W. (Shoreditch & F'bury) Mackintosh, John P. Wallace, George
Driberg, Turn Mikardo, Ian Watkins, David (Consett)
Dunwoody, Or. John (F'th&C'b'e) Moyle, Roland Wells, William (Walsall, N.)
English, Michael Mulley, Rt. Hn. Frederick White, Mrs. Eirene
Fletcher, Raymond (Ilkeston) Owen, Dr. David (Plymouth, S'tn) Whitlock, William
Foot, Rt. Hn. Sir Dingle (Ipswich) Rankin, John Williams, Mrs. Shirley (Hitchin)
Freeson, Reginald Reynolds, Rt. Hn. G. W.
Grimond, Rt. Hn. J. Richard, Ivor TELLERS FOR THE NOES:
Hart, Rt. Hn. Judith Robinson, Rt. Hn. Kenneth (St. P'c'as) Mr. Ioan L. Evans and
Lee, John (Reading) Sheldon, Robert Mr. Ernest G. Perry.