TRANSPLANT SURGERY

HC Deb 20 June 1969 vol 785 cc855-919

11.6 a.m.

Mr. John Brewis (Galloway)

I beg to move, That this House congratulates the medical profession on the recent advances in transplant surgery; and urges the Government to supply sufficient resources for further progress without detracting from other National Health services and to lay down by legislation and regularly review a code of practice that will allay public disquiet by ensuring that the rights of all donors are protected. The Motion starts by congratulating the medical profession on the advances made in transplant surgery in recent times. These congratulations are no less sincere if I feel that some recent pronouncements by doctors are open to criticism. Dr. Donald Longmore, the distinguished surgeon, puts the matter rather well in his book when he says: Those who work outside the field do not know enough about it to form objective conclusions. Those who work in the thick of it (myself among them) are too committed to their projects to offer impartial counsel to the public. Fundamentally, these are the issues that are before the House and they are most important.

Transplant surgery is the logical outcome of those miraculous skin grafts which we admired so much during the war when Servicemen, especially pilots, were terribly disfigured. Today limbs, kidneys, hearts, lungs and even livers have been successfully transplanted. It would be surprising if ethical and legal problems had not been thrown up in addition to the inevitable medical ones.

Today, I wish to touch only on problems connected with donors, but if we peer behind the curtain of the future there may be even more intractable problems connected with recipients. Yesterday, the Scotsman drew attention to the questions which might arise if gonad organs are transplanted which are capable of procreation. Such authorities think that such operations would not be unduly difficult, even at present. In the far more distant future, brain transplants may become feasible, in which case the personality of the donor and the recipient might be exchanged.

I mention these fascinating possibilities because the law and ethical code of conduct must not be left behind by progress in medical science. Already, many people think that the Human Tissue Act, 1961, is out of date. Criticism of the Act centres on kidney transplants. My hon. Friend the Member for Worcestershire, South (Sir G. Nabarro) has brought forward on two occasions a Renal Transplant Bill, but so far it has not been passed by the House. Immense progress has been made in the technique of kidney transplants which is now a fully accepted surgical procedure. It is still a hazardous operation, but much less hazardous than other operations which are carried out by surgeons in this country.

Further progress is being made in such areas as tissue typing. Our surgeons have been in the forefront of this advance. Only this week a Portuguese man of 70 came to this country especially so that he could donate one of his kidneys to save the life of his son. Operations within a family where the blood groups tend to be the same have an excellent chance of success. It is higher for the somewhat unusual identical twins, where the survival rate after two years is approaching 80 per cent. The rate for success when kidneys are transplanted from an unrelated cadaver donor is improving greatly and it is now approximately 45 per cent., nearly one in two successes.

The scope for kidney transplants is large. There are about 7,000 kidney sufferers in Britain of whom perhaps 2,000 could benefit from transplant surgery. The chance of saving many of these lives is being jeopardised by a lack of donors. Few healthy donors can be expected to come forward altruistically to sacrifice one of their kidneys except when a close relative is involved. Many people lying in hospital, dying of incurable diseases, might be perfectly willing to donate, but the chances are that their organs would not be healthy enough to transplant.

There are several sources from which donors may come, from the hospitals, people who have brain tumours, and so on. One obvious source must be from fatal accidents and, more specifically, main road accidents, where there is a likelihood of a victim being brought into hospital in a comparatively short time. There are about 8,000 fatal road accidents a year—an alarming figure. Unless the donor has given prior consent in writing it is, in practice, very difficult to comply with the provisions of the Human Tissue Act, 1961.

The victim is hardly likely to be able to make a declaration before two witnesses, and at such harrowing times few doctors would relish approaching the wife or husband or other surviving relatives to get their consent. If the life-giving potential of kidney transplants is to be realised we must either increase enormously the number of voluntary donors or change the law altering it from what has been called contracting-in to make it necessary to contract-out. Under contracting-out a person would have to give his refusal beforehand for his organs to be used for transplant purposes, whereas by the contracting-in procedure he has to agree beforehand to his organs being used.

I criticise the Government for taking up what is a defeatist and dilatory attitude and for failing to give a lead. There have been several small voluntary societies started recently to recruit voluntary donors. There is the National Society for Transplant surgery, whose office is at 11 Alma Road, Cardiff. The society has hundreds, if not thousands, of potential donors on its register. It provides consent cards which can be, carried in a wallet or handbag. I wonder whether the card will be found in time.

There have been other suggestions such as that there should be a small tattoo mark, perhaps a miniature Christmas tree, on the body of people who have become voluntary donors. It is amazing what people will do for a good cause. This summer we have seen thousands of young and old going on sponsored walks with each mile walked adding to the resources of the Save the Children Fund Here is an imaginative idea.

In the same way, the tattoo mark could be made a badge of pride on the bodies of people bathing round our coasts showing that here was someone who really cared for his fellows. Last year, an opinion poll taken by the paper New Society showed that 73 per cent. of those asked whether they were prepared to allow transplants from their body after death replied that they were. Here is a big pool of potential donors which needs only to be tapped. This is an area in which the Government should take the lead, not only through publicity but through the establishment of a national register, rather than saying, as a former Minister of Health has done, that no amount of publicity could secure individual donors.

Such a register could take the form of a national tissue register where the data, not only about potential donors but about potential recipients, could be stored in a computer and made available for vital tissue matching in the minimum amount of time.

Can the Minister say why the Government have not supported the embryo organisation of a national tissue service which has been established at Air Calls headquarters in London? Those advocating contracting-out, whereby the body of an accident victim is available unless he has expressed a wish to the contrary, are dealing with an important issue. Professor Roy Calne, of Cambridge, has expressed such a view very strongly, but without any disrespect to him I rather discount his views as he is so much in the thick of it. I have to add that he has a formidable ally in the Church of Scotland, which actually voted in favour of contracting-out at last year's General Assembly. The Church of Scotland concluded that there were no theological or ethical reasons against contracting-out.

The body of an accident victim is probably grossly mutilated already and in a short time will be returned either to dust or ashes. The real objection to contracting-out is the feeling of relatives. There is an unexplored spiritual area between the dead body and its living relatives, however irrational this may be. What happens to my body I care not, but I would consider it the grossest insult if a doctor intentionally tampered with the body of my mother, my wife, or my daughter.

Time may well soften attitudes. It might help if prior death was assured. I have told myself that my view is irrational, but if an Amendment to the Human Tissue Act thrust contracting-out on to a reluctant public there would be a calamitous loss of confidence in the medical problem and a drop in its public esteem.

There is a powerful lobby which would like to stop heart transplants altogether. So far, the results have seemed disappointing, not through a lack of skill on the part of the surgeon, but more through problems of immunology and tissue typing, which will be solved in future. Heart transplants, at the moment, are roughly at the same stage of development as kidney transplants were in 1961, when the House showed its confidence in the future by passing the Human Tissue Act.

I believe, in fact, that when kidney transplants were first started there were practically no survivors out of the first hundred or so operations. But surely, in the case of heart transplants, the case of Dr. Philip Blaiberg points the way. In any event, heart transplants will go on, if not in London, in Capetown, in Houston, and in many other countries.

If we are to remain in the forefront, our surgeons need more support than they have been getting lately. The first British heart transplant, for example, lay for several days in the operating theatre of the National Heart Hospital because there was no other room available which could be kept sterile enough, so that operating theatre was denied to patients in those days who needed other perhaps equally urgent treatment. When will the Brompton Hospital be rebuilt to provide more suitable premises? I could ask the same question about the Royal Infirmary, Edinburgh, whose modernisation programme has been referred to.

Since the third British heart transplant last month there has been an immense amount of public concern about heart donors. Yet, except for the family donor, who obviously has not got two hearts to give, the problems are not really different from those of kidney donors. There have been many hundred successful kidney operations with no recent public outcry at all.

The present disquiet is over the question of death. As hon. Members know, there is no legal definition of when death has taken place. In popular parlance, someone is dead when his heart has stopped beating. But last week there was a photograph in the Press of a smiling man standing in his garden, whose heart had stopped beating, I think, 158 times. If he had been dead, he is now clinically very much alive. I think, too, that during an operation the heart may be stopped for up to an hour before being resuscitated. So we must seek a solution which is not connected with the heart.

If we feel that a definition of death is really necessary, it has got to be a definition which will not exclude future progress in the life-giving work of medical research. To a doctor attending a road accident victim kept alive with a respirator, although his brain is absolutely obviously irretrievably damaged, there is no doubt that as a person he is clinically dead. This was the case of Miss Sinsbury, at Guy's Hospital last month. In the ensuing controversy no mention has been made of her relatives who consented to the operation. It must have been an agonising decision. I think that they did a noble act, as did the relatives of Patrick Ryan, who gave the chance of life to two other people besides the heart recipient.

The difficulty really lies in the cases in between. The human body is immensely resilient. No doctor would have given any chance of life to the Cuban stowaway who was frozen solid in the wheel-case of the Spanish jet airliner last month. Rip van Winkle cases are not so very uncommon.

Last month, the Daily Express published a letter from a lady in Bodmin about her daughter who had suffered terrible brain injuries in a car crash. She wrote: A doctor in charge of casualty stated that she had only a few hours to live. A few days later a specialist said that she had irreversible brain damage. We insisted on her being kept on the machine and he agreed to do this for a short while. My daughter is now a help to us on our smallholding and leads almost a normal existence, even taking business calls when we are out. The clinical facts of this case may be in dispute, but I am told that there have been at least four similar cases in Edinburgh in the last year where patients in the intense care units at the Royal Infirmary and the Western General Hospital have, in fact, later been able to walk out of hospital.

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

I am listening to the hon. Gentleman very carefully. He mentioned the Bodmin case. He did not add any commentary about the subsequent observations of the clinical staff.

Mr. Brewis

I do not wish to be unfair to anybody. I did say that the clinical facts of this case may be in dispute. I do not know whether the Minister wants me to go further. I would be prepared to do so.

Mr. Snow

I have made the point.

Mr. Brewis

The decision of the doctor when to turn off the respirator must be unenviable, because there are many considerations which may sway him. I think that we would all agree that there must be some dignity about death, that a patient should not be kept lingering on for experimental reasons. Another consideration may be that the hopeless patient may be a voluntary donor and the respirator may be urgently needed for another case.

This matter has come up before the British Medical Council. In April this year it issued a statement on the determination of the moment of death. It said: The Council supports the following statement by the W.M.A. … regarding determination of the point of death: 'This determination will be based on clinical judgment supplemented if necessary by a number of diagnostic aids (of which the electroencephalograph is currently the most helpful). However, no single technological criterion is entirely satisfactory in the present state of medicine nor can any one technological procedure be substituted for the overall judgment of the physician.' The statement goes on to discuss the qualifications of certifying practitioners, as follows: Pronouncement of death should be undertaken by two fully registered practitioners each independent of the team undertaking the transplant operation, and at least one of the two practitioners must have been fully registered for five years or more. In passing, I should say that the French have taken the evidence of the electroencephalograph as being sufficient.

However, I do not think that the criteria that I have just read out are sufficient to allay public disquiet. The decision should be made by somebody outside the medical profession. Someone has coined the gruesome title, Ombudsman of death. But the local coroner, or procurator fiscal in Scotland, is a more mundane person and reasonably readily available. At present, his duties only commence when death has taken place. He should be empowered to examine all the evidence, including such aids as the encephalograph, and give his impartial decision before the respirator is turned off.

It may be objected that such a formal procedure may mean that potential donors are lost. To some extent life may be prolonged by a respirator to make such a procedure possible. But without some procedure in which the public have confidence, transplant surgery itself will be the victim because the supply of donors will dry up.

I have moved this Motion today because I am conscious that the matter is one of public concern. I hope that the Under-Secretary, when he replies, will be able to give us some news of the MacLennan Committee, when we may expect its report and which way its thoughts are taking it. It seems improbable that the House will have a chance to debate the report before the end 006Ff this year. Action is needed much sooner than this.

11.30 a.m.

Mr. Laurence Pavitt (Willesden, West)

It is customary on these occasions to congratulate the hon. Member who has had the good fortune to see his name come first out of the hat, and I congratulate the hon. Member for Galloway (Mr. Brewis) with particular warmth because of his choice of subject. He has given the House an opportunity to debate some very important aspects of the National Health Service.

Because of the wide range of the Service—hospitals, doctors, nurses, pharmaceuticals and the rest—we often have difficulty in debating specific matters of concern, and the hon. Gentleman has, therefore, done us a service in choosing his subject today so that we may discuss an aspect of the work of the Service which is of extreme importance, both within the Service itself among the people who have to take responsibility for transplants, and in the country generally among our constituents who are, naturally, concerned about the future health of the nation and the advancement of research which may enhance their own health.

The hon. Gentleman drew attention to the Human Tissue Act, 1961, a matter on which we shall all listen with great interest to the reply from my hon. Friend the Under-Secretary of State. The last few years have shown that public opinion has now reached a point when there is need, as the Motion implies, for a much broader and more attentive approach to legislation in this respect, both for the protection of donors and in order to ensure maximum efficiency in securing better care for people who can benefit from transplant surgery.

The hon. Gentleman drew attention, also, to the awkward question of the definition of deatth, the point at which one can be assured that a donor is in no danger that his good will towards someone else who is suffering might be transgressed by, perhaps, terming him as dead before he is, in fact, dead. For a number of years now, there has been talk of psychosomatic medicine. This morning, the hon. Gentleman has introduced a fresh dimension into the question by bringing in the spirit, too, reminding us that we should think not simply of mind and body but of other less definable things and pay attention to that other aspect of human life if we are to be successful in dealing with the health of the complete person.

I draw attention to the words in the Motion: without detracting from other National Health services". If the nation decides that it will limit the amount of public expenditure upon health to about 4 per cent. of the gross national product then, when one has to consider very expensive transplant operations, there must inevitably, since one is working within a ceiling, be a decision somewhere on whether such operations are to be given priority above expenditure in another way.

The whole question of priorities in these matters must arise, especially with reference to the recent heart transplants about which the Press has been concerned. These operations can be very expensive indeed. It is much the same kind of problem as the one faced in almost all research. I think particularly of the developments which have hit the headlines recently, culminating in the journey to the moon. One wonders whether, if another priority had been determined and expenditure of that kind had been given to health, to housing or to social problems, that decision might have been more correct and the world a happier place.

The hon. Gentleman is right to emphasise that we cannot make an easy decision about the extension of transplant surgery without making another decision on priorities. I hope that my hon. Friend the Under-Secretary of State will tell us a little more about the decision-making process. Obviously, the first element in any such decision must be a clinical one, a decision for the doctors concerned who are faced with the problem of a patient's imminent death. But over the whole range of this work, especially as it affects us in the London teaching hospitals at present, it would be interesting for the House to know how the priorities are decided. How far is it purely a matter for the doctors, and to what extent is the other part of the administration of the hospital service called upon in making a decision which, as I say, has consequences for the resources available in other fields?

We have been much concerned with the rights of donors. I believe that one extension we are looking for is a scheme to establish the basic right of an individual who wishes to do so to be able to donate parts of his body for transplant purposes. This is an element of the matter upon which we hope to see further action from the Ministry. For this purpose, the Ministry should, I believe, consider the institution of a voluntary medical identity card.

It has been mooted for other purposes, as well. For several reasons, it is important, especially at the time of an accident, that medical knowledge about the person involved should be quickly obtained—for example, the blood group to which a person belongs, or whether he is under treatment with some of the powerful and sophisticated medicines which might give rise to serious consequences if, after an accident, he is treated with certain other medicines.

A voluntary formal card of that kind need be no bigger than the old wartime identity card, but it could give certain basic medical information to the medical profession. In addition, it could include a declaration to the effect that the person holding the card was willing, in the event of serious accident and had cleared the matter with his relatives, to offer his heart, kidneys or other organs for someone else's benefit. As I say, this idea has been mooted for some time, but I believe that public opinion has now reached a point when it would be prepared to accept it.

I am not advocating compulsory card-carrying. We have enough documents already. But it should be possible to arrange voluntarily for such a card in a format easily understandable by the medical profession and readily acceptable to the individual concerned and the general public, so that vital information could be quickly obtained in case of need.

We have concentrated upon the heart because, perhaps, we are a sentimental nation; we think always in terms of heart transplants because the heart is the most dramatic organ, pumping the blood which keeps the rest of the body going. But it is in other fields that so much important work has been done in recent years. A great deal of advance has been made not so much in the transplanting of the heart itself, but in the transplanting of valves, and so on, advances which have been made possible because of the readiness of the medical profession to push further through the frontiers of biological engineering.

I draw special attention to what the hon. Gentleman said about renal transplants. I supported the Bill, as one of its sponsors, introduced by his hon. Friend the Member for Worcestershire, South (Sir G. Nabarro) on this subject. Undoubtedly, the only way by which we can give comprehensive service in cases of renal failure is by supplementing renal dialysis—the kidney machine—with a full programme of renal transplant. The two aspects of the matter are not separate but are complementary to one another. I have a personal interest here in that my daughter is sister in charge of the renal department at the Royal Free Hospital, one of the outstanding centres of the world.

Naturally, like all right hon. and hon. Members, I am proud that Britain leads the world in renal dialysis treatment and we have, per capita, more kidney machines here than in any other country, including the United States, a nation which has learned quite a lot from us about it.

One of the problems here is that, if dialysis is completely separated clinically within the hospital department from renal transplant surgery, one fails to do both jobs to full capacity, depriving patients of the full benefit of all that can be done. I hope that as a result of the Motion and any future steps which the Ministry takes the practical alignment of transplants of kidneys and renal dialysis will be very close in all hospitals undertaking these treatments.

There are other spheres of transplants which have been very interesting in recent years, and again I speak with personal interest. The House may know from my previous Questions to the Secretary of State that although the clinical trials have not been completed, and, therefore, we cannot be certain, bone transplants in certain cases of deafness are showing a high probability of success. This is not stapedectomy, which is a different and highly successful operation, but before people who are hard of hearing get too hopeful as a result of this statement, I must say that this new transplant affects only a very small proportion of deaf people. Nevertheless, if this new transplant procedure for bones can be successful in cases of lost hearing, obviously it is another step forward for that section of the community.

I am sometimes surprised at the lack of sympathy for deaf people. One often hears people say, "You are very fortunate. If you are deaf, you do not have to hear the speeches of your colleagues", but nobody ever says to a man who is blind, "You are lucky, because you do not have to see ugly things".

Although I cannot yet see the possibility of the transplant of the inner ear, which would be the main advance in science for most people suffering from sensory neural deafness, because there would be 20,000 small ends of nerves to secure, I do not despair that as far as the whole hearing mechanism is concerned there could be considerable advances in transplants, and the Motion will facilitate that.

I propose to say a few words on a similar Motion on the Order Paper in the names of my hon. Friend the Member for Eton and Slough (Miss Lestor) and myself and others which strives to bring home the responsibility of hon. Members and asks that we give a lead in signifying our willingness to bequeath our own organs in the event of death. I welcome this very much. The House has a unique place in the country, and it is right that hon. Members should give a lead in this regard, not only in being prepared to give their organs for transplants, but also their bodies for research.

We are a curious set of people in this House. My only fear is that after a long Session we shall be half dead already. I fear that our bodies will not always be of much value if they are worn out after a large number of all-night sittings on which you, Mr. Speaker, are an expert, as you perhaps have to go through more of them than any other Member.

There is no doubt that if our bodies can be made available for research, the steps that are being taken, especially where certain medical histories taken when the person is alive, are able to be matched with the organs being examined, could result in a great advance in medical knowledge and diagnosis.

I congratulate again the hon. Member on his success in the Ballot, having been balloting myself for 10 years with no success. I hope one day to follow the hon. Gentleman, and, if I do, I shall follow his good example and try to pinpoint attention on something of general public interest in the National Health Service, but which, because of the procedure of the House, we do not otherwise have the opportunity of discussing. The hon. Gentleman has given us that opportunity, and I hope that not only will we accept this Motion, but that we will continue in our own responsibilities as Members and as leaders within our constituencies to enhance the cause which he has so earnestly expoused this morning.

11.44 a.m.

Mr. W. F. Deedes (Ashford)

We listened with particularly close sympathy to the penultimate remarks of the hon. Member for Willesden, West (Mr. Pavitt), and I hope that the subject which we are discussing may eventually lead to the sort of results of which he was speaking on behalf of those who suffer from deafness and kindred difficulties.

We all agree that my hon. Friend the Member for Galloway (Mr. Brewis) has done a useful and timely service in putting down this Motion and speaking to it as he has done. I want to take up only one peculiarly difficult aspect of this new era of surgery and apply it directly to the last part of the Motion which refers to the protection of the rights of all donors. It centres on something which my hon. Friend did not mention, but which will no doubt recur in this debate, and that is the attitude which the Press are adopting to particulars of these operations. In doing this, I must declare an interest. I have been associated with newspapers all my working life, and what I want to talk about closely involves my own camp.

I am prompted to do this by the remarks of the Lord Chancellor in another place a day or two ago, on which I think it is right to put a countervailing view. On this difficult issue, it is fair to say that the newspapers are themselves divided, and this is really not at all surprising. As the newspapers see it, this is a very narrowly balanced issue—how far should they go, how much should they reveal, what particulars should they give of those who are involved as donors or as patients in these operations? As most of the public, I judge, see it, it is not a narrowly balanced issue. Broadly, it seems to me that the public are strongly on the side of the doctors in believing that to publish the names and addresses of donors or recipients is an unjustifiable and an unwarrantable intrusion into privacy.

Nor is it entirely an issue of privacy, or a matter of ethics. What this issue involves goes rather further, because some doctors declare that publicity given to individual donors positively discourages those who might otherwise be willing to donate. Not to put too fine a point on it—that because of the action of certain newspapers, some patients have been condemned to suffer, some even to die who may otherwise have survived, through lack of donors willing to come forward. There could hardly, even indirectly, be a graver charge, and I do not think that in a debate of this kind it would be right to avoid it or to evade it.

I must go on to say, as one closely concerned and interested in this profession, that appearances are against the newspapers which take the minority view. It is not easy to defend the manner in which some news of some transplant operations has been presented, with a wealth of garish detail and garnished with what Fleet Street's critics categorise as trivia. It is this very style of presentation by some which gives rise to the cry of hypocrisy where certain newspapers seek on serious grounds to defend disclosure. It is not unknown to hon. Members that newspapers are apt to damage the justice of their cause by extravagance. The point that we have to establish is whether, submerged below all this, there is a point of substance, whether there may not be some right in those who press for the fullest disclosure in present circumstances, and I suggest that there is, without, I hope, being didactic in what I admit is a very difficult issue.

We are discussing an issue which touches as closely as anything can the sanctity of human life, and that refers to the life of the donor as well as to the life of the recipient. We are, moreover—and this, I think, members of the medical profession themselves will concede—probably only on the frontier of what will prove to be far bigger territory.

Sooner or later we shall get round to designing rules and precautions to safeguard and govern these new advances. Whether we shall necessarily be safer when this House has done its work my experience of recent legislation on kindred subjects gives me reason to doubt, but we shall try—and we may succeed—to achieve safeguards which do not exist under current legislation. When that happens we shall have a new situation. But we have to deal with the interim, and we are dealing with a development for which no specific statutory safeguards exist and which, if some had their way, would be conducted in total secrecy.

Can we be entirely easy about that? Some would. Some may challenge the expression "total secrecy" especially in view of the fact that these operations must be registered somewhere. Certainly, in the hospital concerned a limited circle must, of necessity, know all the details, and no doubt the system could easily be improved and centralised, with a register open to inspection by certain persons and containing perforce, certain details. That does not obtain now. It may do, but it does not at the moment.

When we come to the point I have a feeling that we may tend to overdo the regulations, restrictions, conditions and controls imposed. At the moment, we fear that we do not go far enough. Ultimately, the danger may be that we shall go too far, and may register and control to the point when the medical profession will see some benefit from the circumstances which prevail now.

What is at least arguable is whether we shall be able to devise a safeguard which is at once simpler and stronger than the publication of the name and address of the person principally concerned—in this instance the donor. That, before it is derided, is after all, the central feature of our system of justice, and one which we guard very jealously, with certain rare exceptions. Again, there is room for argument about timing. Some members of the medical profession will argue about this. I take issue not with those who want to discuss the question of the timing of the publication of the names and addresses of those involved but with those who declare that publication of these particulars at any time is contrary to the public interest and, conversely, that secrecy is in the public interest.

Do we really accept that? That is the most important question that we have to consider. It is not simply an issue between the newspapers and the whole medical profession. We know—I am sure that it will be acknowledged later in the debate—that some members of the profession are profoundly uneasy about certain aspects of this business and have been brave enough to speak out publicly about it. Even though these operations are conducted at a very high level, among professionals there remain large areas of doubt. While these doubts remain, are not some safeguards—temporary and inadequate, if you like—essential in the public interest?

Slightly different arguments apply against publication of particulars of recipients, yet, again, a case can be made out. The operations mentioned by the hon. Member for Willesden, West are prodigal of certain resources—blood plasma, and so on. They absorb a large share of hospital resources, human and material, and the public have a right to certain facts on which to form judgments of their own. The question is: ought not these facts to include particulars of the individuals concerned?

There is some paradox in the current mood of believing it right to secure the maximum disclosure of much that Whitehall might wish otherwise to keep secret but insisting on the closest of secrecy in this sphere. Of course there is a distinction between public business and private affairs—but is this an entirely private affair? The Lord Chancellor, in another place, has offered some reflections on this. I must not refer to those remarks, but there seems to me to be the clearest distinction between the publication of details about persons involved in this sphere and the publication of particulars of someone involved in the distant past in some misdemeanour.

For that reason I found the analogies used by the Lord Chancellor surprising and unacceptable. We are talking about an issue of the widest public interest and the closest public concern. We may deplore—as I began by deploring—the capacity of some newspapers to obscure a small candle of truth by unnecessary pyrotechnics of their own. But we should not lose sight of the small central flame. If we decide that the Press is wrong—and some hon. Members emphatically will decide that—in seeking to discover and publish these particulars, we must ask whether total secrecy is acceptable. If we decide that total secrecy is not acceptable, as I think we shall, we must determine what alternative safeguards can be offered in present circumstances. All I say is that some safeguards there must be.

11.56 a.m.

Dr. Shirley Summerskill (Halifax)

I join with previous speakers in welcoming the opportunity given to us to debate this extremely important subject—a subject with ethical, legal and medical implications. It is far too large a subject for any really good conclusions to be drawn in the short time available to us. Many of its aspects are deserving of almost a week's symposium. We can only hope to put forward a few general observations, without committing ourselves to anything in too much detail.

I foresee discussion on the subject of transplants in general recurring over the years. Most of us owe our lives to the fact that at some time someone else's blood has been transfused into our veins. I know that I do. We none of us comment on this fact, or wonder who the donor was. It is a commonplace event, and there are blood banks with other people's blood which are drawn upon in emergencies. This is a part of everyday medical and surgical procedure.

From that we have progressed to grafting. We have progressed to kidney transplants, which are now fairly common place, and heart transplants, which are still in their infancy. We foresee lung transplants which, if successful, will save the lives of millions of people who are now dying from cancer of the lung. Lung transplants will probably play a far larger part in our lives than do heart transplants. The extent of this subject is enormous, and it is growing. I have no doubt that transplantation is here to stay, and it should be given the encouragement that it is given in the words of the Motion.

I find far greater pleasure in a photograph of Dr. Blaiberg swimming in the sea, or having finished a game of tennis, than I do of astronauts having returned from the moon. Both are examples of human endeavour in science. I am not criticising space research, but my own personal preference, if vast sums of money are to be spent, is for them to go towards medical research.

Far too little credit is given to the surgeons and doctors who are doing everything possible to save the lives, against seemingly impossible odds, insuperable odds, of people who have chronic kidney or heart disease. Many of the operations are unsuccessful, but all credit should be given to the doctors and surgeons for those which are successful. The survival rate will increase in time as more operations are done.

The problem has been changed because we now have machines which can artificially maintain circulation and respiration almost indefinitely. That is why the problems which we are discussing have arisen. In Britain, at any rate, we have the greatest medical service in the world and I personally would willingly be a donor of any organ which the medical profession found useful to save a life. The standards of ethics of our medical profession in Britain are of the highest, and I have the greatest confidence in its judgment.

There have been more than 130 heart transplants throughout the world, but only two patients have survived for more than a year. The results of kidney transplantation 10 years ago were worse than the present results of heart transplantation, which is an indication that we must allow our surgeons and doctors to persevere and be given an opportunity to conquer the whole problem.

I was most interested in the remarks of the right hon. Member for Ashford (Mr. Deedes) about the publicity aspect of the matter. We never heard so much about all the kidney transplants which took place, because the heart has a romantic connotation. It is always felt to be the seat of emotion and feeling. I am sorry to say that it is merely a mechanical pump and that it is the pineal body which is the seat of the soul, a small pea-like structure at the base of the brain. But no one has ever written a poem about the pineal body.

Lord Balniel (Hertford)

The hon. Lady is, of course, absolutely correct in speaking of the heart in the mechanical terms, but will she not also recognise that for generations the heartbeat has been the definition of life and death? It is not quite so simple as to describe it simply as a mechanical pump.

Dr. Summerskill

But it is still a mechanical pump, although, as the hon. Member rightly says, until recently the heart beat and respiration were taken into consideration when defining death. I shall come to the definition of death a little later. We now have to reassess the whole situation.

Professor Barnard himself should not wonder what all the fuss is about. He says that for years we have been putting hearts in bottles and that nobody has minded. But when we put the heart in a human being, obviously an emotional factor is involved. This is understandable and one must take it into consideration when considering heart transplants.

I agree with some of the remarks of the right hon. Member, but anonymity of the donor and the recipient—he said more about the donor, but it is also true of the recipient—is very important. It is difficult for a recipient, in hospital trying to get well, to feel that the eyes of the world are upon him, and for his relatives, who are obviously extremely worried and distressed at that time. I hope that there will be more anonymity in this connection.

However, it is obvious that if heart transplants become everyday occurrences, there will be much more anonymity. With the survival figures so few, they obviously have news value and it is difficult to stop the newspapers and the public from expressing interest. But once they become an everyday occurrence, they will no longer have news value, and to be a donor or recipient will not be regarded as so extraordinary.

Of course, there should be safeguards, but also in connection with the medical profession. During the last few years, doctors have been submitted to the public gaze far more than they used to be. There was a stricter code of ethics in operation 10 years ago and doctors who went on television or gave interviews were not named. Obviously, there is public interest in what night clubs Dr. Barnard goes to, and so on. It is the fault of the newspapers; they would say that the public wants to know.

But I hope that the medical profession will give this matter some thought and perhaps suggest to its members that they should be less inclined to give so much publicity not to their work necessarily, but to themselves if pressed to do so by the Press and television. They should give publicity to their work, but anonymously, in the same way as donors and recipients might be anonymous.

It is impossible to go into the definition of death in great detail. Its study has acquired the status of a new branch in medicine called thanatology and it is obviously something which will be with us for some time. The use of mechanical methods of resuscitation has called for a new definition of the point of death and the criterion of the heart stopping has had to be abandoned.

At the 21st World Medical Assembly last year the dominant view of representatives was that the death of the mind or brain in an absolute sense, or in the sense that doctors could find no hope whatever of recovery to normal function, would seem to be the only reasonable basis for a new definition of clinical death, but, in fact, there is no single criterion.

Without going into the details, it is clear that this new definition would have enormous legal complications. Eminent lawyers have shown the chaos which would occur if that, rather than heart beat and respiration, were the definition of death. There is an enormous area for dispute and study, and the House could certainly never attempt to bring in any sort of legislation which attempted to define death.

I spoke earlier of my pride in the National Health Service. I am confident that if two doctors, not related to a transplant team, base their definition on an electroencephalogram, as they do at the moment, with their high standard of integrity and ethics, this is the best situation which may be reached at the moment. Another consideration, as has been said, is that on the whole transplants in Britain are done under the Health Service and, therefore, there is no financial incentive on doctors to say, "I must do this operation because I will get so much for it." That is the great safeguard to the donor or recipient—that the operation is being done because it needs to be done and there is no element of financial gain.

Mr. Snow

Would my hon. Friend not agree that, whereas there is obviously no financial factor in the minds of surgeons, there must be a very strong factor, made up not only of professional pride and ambition but of a desire to help the human race?

Dr. Summerskill

I agree, but no surgeon wants to perform this operation unless he thinks it necessary. He would obviously attempt to make it succeeed to the best of his ability. We will not suffer from the problem of over-zealous transplant surgeons as we have on a smaller scale in "The Doctor's Dilemma" and as may occur in other countries.

I come to the question of the shortage of donors. We should stress the very serious situation about the lack of donors for kidney transplants. Professor Roy Calne, of Addenbrooke's Hospital, in Cambridge, wants the law to be changed. He has said that in his area, in 1967, 20 patients with renal failure died while on the waiting list for kidney transplants. He would like a change in the law relating to this and to see enacted a suggestion that kidneys could be legally removed from persons dying in designated hospitals, provided that the patient, before it was done, had not forbidden the procedure or belonged to a religious group which did so.

The publicity which has been given to heart transplants will, ironically, draw attention to the need for kidney donors. I hope that this debate and subsequent publicity makes the offering of a kidney, or any organ, a matter of pride among the public, rather like people who donate blood and who often boast about having donated 50 pints and obtained a badge for it. Others do not boast, but go along and give their blood without comment. I hope that offering our organs to save lives will become equally commonplace.

This is a question of impressing upon public opinion the importance of this in saving lives. Members of Parliament can give a lead here. Transplants are not undertaken lightly. There are major difficulties. The patient is always very ill and needs to be under constant supervision. The donor needs constant resuscitation; he has to be near the recipient, involving enormous difficulties. Doctors have to be constantly in reach of the hospital because a suitable donor can become available at any time. Finding suitable donors is a great difficulty, leading to the loss of lives at the moment, and the drugs required produce their own problems.

We have by no means overcome the problems of the operation and the chances of survival. I do not believe that a doctor takes a life when he has a chance to preserve it. The B.M.A. Council has issued a statement saying that to remove desperately ill people from one hospital to another, to be near a potential recipient of their organs, is ethically indefensible.

On the other hand, if we impose restrictions on doctors, then we defeat our own object, contained in the Motion. It is time now to await the report of the Government committee set up to investigate this, continually to review the whole situation, to urge people to become donors, to try to reduce the amount of sensational publicity given on the subject, but certainly not to impose restrictions on doctors.

The public has enormous confidence in doctors in our hospitals. It used to be a risk to have an appendix operation; now people go into hospital without thinking twice about that. I would like them to have a similar confidence in doctors who are doing everything possible to save lives by transplants and to make future heart transplant surgery successful.

12.13 p.m.

Mr. David Lane (Cambridge)

I, too, wish to congratulate my hon. Friend the Member for Galloway (Mr. Brewis) on his choice of subject and his admirable opening speech. There is a great deal of public perplexity, reflected in the Motion already mentioned and the Amendment to it in the name of the hon. Member for Liverpool, West Derby (Mr. Ogden). We have a very good opportunity now to air the subject, which I hope will lead to further debate and, most important, Government action. Talking of Government action, may I say how good it is to see the Under-Secretary restored to health and back in action again on the Front Bench.

I am very conscious that this is a difficult area for a layman to venture into. On the other hand, it is a responsibility which we in this House, experts or laymen, cannot shirk. I have to declare a constituency interest in this, because Professor Roy Calne and his team are based in my constituency of Cambridge. They have done a great deal of pioneering work in kidney and liver transplants, and I would like to pay tribute to them. I hope that this does not make me a blind or uncritical advocate of the cause of the pioneer teams in transplantation surgery.

I wish to make three pleas. First, I ask that further progress in kidney transplantation should not be jeopardised by misplaced anxieties about transplantation generally; secondly, that inside and outside the House people should apply themselves to the problem with cool thought rather than hasty emotion; and, thirdly, that the Government should recognise their resonsibility to reassure public confidence and, as far as possible, to lay down lines for future advances.

The basic facts of kidney transplantation are well known, and I will only summarise one or two. This area of transplant surgery has been going for well over 10 years and, compared with some other areas, a good deal of experience has been accumulated. I do not want to exaggerate the claims of success in kidney surgery, but it is fair to say that progress in this branch is substantially ahead of other branches.

The positive treatment for sufferers from kidney disease is a combination of artificial kidney treatment and kidney transplantation. At present, the result is that about 60 per cent. of patients are alive one year after they start treatment and something over 50 per cent. after two years. Methods of preventing rejection of transplanted kidneys are improving all the time, while tissue typing is making it possible to predict whether the result of transplanting a given kidney to a given recipient is likely to be good. Thus it may be possible to go on improving the results of kidney transplantation considerably over the next few years. Here we are up against the difficulty already mentioned, highlighted by the fact that every year more than 2,000 young people in England and Wales die from kidney diseases when they might be saved if there were a greater availability of kidneys for transplant surgery.

This was vividly brought home to me, and possibly to other hon. Members, in an interview during the B.B.C. programme "Today" on, I think, Tuesday morning of this week. A boy of 12 years of age, who had had his kidneys removed and was awaiting new kidneys, and his father were interviewed. The interviewer said to the father: At the Paddington Hospital the kidney transplant operations have fallen off this year because they are not hearing about donors. How do you feel because some of the public are objecting to transplant operations?". The father replied: Well, if they visited these patients or saw these patients after they'd received a new kidney, they really are practically 100 per cent. They would have a change of opinion, I think". The present law, the Human Tissue Act, 1961, contains very restrictive provisions in the light of advances which have since been made. In practice, it requires the positive consent of the next of kin to be given. This has been well pointed out by the hon. Member for Galloway, who also mentioned the Renal Transplanation Bill introduced last Session and this Session by my hon. Friend the Member for Worcestershire, South (Sir G. Nabarro). In brief, its purpose was to substitute, with some exceptions, a contracting-out system for the present contracting-in system, which would have made it possible for kidneys—and it was restricted to kidneys—to be removed from dead bodies unless there was reason to believe that the deceased, during his lifetime, had instructed otherwise.

Last Session, a considerable majority of the House gave leave to my hon. Friend the Member for Worcestershire, South to introduce the Bill, but it did not get beyond the Committee stage. When he reintroduced it in the present Session, in January, it was defeated on Second Reading by a clear majority in a very thin House.

I should like to say a few words about the Government's attitude on these last two occasions. I appreciate the difficulty of the then Minister of Health, the right hon. Member for St. Pancras, North (Mr. K. Robinson), and the Under-Secretary of State in answering the debates on the Bill. They were dependent on the advice of the Advisory Committee and on the conference which sat about a year ago. Their general feeling was one of sympathy with the objective of the Bill—that the scope for kidney transplantation should be widened—but anxiety not to go too far ahead of public opinion. This is still the position today, and I look forward to hearing what the Under-Secretary has to say.

It may be premature to move over now to a full-blooded system of contracting out on the lines of our Renal Transplantation Bill. We know the objections of many people, and it is absolutely right, as Government spokesmen have said, that there must be full safeguards which satisfy public opinion. But, subject to that, I am sure that the time has come to move some way forward from the present Human Tissue Act, whether it is by an alteration of the law or by greater publicity on the need for more donors, with perhaps the opening of a register.

I join other hon. Members who have spoken in saying that I would be willing for organs of mine, if they were of any use, to be used for this purpose after my death. The A.A.'s initiative, in the magazine Drive, in providing forms for motorists to fill in information about their willingness was excellent. I hope that something more on these lines can be done over the next few years, even if it is felt that we cannot yet go quite as far as was proposed in the Renal Transplantation Bill.

I hope that the Government will soon be ready to move further forward from the somewhat negative attitude they have had to adopt towards kidneys up to now and that they will consider supporting a partial amendment of the law, or, failing that, taking the lead in ensuring that greater publicity is given to this matter. It will be lamentable if progress in this highly promising branch of kidney transplantation surgery is set back for largely extraneous reasons and if, in consequence, many more thousands of sufferers from kidney disease are denied the opportunity of benefiting from modern medical skills.

I turn to my second plea, for cool thinking rather than hasty emotion. There is disquiet among the public, and I think that it is fair to say that in a very few cases the conduct of doctors and of the Press has fallen below the high standards which are essential if we are to arrive at right judgments and decisions in this difficult matter.

I echo what the hon. Lady the Member for Halifax (Dr. Summerskill) said about the high esteem in which the mass of doctors is held by the mass of public. Any anxieties which have and express should be kept in proportion. However, there are suspicions that if transplantation surgery, particularly heart transplantation surgery, goes much further, something less than maximum effort to keep desperately-ill patients alive may be made by some doctors if there is a chance of their organs being used for transplantation. I do not believe this, and I am prepared to trust the integrity of the medical profession.

I should like to quote what Professor Calne recently wrote to me. In seeking to widen the law in favour of more kidney work, he realises absolutely that reassurance of the public is vital. He says that there must be reassurance that there will be. no diminuation of efforts … by the medical and nursing profession on behalf of the person who appears to be dying because he might be a suitable organ donor after death. All I can say here is that in my experience the reverse is true: doctors and nurses redouble their efforts to care for their patients to the best of their ability. Reassurance on this point really requires confidence in the integrity of the medical profession. I do not believe, either, that a new legal definition of death is to the point. I agree very much with what was said by the hon. Lady the Member for Halifax. On the other hand, doctors must recognise and respond to the present public concern which was well summed up by a recent article in a medical journal, Medical Tribune, which stated: It was no wonder that thinking members of the community found very disturbing the odd mixture of near-casualness and incomplete disclosure of information which characterised the circumstances surrounding this particular operation". That was a reference to the third British transplant operation carried out at Guy's Hospital.

It is fair to appeal to doctors involved in this matter to refrain from making the very lurid comments which we have heard from a few of them in recent months. It does not help rational debate for doctors to talk about "transplant vultures" or "shotgun consent" by the relatives of donors.

I wish to draw attention to what I thought was an admirable letter written to The Times on transplant surgery by Professor Peart, of St. Mary's Hospital, another of the pioneers, and published on 3rd June. I wish to quote two sentences about doctors' public statements: When criticisms of their colleagues are voiced by doctors, the temptation to use the cheapjack phrase should be resisted, since while public controversy is important vital issues can only be obscured by mud-slinging. The motives of doctors who use such language have to be scrutinised carefully in relation to their own personal need for publicity". I recognise absolutely the interest and duty of newspapers and television, and I applaud the efforts which many of them have made to widen public understanding of what is involved. I agree with my right hon. Friend the Member for Ashford (Mr. Deedes) about the safeguarding function of the Press in the present situation. With all respect to my right hon. Friend, however, I was sorry that, in my view, the Daily Telegraph overstepped the bounds during the recent reporting of the third heart transplant operation. It fell below its usual high standard in disclosing the name of the recipient, although I understand that the Press had been particularly asked by the relatives not to do so.

The Lord Chancellor's speech earlier this week has been referred to. Although I do not necessarily agree with all that he said, he put very well the dilemma between the need to reassure the public and the need to respect the privacy of patients and their families. What we need, I suggest, is greater frankness by the medical profession and greater discretion in reporting. The patient surely must be paramount. In other words, the interest of the patient, whether donor or recipient, must come before the convenience of doctors or the curiosity of the Press.

Thirdly, I plead that the Government should recognise their responsibilities. We know from an Answer earlier this month that the Secretary of State is shortly expecting advice from his Standing Group on this subject. I doubt whether we should try to put in legislative form any new definition of death. I would be prepared to leave that to the wisdom, experience and high ethical standards of the medical profession. The time has come, however, to reconsider the Human Tissue Act in an effort to give a reasonable widening to the scope for transplantation surgery, particularly kidney transplantation.

The Motion mentions, and the hon. Member for Willesden, West (Mr. Pavitt) has particularly stressed, the problem of the resources of the National Health Service. Again, it is necessary, knowing the vast expense in financial and other terms of any kind of transplantation surgery, to reassure the public that advances here will not be at the expense of the main part of the National Health Service.

I therefore hope that the Government will be willing to set out their view in a White Paper before the end of the year which can lead to further consideration in this House.

Our problem, in brief, is to ensure that the frontiers of medical science continue to advance and that opportunities for life-saving treatment are further enlarged. While also ensuring that the sanctity of human life is honoured and individual privacy safeguarded, I hope that this debate today is a step towards solving this difficult problem. I hope, too, that the Government will recognise their responsibilities and act upon them.

12.33 p.m.

Dr. John Dunwoody (Falmouth and Camborne)

I, too, congratulate the hon. Member for Galloway (Mr. Brewis) on his good fortune in the Ballot, on his selection of the subject for discussion and on the reasoned and rational way he put forward his Motion, which, in the general sense, I support.

I would like briefly to take up a point made by the hon. Member in his speech when he mentioned the controversial case in Cornwall, which is in my part of the country. As the hon. Member said, the facts are in dispute. Both the hospital management committee in West Cornwall and the staff at the hospital have denied a number of the points that were put forward in the Press. I should not like anything that was said in this House to suggest that the standards of treatment at the Royal Cornwall Hospital were not of the very highest. It provides a remarkably high standard of service in a peripheral and difficult part of the country.

In dealing with the problem of transplants, we need to be conscious of the danger of taking up an extreme position. It is complete and utter nonsense to talk, as some people have done, of body snatchers or a sort of twentieth century Burke and Hare situation probably arising. It is, however, equally unrealistic to look at transplant surgery as though it is just another sort of surgery.

I am a little concerned when I see efforts made to shroud in secrecy what is happening and when I see hints of censorship, of which we have one or two in recent months. There has inevitably been a great deal of publicity about this subject. There has been much criticism of the mass media, the Press in particular. In my view, the great bulk of this criticism has been unfair.

Perhaps we are wrong to talk about the curiosity of the Press. In dealing with a subject like this, the Press have a responsibility and, inevitably, have largely to represent the community as a whole. There is genuine public interest and concern about this subject, and rightly so. We are an increasingly more sophisticated and educated community, and we are not dealing here with solely medical problems. There are big moral and ethical problems. It is right and proper that the Press should take a healthy interest in the subject. After all, we cannot be critical because the Daily Express does not deal with these matters like the British Medical Journal, or the Daily Mirror never deals with medical topics as does the Lancet. They appeal to very different audiences.

The one area where I have doubt concerns the publication of names of either recipients or donors against the wishes of the recipient or of the relatives of the donor. I am concerned about this, although I cannot accept that we can have a situation of total secrecy. Perhaps some sort of halfway house should be devised by which this information is available but not publicised widely throughout the country in the national Press.

If that were to happen in the case of a recipient, in some situations it could retard his recovery from a major surgical procedure. In the case of donors, if publicity was given to the family of the donor after they had specifically requested otherwise, this would jeopardise the chances of sufficient donors coming forward in the future. If people did not believe that they could obtain at least anonymity in the daily Press, in many cases they might not be prepared to consent to a relative being a donor although they would consent in other situations.

The other field in which there has been criticism—and I share some of it—is the attitude of some of those doctors and surgeons who have been involved in the rapid advances which have been taking place in this field. There have, I think, been occasions when the attitude and methods of publicity adopted by these surgeons have been open to criticism. We do not want to be too critical, because very often these men are under considerable pressure and subjected to intense publicity. Nevertheless, one has to say this.

We have been talking about transplant surgery. The danger is that we will talk simply about heart transplants. Let us not forget that the number of heart transplant operations has been a mere handful and the results rather disappointing. There are other major organ transplants which have taken place—liver and lung transplants. It is in kidney transplantations, however, that the most remarkable advances have taken place. We have heard from hon. Members the statistics. Indeed, in expert hands and in the right units, kidney transplantation is no longer an experimental technique.

The contrast between heart transplantation, on the one hand, and kidney transplantation, on the other, was suggested by my hon. Friend the Member for Halifax (Dr. Summerskill) to be perhaps primarily tied up with the fact that the heart has for generations been considered as the seat of emotion. An hon. Member opposite pointed out, quite rightly, that the heart beat has often traditionally been accepted as an indication of life. This adds a more practical factor.

The important difference to my mind is that we can all, and many people do, survive with only one kidney. The removal of a kidney does not inevitably mean the end of our lives, whereas the heart is essential to our survival and its removal is incompatible with continued life.

That means that with renal transplantation there is, first, the possibility of a living person being a donor quite deliberately and, secondly, there is, perhaps, not the tragedy, and possibly not the cause for concern, that there is with heart transplantation as to what is exactly the moment of death when a corpse is being used as the donor. We therefore have a situation in which there are major problems, some of which are common to all sorts of transplants and some of which are confined to the more dramatic procedures.

Perhaps my main concern in this subject is regarding the resources of the National Health Service. We in this country are short of doctors, nurses, hospitals and staff. We have very long waiting lists in virtually every hospital. Transplant surgery makes very great demands on the hospitals where it is performed, on the hospital staffs, on the facilities, on the laboratories and on blood banks. Research and advance must continue, but not at the expense of the day-to-day treatment and the routine services that our Health Service has to provide.

I now turn briefly to the question of legislation, to ask whether it has a role to play. I underline that this subject is one of extreme difficulty, and I would say that, accepting that there is extreme difficulty, a quite long period of consideration, consultation and debate may have to elapse before we can find any all-embracing legislation. Serious thought should be given to the field of renal transplantation, because here the need for legislation is perhaps more urgent, and also, perhaps, it is easier to evolve satisfactory legislation in that field than in the field of transplantation as a whole. We must ask whether legislation has a possible role.

The question of the definition of death has been raised, and here I would utter a very serious word of caution. If we are to attempt to write into legislation some form of definition of death, we are possibly getting out of the frying pan into the fire. I agree very much with what the World Medical Association had to say, that there is no single criterion. Although we have electroencephalography and E. C. G., there are also physical, emotional and other factors, which have a very important rôle. We have to consider the whole clinical picture and not just one organ system.

I should like the question of the certication of death to be considered. At the moment, where cremation is being considered, there is required a special form of certificate of death. Various suggestions have been aired in the debate. A special form of certification where donors are concerned should be seriously considered, like the suggestion which has been hinted at, that a coroner should have some rôle to play, and that should be discussed, although I am not very happy about a lay coroner being asked to interpret an electroencephalograph, which, I think, one hon. Member suggested.

Mr. Brewis

I was suggesting that he should make his decision on the evidence put before him, and that would include that of the machine.

Dr. Dunwoody

Yes, I accept that evidence by witnesses, who would, presumably, include expert witnesses, would be reasonably satisfactory.

The question of a code of practice has been brought forward and whether there should be some formal certification of the desirability of this particular sort of surgery, and whether this should be written into legislation. This, again, is something which should be considered, and in considering it we should take into account the interests not only of recipients but also of donors.

I wonder whether the question of the registration of premises where transplant surgery is performed might be considered, not because I am in any doubt about facilities which are available, nor because I imagine that there will be a vast numbebr of hospitals in the months immediately ahead which will attempt to perform transplant surgery, but because it might be a useful means of checking that the code of practice which is desirable is being adhered to.

It would be a means of ensuring that the day-to-day work in a hospital does not come to a standstill, as I think sometimes it is tending to do on occasions in certain hospitals at the moment, because of diversion of resources. We certainly do not want to see any wasteful use of manpower and resources. If we had checks on these things, that would give the confidence to the general public which they have a right to expect.

Doctors are rightly always concerned with the welfare of their patients, and all of their patients, and we are concerned to offer the appropriate treatment to patients who are suffering from organ failure, whatever the organ may be, but we have also a responsibility to protect the rights of donors. Donors are very often also patients; they also are often desperately ill, and they also have their right to appropriate treatment. The situation of the relatives of donors should be very specially borne in mind; and I am thinking, also, of those who have violent objections, perhaps of a religious nature, to organ transplantation, and concern for the welfare of our patients, we must also be concerned to ensure that there is no reduction in standards.

We can do all this, but there has to be a period for consideration, open and frank debate such as we are having here this morning, in which the public, patients, doctors, Government and Parliament all take their part.

12.45 p.m.

Lord Balniel (Hertford)

I apologise for intervening at this stage, because I appreciate that there are other hon. Members who wish to take part in the debate, but it is possible that I shall have to leave before the conclusion of the debate, so I intervene now.

I am rather diffident about taking part in this discussion, because it touches on the very issue of life and death and I am very well aware that I have by no means mastered all the technical, medical, legal, and ethical implications which are involved in transplant surgery.

Unlike the Under-Secretary of State I do not have behind me serried ranks of civil servants to assist me in compiling my arguments, and unlike the hon. Lady the Member for Halifax (Dr. Summer-skill) and the hon. Member for Falmouth and Camborne (Dr. John Dunwoody), I do not bring to the debate the medical experience which they have contributed. I suspect, however, that I find myself in the good company of the great mass of our countrymen in discussing this matter with humility. Equally, surely, it is right that everyone concerned with human life should have his say in this important debate.

The hon. Member for Falmouth and Camborne, in his extremely interesting speech, referred to the Burke and Hare situation of many generations ago. I myself have almost a family interest, because the body of my great-great-grandfather was taken from its tomb by the resurrection men in the hope that they could blackmail my family. I am glad to say that even in those far off, distant days they had a very modern attitude, and refused to pay up. The body was ultimately discovered and restored to its tomb.

Also, I do not deny that I have some nostalgia about this debate if one can possibly use such a word in this context, because I am one of only two or three Members of the House who actually took part in the debate on the Human Tissue Bill of 1961. It is this Act on which the law is based at the moment. Then, of course, we were thinking—including Ministerial spokesmen—of cornea grafting, of skin tissue grating, and simple transplants. It is, indeed, a measure of the superb technical advance which has been achieved in recent years that the debate today has been concerned overwhelmingly with complex transplants relating to the kidneys, the liver, and the heart. It is a measure of the gratitude which we owe to my hon. Friend the Member for Galloway (Mr. Brewis) for introducing the debate that this is the first debate we have had on this subject since the passing of the Human Tissue Act.

The Observer, of 1st June, 1969, opened its leading article by saying: Doctors really should not be surprised that the public tend to react with bewilderment and suspicion to heart transplants. This kind of expression of view is the one which has been echoed in many newspapers in recent months. These operations do carry emotional overtones. For reasons to which I will refer in a moment, they are invested with great drama. They involve a judgment as to when a donor is dead, a judgment on which there is a great diversity of view amongst lawyers, amongst laymen, and in the medical profession itself.

The moment of death is not defined in law, and the World Medical Assembly, at its recent meeting, failed to agree on a definition. In my opinion, a definition of death is basically a medical decision, and I suspect that attempts by the House to secure an acceptable legal definition will land us in a fearful tangle.

It may be that much of the worry about heart transplant operations is based on ignorance. It may be that many of the suspicions and fears are irrational. The last thing that I would want to do is to tell the medical profession what operations they should or should not conduct. In some countries though heart transplants are forbidden, for example, in Sweden, where the definition of death is the permanent cessation of all heart activity. My preference is to leave such decisions to the clinical judgment of doctors, to their conscience and their sense of responsibility. Either we trust the profession or we do not.

This must be a personal decision and not one for the House. Our responsibility in the House of Commons lies in laying down correct procedures for certification by independent doctors, the consents which are required from relatives, a code for donors and, perhaps, instructions for coroners.

Mr. Snow

Do I understand from what the noble Lord is saying about the rôle of the clinician that he would impose on the clinician the total responsibility for the ordering of priorities in the use of resources?

Lord Balniel

I will deal with this as I develop my speech. Indeed, my next point is that whilst I believe the responsibility must ultimately rest on the clinician, those who take that decision would be well advised to take into account other considerations, such as public opinion as we try and represent it in the debate.

Whilst I believe that responsibility for deciding whether or not to proceed with such operations is a clinical responsibility, we are all members of society. I would hope that the medical profession will bear our views in mind in taking these decisions. We have not, of course, their professional knowledge, but we can perhaps contribute something of value out of our experience to the debate which is going on. The medical profession must be under no illusions at all about the enormously deep concern which is now felt by the public about heart transplant operations.

We are here in the House of Commons as laymen, elected by our fellow men and women to exercise to the best of our ability our judgment in the interests of society as a whole. Part of our responsibility to society is to emphasise to the medical profession that the brilliant technical aspects of the operations are only part of the total consideration which has to be weighed. Although the technical aspects are the most spectacular, they are by no means the most important consideration. The wide measure of respect which we accord to the medical profession is accorded not only because of its medical skill, but because of its moral and ethical integrity. If people are ignorant, and are worried, in large measure the responsibility for educating society rests with the medical profession.

The reason people are now so deeply concerned is not as the result of over-dramatisation by the Press. I have been enormously impressed by the quality of recent Press and television comment on this subject. There may be some exceptions which I have not seen, but my general impression is that these matters have been discussed responsibly by the Press and television. There are though two reasons for concern which exercise the public mind; the first one is general and the second revolves around a specific incident.

Until recently most transplant surgery involved the removal of organs from the living body, where the agreement of the donor was obtained after quiet thought and consultation. Alternatively, it involved the leaving in one's will of an organ of one's body, for instance, a cornea to help the blind to see again. These were carefully considered actions taken deliberately by the donor and not by anybody else on his behalf. The new anxiety comes from the need of surgeons for organ transplants from the dead to the living, and the fact that we have no clinical or legal definition of death. To put it bluntly, the fear is that an organ, say a heart, might be taken from somebody who is not "absolutely" dead.

The second reason for public concern arises specifically from the circumstances which surrounded the third heart transplant operation. Concern arises from the way in which the information about this case was made available to the public. I echo the words of my hon. Friend the Member for Galloway in expressing our sympathy for the anguish of the relatives of this young lady, the relatives who took such a grave and correct decision. It is precisely because we never had at an early stage an explicit and clear explanation from the medical authorities concerned that so much worry exists.

I turn to the point made by my right hon. Friend the Member for Ashford (Mr. Deedes), with every word of whose speech I am in complete agreement. I believe that in present circumstances, where heart transplant surgery is still experimental, the decision of the Daily Telegraph to publish the name of the donor and the recipient was a correct decision. I know that this is not universally accepted and that immensely difficult arguments are involved. I have read the rather heated leader in the British Medical Journal of 31st May, taking the contrary view. I hold the British Medical Journal in the highest esteem, but I simply do not agree with its conclusion that The plea of public interest cannot be sustained". Like my right hon. Friend the Member for Ashford, I have no wish to be didactic, but there have been few occasions when I have felt more absolutely certain that it was essential that the fullest facts should be made publicly available. No one with a decent sense of compassion wants to pry into the harrowing scenes of grief which surround tragedies of this kind and which are inevitably associated with heart transplant operations. But for literally thousands upon thousands of years we have taken the beat of the human heart as the criterion by which we judge the existence of life and the moment of death. We now know, of course, that cardiac resuscitation makes this criterion no longer an adequate definition. We know of the laboratory equipment for measuring electrical impulses of the heart or of the brain. But in most normal circumstances it is the continuance of respiration and of the heart-beat which is the indication of life.

On this occasion, after a road accident the patient was moved from one hospital to another. One of the reasons was that she might have to remain in intensive care for months and that the facilities for such intensive care existed only in the larger hospital. Her heart was still beating when she was pronounced dead—albeit it was beating as a result of the use of mechanical equipment. The machine was then switched off, and 18 minutes after the heart had ceased to beat the operation was begun. I understand that this was seven hours after the consultant neurologist had decided that there was no hope of recovery.

I am absolutely convinced that the hospital authorities and the doctors concerned acted with propriety. I am sure that there was no collusion between the different surgical teams involved. I am sure that they were punctilious in their observance of the codes of conduct. But I am equally sure that the profession would be wise to pause before repeating heart operations which are conducted in these kind of circumstances, at least until the MacLennan Committee has reported.

I have very grave reservations about these heart operations being associated with sudden tragedy, like road accidents. I should like to quote from a wise article written by Lord Brock, former President of the Royal College of Surgeons, in The Times on 1st January, 1968, although in fairness to the House I must explain that much of his article is concerned with the need for anonymity. Lord Brock wrote: If the impending death is the result of a sudden accident the tragedy is so enhanced that a grievous situation is rendered almost insupportable by the request for permission to use the heart as a transplant as soon as death has occurred. That this situation is intolerable and totally unacceptable will be generally admitted. In fact it is the aspect of the whole venture which has been repugnant to most sensitive people. Many have found it colours their whole thought on the problem and obscures or denigrates the worthiness that the technical success deserves. I believe that there is an inevitability about the development of heart transplant surgery. Just as blood donation was once rare and highly controversial, so it is now frequent and generally accepted. Just as corneal grafting or kidney transplants were once rare, so they are now not uncommon. The same will be true of heart transplant surgery. These other operations have become widely accepted because research has made it possible to preserve to a greater or lesser degree the tissue, in cold storage, in a medical bank. In this way one achieves the quiet, unhurried, anonymous surgical advance instead of the drama that surrounds heart transplant operations of today.

I speak as a complete layman, and I would hope that the selection of research projects could primarily be left to the medical profession. Certainly, I share the anxiety to develop the kidney transplant operation. However, I should have thought that research along these lines—the development of preservation techniques and mechanical spares—was of a greater long-term value than a continued rush of experimental surgery which is causing deep unease in society today.

Whether we are humanists, agnostics or religious, the moment of death should so far as possible be invested with dignity. It is this which is so lacking in some experimental operations at present. I suppose that this is a longer term view, but the development of manufactured synthetic parts will one day make these transplant operations a mere ephemeral stage. Soon surgeons will be able to replace most of the joints of the human body—hip joints, knees, finger joints, shoulder joints—with mechanical spares. This kind of development of mechanical synthetic parts could bring enormous relief, for instance, to arthritic sufferers. I would like to see a shift in the balance of money which can be allocated towards this particular research. It is too limited at the moment.

I should like to end by commenting on an aspect which was referred to by my hon. Friends the Member for Cambridge (Mr. Lane) and the Member for Galloway. It has been suggested by one of the most eminent surgeons in the country, Professor Calne, that procedures should be developed so that we should all be able to contract-out of donating our organs, but otherwise on death we shall be assumed to have made those organs available for transplant. I understand the thinking behind the argument. However, I do not think that the public is ready for this change. My hon. Friend the Member for Galloway said that it would result in a calamitous loss of confidence in the medical profession. He has put in dramatic form what I believe would be the reaction of the public.

I expect that the next stage will be the publication of the MacLennan report within a month or two months' time. I hope then that the Government will issue a White Paper based on all the experience and resources of information on which they can draw, and that we shall then have an opportunity of a further debate on one of the most intractable and difficult problems today facing both the medical profession and the lay community.

1.7 p.m.

Mr. Eric Ogden (Liverpool, West Derby)

The hon. Member for Hertford (Lord Balniel) has confirmed his real sympathy and understanding of this problem, more than one would normally expect from formal duties of a member of the Opposition Front Bench, or, indeed from our own Front Bench. The House appreciates his real concern in the matter. I have points of disagreement with his speech, but they are minor ones. He was right to emphasise the large measure of agreement in the House among those of us who have taken an interest in this subject. There is probably more agreement in this House today than we have seen for many days or weeks, which is a good thing.

I join in the congratulations to the hon. Member for Galloway (Mr. Brewis) upon choosing this subject for debate today since it is rare that we have an opportunity to debate these matters. It will help to focus the attention of the House and of the country as a whole upon this matter. It is another example of the way in which the House can lead, or indeed form, opinion on a subject such as this.

I should perhaps emphasise at the outset of my remarks the broad agreement which exists before going on to the disagreement. People often ignore the 90 per cent. of agreement and tend to concentrate on the 10 per cent. of disagreement. Having regard to the Motion of the hon. Member for Galloway and the Motion of my hon. Friend the Member for Eton and Slough (Miss Lestor), together with my Amendment to it, the House will agree that there is a common interest in and concern about the problems of transplant surgery, its achievements, and the need for the allocation of more resources for research.

There is also the question of what action should be taken as more donors become available. It is not a straight equation that simply because one has X number of donors available one will then be able to deal with X number of recipients. There is agreement on the need for a national register of donors, on the inadequacy of the present law, and on the need for adequate protection for donors, recipients, and members of the medical profession. The need for urgent reform is accepted by the whole House. There is a need for a code of conduct. I am glad to have heard today that we should not seek to define it in any narrow sense, drawing every line, writing in every comma, but a broad code of practice should be proposed in the form of a White Paper so that discussion and legislation could follow.

Thus we start the debate with a large measure of agreement. If from now on I concentrate on the disagreements, I hope that I have at least tried to keep some balance. The Motion congratulates the medical profession on the recent advances in transplant surgery". We can also add our admiration of the courage and faith of those who have freely given and received and of the relatives of those who may not have been able to do one or the other. The fact that the medical profession has been able to make this advance is due in large measure to the support which it has had from people in difficulty and the courage of those people. The remaining problems are great. The danger is that at the beginning we raise too many hopes which we are not able to fulfil with the passage of time. This is understandable, but it must be borne in mind.

During recent weeks there has been criticism of the medical profession as to some of the circumstances in which some operations were performed. That criticism has been in the main justifiable. I do not think that we can leap to any conclusions about there being vultures waiting to pounce. It is a narrow difficulty. Perhaps some things have been done which should not have been done—and the other way round.

It may be that the medical profession is proceeding with extreme caution because of the difficulties. It may be that some of the difficulties it has experienced have arisen because of its caution. I do not think that the medical profession has any right to criticise the Press or other reporting agencies for what they have or have not done. The Press and other reporting agencies have also shown great restraint and care.

We need not only money for the allocation of resources in experimenting on transplantation. We may be in danger of saying that we are giving too little money for the curing and preventing of illness and too much money in comparative terms for transplants, dialysis, and such things. We hear much about the need for more kidney machines. Over two years ago I was surprised to learn that the provision of another 200 such machines would not necessarily mean that another 200 patients could be helped.

There is far more to it than just the provision of a machine. A high degree of intelligence is required to operate it. The support of the patient's family is essential. It needs room and facilities. Things can be over-simplified by saying, "If we raise the money we could get the machines and help a great number of people". I am worried that we may be concentrating too much on spare part surgery and not enough on either prevention or cure. The motto might be, "Prevention and cure are better than transplantation or surgery".

A code of practice is desirable. I agree with my hon. Friend the Member for Halifax (Dr. Summerskill) and others who have said that it should be in broad terms. We should lay down the base lines. Inevitably, we must trust the doctors and surgeons. They must not be too free, but equally they must not be too fettered. Some of the possibilities were mentioned by the hon. Member for Cambridge (Mr. Lane). He and I played some part in the passage of the Renal Transplantation Bill. I used the phrase, "Burke and Hare Mark II" when the Bill began its passage. That was not about the doctors, but about the contracting-in and the contracting-out.

In Standing Committee on that Bill I was one opposing member out of a Committee of 20 members. I had no chance of outvoting anybody else. The Bill, which went into Committee with four Clauses, came out with 16 Clauses. This was because it was accepted by reasonable people with good advice that we could improve the Bill to the satisfaction, not of the lowest common denominator, but the highest common denominator. I would not dare to argue with the doctor in his own field. Although I have moved some way towards the hon. Member for Cambridge and others, some members of the medical profession who served on that Standing Committee have moved my way.

One of the proposals I made in that Standing Committee was not only that the surgeons should be licensed to carry out operations, but that the place—the hospital, clinic, operating theatre—should also be licensed. I am glad that my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) has argued the advantages of having the place of operation licensed. The lesson to be learned from the Renal Transplantation Bill is that we can get the highest common denominator rather than the lowest common denominator to get the widest area of agreement.

The right to life has been well established. The right to die is rather more difficult to define. The problem of transplants is easier for those of us who believe that there are more worlds than this, that everything does not end when human life passes, that there are other fields ahead. It is very hard to find a definition of "death". It may well be that we are reduced to "the absence of life". We hear about people who are living vegetables, whose life is maintained, who are breathing, who have no minds of their own, no real heart beats of their own unless they are provided by heart and lung machines.

I cannot accept that dead people breathe. As long as a body is breathing, I cannot accept that it is dead. I do not think that anybody else will accept that it is dead. It might be a remnant of emotion; it might be 100,000 years of history, but to my simple view, and in that of most people outside the House, dead people do not breathe and as long as a person is breathing he cannot be said to be dead.

Much of the public disquiet will be answered by adequate information—not about the name, address, age and circumstances of the person who is either about to receive or to give a heart, but about the circumstances in which the operation has taken place. Above all, not only should we know about it when it goes right, but we should also know all about it when it goes wrong; the coroner should know all about it, and all the information should be given at the right time and in the right place.

The public—and certainly myself—would be willing to pay more attention to the report of the Conference on Transplants and the Advisory Committee if we knew, not only the name of its chairman, but the names and qualifications of those who are giving advice to him. I do not think that any Member of Parliament or anybody else should be expected to accept advice from an almost anonymous body of persons. We have to judge the two together. The sooner the conclusions of the Committee, together with the names of the persons involved and their qualifications, are made available the better.

The basic concern now is not only about the possibility of transplants but the price we are prepared to pay for that progress. I have learned and accepted over the last few years that a price must be paid for that progress. It is all bound up with the time factor of the deterioration of a human organ once it is deprived of oxygen. This is a very fine balance indeed.

The time may come—my saying this may show my hon. Friends that I have moved a fair distance in the last two years—when we had to accept that human beings will be kept alive artificially, not for their own value, but because they may be of value to other human beings. This is a tremendous emotional problem. It might tear the medical profession apart. The first duty of the medical profession is to the first patient, not to any side effects. This has always been my opinion. But the time may come when the wellbeing of one patient may have to be put second to that of another patient.

I shall not go into all the 1980 science fiction horrors which could flow from that. Such a situation could be accepted only if the chances of success were so good that it would be worth while. I do not think that we have yet reached that situation. A person who has been seriously injured, but who has some good parts in his body, might be artificially kept alive so that those parts should be available for another human being, but the time of his dying should not be determined by the attitude, "There is nothing else that we can do for him; turn off the machine." He may be deliberately kept alive. That action being taken could only be justified if it was certain that by doing so the heart or some other organ could be used to give a useful span of life to someone else. I do not think we have reached that stage yet.

In the meantime, it would be wrong to call for a ban on heart transplants. That is not a decision which can be taken in this House or anywhere else. We have to accept that there are responsible people in the medical profession. If people want fame or easy money, there are easier ways of doing it than through the medical profession. We should ask for restraint. At the same time we should not say "You will do this" or "You should not do this."

My own concern has been expressed on many occasions, and it is this. If there is the danger in the way in which these operations are conducted that men and women will be regarded as a collection of spare parts, I want nothing to do with it. The human body is much more than a collection of spare parts. It is a creation of wonder and mystery, entitled to respect and dignity in death as in life. Therefore, these activities of which I have been speaking have to be strictly limited and controlled.

I only hope that this debate will help to move to a situation in which we can help each other and maintain the dignity and respect for the human body which it deserves.

1.22 p.m.

Dr. David Kerr (Wandsworth, Central)

I must apologise to the hon. Member for Galloway (Mr. Brewis). In making a small contribution to ensuring that fewer people might need heart transplants, or might be donors of hearts, I was delayed and was unable to hear the hon. Member's opening remarks. I have also suffered, I suspect, by my late arrival from having all the best of what I have to say stolen from me, and I am left with the onerous problem of being repetitive without appearing to be so.

This has been a remarkable if rather an unexpectedly brief debate on a matter which illustrates more dramatically than I can think of the impact which technical change makes on our social thinking. We have had, as the noble Lord the Member for Hertford (Lord Balniel) was careful to point out, the most dramatic changes in the last eight years, which have forced upon us the need to discuss this matter publicly. It may face us with legal change—although I question it—and it is forcing upon the public a whole alteration in their attitude towards medicine, doctors, life and death and even the somewhat rather folklorish attitudes to what the heart is and what it does, and what other organs may or may not do.

As an extension to this, I should like to throw in the additional idea that this debate provides the perfect answer to those who want to live in a technocracy. It is a perfect illustration of how impossible it must remain for people who are not technically equipped to leave major policy decisions to those who are. This is not a matter for doctors, and I speak as one myself. It is a matter for the community. If for no other reason, our gratitude is due to the hon. Member for Galloway for illustrating that fact so well for us.

More than one person has referred to the ethical standards of doctors. In moments like this, while verbally crossing our fingers, we say how much we trust them. From what we hear outside about the attitude of people towards doctors, it is not always couched in such friendly terms. At the same time, we have got to start with this avowal of faith. There is no other way of looking at this problem except with an expression of confidence. Here again we owe a great deal of our ability to repose that confidence in doctors to the fact that there is no economic factor involved in transplantation in this country. I would not feel that same confidence in America where a whole string of heart operations conducted in Texas have a rather sinister and suspicious aspect about them. Let us give thanks for the National Health Service which prevents any suspicion that these operations will be undertaken with the hint of economic and financial gain behind them. In America it is common practice to sell one's blood for the purpose of blood transfusions. That does not happen here. One wonders what might be the financial position of heart donors in America, and, indeed, in other countries. We should be thankful for the fact that whatever pressures there may be in this country for greater numbers of donors, this at least is not one of them.

When we are talking about the ethical behaviour of doctors, we must remember that ethical behaviour is not determined by the doctors. It is certainly accepted by doctors and codified by them, but in the end what doctors do will be determined by the attitude of people in the community as a whole. Although this is a new and delicate confrontation that we have to make, doctors and laymen alike, it will nevertheless be the responsibility of public opinion, expressed here, in the Press, in pulpits and in discussion everywhere, which must in the end shape the way in which doctors approach this difficult problem.

Very much of today's discussion has touched upon or even concentrated upon this difficult question of death and dying. There are perhaps two things to say about a new breed of operation, a breed which at the moment includes the heart and the liver, but which might one day include the brain. Those two things are, first, that only one of two people can survive such an operation; and, second, that despite some of the things which I have heard said today by people, including my professional colleagues, it is still not sufficiently understood that when we are dealing with the donation of an organ such as a heart or liver, it is of no use at all once the moment of death, however described, is passed and the organ has died. In other words, we are dealing with the rescue from a still living person of a still living organ, or at least one capable of resuscitation.

These two ideas are quite new to us, with which we are only now beginning to grapple. To distract our attention with arguments about the legal definition of death has the same relation to science as arguments about the number of angels on the head of a pin have to theology.

The noble Lord referred to somebody being "absolutely dead." What we understand now is that while there is this very colourful difference between a corpse and a living person, it is not a sudden shut-off. We know that different parts of the body die at different rates and that the death of one part may not be accompanied by the death of another for a considerable time afterwards. Death is a much slower process than the bullet in the brain or the drop of the guillotine might indicate.

It is a little unfortunate that so much of today's debate, or that part of it which I have heard, has failed to set this very dramatic and brilliant achievement into the context of scientific research. This is not simply a great advance in plumbing. The whole story of transplants of all sorts is the story of a multi-disciplinary approach to an extremely delicate scientific and medical problem, involving, in particular, study and research into the wide field of immunology, research for which I claim on behalf of this country some of the pre-eminent results. It is all very well if a South African surgeon carries out, with the brilliance which must be envied, the particular procedure of transplanting the first heart, but behind it lies much research and investigation undertaken in this country by some of our best thinkers in various fields, notably immunology and tissue reaction.

This leads me to an aspect of the matter to which I have not heard reference. If there is one scientific argument for maintaining a programme of research into heart and other organ transplants, it is that the scientific fall-out in terms of knowledge on a much wider scale must not be sacrificed. It should be much better known, for example, that investigation into the problems of tissue rejection is certain to give us valuable information extending our knowledge and understanding of the problems of cancer. It would be wrong to fall into the mistake of rejecting heart transplants unless there were powerful reasons for so doing, lest we sacrifice this method of testing some of our most important growing areas of research into human biology.

Again, with the drama of heart transplants in mind, we cannot too frequently pay tribute to the work of Professor Roy Calne, whose efforts to transplant the liver, in my view, exceed the achievement of heart transplants. This, also, is something in which we as a nation should take great pride, making sure that it is well known not only among ourselves but in the world generally.

Now, I must say with regret that the noble Lord stole one of my best lines. He threw it away rather casually, but I believe that he was right to suggest that this whole matter about which we are a little concerned today may prove to be a cul-de-sac. He suggested that the future might lie in artificial synthetic constructed alternatives. I go with him all the way. Considering for an objective moment the absurdity of heart transplants, which seem almost to make of medicine and surgery something closer to a sterile butcher's shop than one would wish to see, it must be clear that the best of our research ought to be devoted to finding good and trustworthy mechanical alternatives. Incidentally, I am sure that the noble Lord, with his interests, is better informed than to say that one day we shall be able to replace knee and hip joints. We are already doing it successfully with a number of synthetic products, and this is another growth point at which we can hope for further advance.

We must be careful. There are two sorts of transplant. On the one hand, there is the purely mechanical. No one thinks, for example, of doing research into transplanting legs or arms, though there may be arguments for transplanting hands because of their much more delicate construction. Transplants in this field are best undertaken by mechanical means. On the other hand, transplants of the liver and brain and, for the time being anyway, of the kidney are biological transplants which it is not yet possible to forecast could be replaced by mechanical means. The heart lies somewhere in between the two. It is a mechanical organ, but its biological complexity makes it an immense problem to devise a synthetic artificial alternative. But the wit of man which can, in the next week or two, send two human beings to the moon, land them and bring them back could surely be devoted to other mechanical endeavours which, if nothing else, would rid us of the vexatious problem of death and dying and the preservation of human tissues.

My hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) referred to coroners and death certification. From time to time in the House, a vexatious Question from the hon. Member for Cheadle (Dr. Winstanley) reminds us of the existence of the Interdepartmental Committee which is considering the work of coroners and death certification. I am a member of that Committee. Anything which I say must not be taken down and used in evidence against the Committee. I am personally responsible for what I say, and I have no wish to suggest that it would be the finding of the Committee, since the Committee has no finding as yet.

I assure the House that this problem has been considered, and the Committee has had the benefit of evidence from a number of witnesses active in this field to assist its deliberations. In my view, the question of death certification is more complex than my hon. Friend may think, and the time is not now for any recommendation for a special kind of death certification in respect of a donor.

The rôle and relationships of the coroner, I believe, is far more important than has been suggested in today's debate. At present, I understand that it is the practice of those engaged in heart transplant surgery to keep the coroner informed of their proposals. However, we live in a curiously complicated legal situation in which the coroner is responsible for a corpse in his area. If one moves a potential corpse from one area to another, who is the coroner to have particular responsibility? Who is to be consulted about it? What is to be the attitude of doctors to coroners who indicate that they will not accept the views of the doctors about the inevitability of death?

Moreover, there is an important further question arising from the rôle of the coroner, because the coroner, under our present law, can consider only the corpse. He cannot forecast and he cannot make pronouncements. He cannot do other than give advice on the basis of what his views will be once a corpse has occurred, whether that corpse occurs as a result of road accident or as a result of switching off a resuscitating machine.

It is a difficult problem. I simply pay my personal testimony to the way in which coroners, with one or two rather unhappy exceptions, have co-operated with the doctors, giving them the benefit of advice and of knowledge and helping to further this development and not, as might have been the case, to delay and obstruct it.

All of us, doctors and laymen alike, are a little bothered by the thought that we are all potential donors in any hazardous situation, to which we are all at some time subject today. There are some of us, under a law which makes some more equal than others, slightly more likely to be subject to pressures. I was alarmed to hear my hon. Friend the Member for Liverpool, West Derby (Mr. Ogden) refer, as I thought—I hope that I was wrong—to a judgment about the value of life rather than the fact of life. If I understood him correctly, he was opening up one of the most difficult and, I submit, one of the most dangerous approaches to this whole question of donating organs.

I am willing to be corrected, and I am in no way critcising my hon. Friend or suggesting that he is evil—I wish merely to dispute with him in a purely theological way—but I understood him to suggest that, if a neurologist can look at a patient and say, "This patient can never survive save on a heart-lung machine, he will never recover but, as time goes on, he will suffer from bed-sores and other troubles and will have to be kept alive on penicillin", his survival is worthless and we must switch off. I see that as an argument, but it is not one which I dare accept. I could never face my patients again if I did. I hope that hon. Members understand that. One could never accept that argument, but, if ever one did, the door would be open one inch, and the next inch would be to look at the many severely subnormal children whose lives, by our value judgments, would be similarly worthless and similarly a burden on the community. How much further would the door be pushed open once that tiny crack was created?

I say this simply because my hon. Friend raised the issue. I have raised this question before outside the House, and I am delighted to have this opportunity to raise it again, because here is one of the most important problems that the community has to face. We are now dealing with an entirely new situation in which the value judgment of a person's life is no longer based on the value of that one person, but on the possible potential value of two people, of whom one may have a greater claim than the other, and this becomes immensely difficult.

Mr. Ogden: That was the point that I was raising, that there are circumstances, of which we have all read and know, in which a person who has been very badly injured is receiving aid, and perhaps life, from a machine. If it was known that there were no donors, and no possibility of a transplant, the machine would be switched off, and it would be a separate independent decision. Once the doctors in charge of the first patient know that there is a potential recipient somewhere, there cannot be an independent judgment. Somewhere at the back of their minds they know that there is a potential donor. The decision to switch off the machine to help somebody else can be contemplated only if the success of the operation is overwhelmingly guaranteed, bearing in mind the dangers of rejection of tissue. We do not know yet, and we cannot accept it, but it is a problem which we should be prepared to face in the not-too-distant future.

Dr. Kerr

I am grateful to my hon. Friend, but there is an overwhelmingly important fact which must not be lost sight of, and that is the possibility of error in forecasting. From America we know that there has been a study of such cases, and that a significantly high proportion of people who are regarded as vegetables recover, but there is this possibility, however remote, of error of judgment which must bother us. One can say that we are likely to be right ten times out of eleven, or 99 times out of 100, but the community must decide in weighing up the difficult judgment, is Mr. A, who needs a heart transplant, to have precedence over Miss B, who is lying in hospital with a crushed skull? In taking that decision, one must also take into account the remote possibility that Miss B. is, after all, going to recover and live a useful life.

We have all spoken of the difficulties. I think that few of us have offered any solutions, and that is a great tribute to the humility of us all, both those professionally qualified, and those who are not. I have been deeply impressed and humbled by the understanding and sympathy of those who do not come face to face, as every doctor does, with the fact of death. It is that we are talking, not about the fact of death, but about its determination by our fellow human beings, which gives to the hon. Member for Galloway the very special distinction of selecting this topic for discussion.

1.44 p.m.

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

I share the view expressed by many hon. Members that this has been an excellent debate, and we are indebted to the hon. Member for Galloway (Mr. Brewis) for selecting this subject for debate. I think that the House will agree that this debate, at this time, can be little more than a rehearsal of many more discussions and debates which must take place on this subject, not only in the House, but among the public generally.

One undertaking which I can give today is that these proceedings will be most carefully studied by my Department. I hope that they will be studied by the professions and the wider public too, because they can be a basis on which a better informed Parliamentary and public element can acquaint itself with the situation.

The hon. Member for Galloway, in his introductory speech, touched on a number of matters which, in various forms, were mentioned by other hon. Members. I have a list of the subjects which I think epitomise the debate as a whole, including the diversion of resources, the Press and its rôle in educating the public and its difficulty sometimes of equating its competitive rôle with other newspapers and its educational rôle, the definition of death, the success and development of kidney transplants—and I am glad that the hon. Gentleman drafted his Motion as he did to cover transplants generally, and did not confine it to the more immediately interesting problem of heart transplants—and, lastly, the question of coroners' rules. As I proceed I shall, as far as I can, comment on the points which have been made on those specific subjects.

I do not propose to comment, as the hon. Gentleman did with perfect propriety, on the Bodmin case, for the very good reason that, owing to the dedication of the doctors, the skill of the nurses, and the faith and resolution of the family, this young lady is in good health. I think that it would be a pity to pursue the matter.

The grafting of various kinds of human tissues, as one hon. Gentleman said, has been proceeding for many years. The enormous value of blood transfusion, which is sometimes overlooked by laymen as one of the earliest uses of tissue of one human being by another, can hardly be overestimated. It has saved countless lives, and the service could not exist without the gift of their blood by millions of people. Success has also been achieved in the grafting of such tissues as bone, skin, blood vessels, and the cornea of the eye. Thus, in certain areas of surgery, the techniques of transplant are established, accepted by the public now, and innumerable patients have benefited.

I am told by those better informed than I am with medical history that the outcry and controversy which accompanied the tranfusion of blood and vaccination against smallpox and other innovations of their day caused the most extraordinary outburst of public emotion. I think that the present public reaction about heart transplants has, by those standards, been rather more moderate.

I say in parenthesis that I was interested and amused by the little anecdote of family history given by the noble Lord the Member for Hertford (Lord Balniel). I only hope—and I know that he will accept this—that that very good story will not be used as the headline for this debate which is on a very serious matter.

More recently, success has been achieved in the transplantation of kidneys into patients who would otherwise die of chronic renal failure, though such patients are also being helped by intermittent dialysis, a procedure which has supported patients in conditions of reasonable life for up to eight years. It has yet to be shown how long life can be prolonged with the help of a transplanted kidney. The technique has only recently reached the stage of being an established therapeutic measure, and improvements in matching tissues, which greatly enhance the chance of long-term success, are going on all the time.

The success of transplanting kidneys has to date varied according to the source of the kidney. Where the donor was an identical twin, prolonged survival has been recorded. This also applies to the case of siblings. Where the kidney was taken from a donor who had died, in other words, a cadaver, the survival rate of the grafted kidney has been less good.

It is possible, if the transplanted kidney fails, to fall back on an artificial kidney machine. The problem of the rejection of grafted organs arises from the body's natural reaction to the presence of strange tissue. Work is being done on immunology and on matching tissue types which offers promise of much greater success in future. An Advisory Committee on Renal Transplantation advises my right hon. Friends on the development of renal transplantation in the National Health Service.

Centres for renal transplantation are being set up as a special medical development for which funds are separately allocated following the advice of this Committee.

I have thought it wise, so as to get it on the record, to indicate where this sort of work is being carried on, since it may be of particular interest where, by coincidence, these centres are in constituencies represented by hon. Members who are here today. So far, the Departments have agreed to support centres to carry out renal transplantation in London—at St. Mary's Hospital, Hammersmith, Charing Cross, Guy's and the Royal Free—and in the provinces at the Newcastle teaching hospital, the Birmingham teaching hospital, the Cambridge teaching hospital, the Manchester teaching hospital, at Southmead, Bristol, and at the Sheffield teaching hospital. In South Wales, there is a centre at the Cardiff teaching hospital and, in Scotland, at the Edinburgh and Glasgow teaching hospitals.

Mr. Robert Maclennan (Caithness and Sutherland)

Will my hon. Friend indicate with a little more precision which teaching hospitals in Glasgow and Edinburgh are concerned?

Mr. Snow

It is my understanding that this is a combined exercise and that at the present state of development it would be wrong to identify one hospital, but I will let my hon. Friend know with a little more precision when I have a little more information myself.

Under the criteria of the Committee, each centre has a director and deputy. Four of the centres which I have mentioned, St. Mary's, Hammersmith, Cambridge and Edinburgh, were early pioneering centres and have considerable experience behind them. Others are in the course of development, most starting in a small way, and they will be built up in due time. The Advisory Committee on Renal Transplantation has been in being for only about 18 months.

Another criterion for the development of renal transplantation in a certain centre is that adequate dialysis facilities should be available. Other procedures, such as the transplant of the liver or heart, are still in the research stage, and there is no fall-back position as with the artificial kidney machine if the kidney transplant fails. Whether or not it is desirable for a certain patient to undergo such a transplant operation is a clinical problem, and doctors must be allowed discretion in the procedures which they use in the interests of their patients.

The question whether or not more money within the National Health Service should be devoted to transplantation generally and the question of the priority which it should take in relation to other aspects of hospital care are for hospital boards to determine, with professional advice, in the light of the competing demands before them for the resources at their disposal.

I thought it important to give the general principle underlying that because I made inquiries whether our channels of technical comunication were adequate, and I am satisfied that, in the present state of our knowledge, they are. In other words, there is no reason why technical demands and the interests of patients cannot be fulfilled and married up to the physical facilities which can be provided.

There are great problems surrounding this matter, and in the matter of transplant surgery of this major kind we know that the essence of the ethical problem arises because the development of major transplant surgery has underlined the fact that some person can benefit from the use of another person's organs only after that person is dead. Moreover, in the present state of knowledge, some organs must be removed very shortly after death.

What should be our attitude in the light of this situation? We know that some people object on religious grounds to the removal after death of any part of a body. I was interested when the hon. Member for Galloway mentioned the attitude of the Scottish Church in this matter. Apart from religious conviction, some people object because they feel repugnance at the idea of their own body or that of a close relative being used in this way. Such objections must clearly be respected.

Most of us are indifferent in this matter and feel that if our organs can, after our death, be used to save the life of another they should be used in this way. Some people consider that if this is the case it should be possible to remove organs after death in the absence of a specific objection or indication that a person or his relatives would be likely to object. Others consider that this is so personal a matter as to require specific consent.

The new situation can also cause perplexity to doctors and nurses apart from the responsibility of Parliament. Their obligation is towards their patients and it is essential that they, as well as the general public, should have complete confidence in the procedures governing transplantation. Behind some of the publicity that these cases have aroused may be the fear that the interest of a potential donor may be subordinated to that of a potential recipient—and, in particular, that it may be terminated prematurely by removal of artificial aids, the decision in either case having regard more to the patient as a potential donor than to the patient as a patient. Hence, too, the suggestion that there should be a legal definition of death based upon some arbitrary definition of signs, instead of leaving the clinical judgment, which must be made on the balance of such signs, to be determined by experienced doctors.

It is essential that the public should be able to continue to feel confidence in the traditional ethical standards which enjoin the medical and nursing professions to treat their patients to the best of their ability.

There have been many references to the case of Nurse Sinsbury. This patient sustained a head injury in a road accident and was taken to Putney Hospital. I am anxious, for reasons that the House will understand, to go no further than the basic facts which are strictly relevant to this debate. Her head injury was severe and she required resuscitation after cardiac and respiratory arrest. Her only chance of survival was in an intensive care unit where neurosurgical intervention would be available. The surgeon, in whose care she was, was also on the staff of Guy's and he transferred her to Guy's, which had the necessary facilities. This was a quite proper course in the patient's own interest. The fact that there were shorter ambulance journeys is not really relevant, as an anaesthetist accompanied her.

At Guy's, she was maintained on a respirator, and suffered further cardiac arrest, requiring resuscitation in the intensive care unit. In spite of these intensive efforts her condition continued to deteriorate and life could not be maintained. The consultant neurologist and a senior registrar finally reached the decision that she was dead and that the semblance of life was being maintained only by the respirator. Before she left Putney Hospital the consent of relatives had been obtained to the use of the heart if death ensued, and the coroner who was consulted expressed himself satisfied with the doctor's conclusion. When it was apparent that she was likely to die typing tests were made on her blood. The respirator was stopped and after the heart had stopped beating an operation for its removal was undertaken.

We are satisfied that the doctors concerned did everything possible to preserve the patient's life, and that they acted fully in accordance with the procedure recommended by the Conference on the Transplantation of Organs, to which I shall refer later. In particular, she would not have been transferred had not the surgeon concerned believed that this gave her a chance of survival which she would not otherwise have had.

That brings me to the point mentioned by my hon. Friend the Member for Falmouth and Camborne (Dr. John Dunwoody) and my hon. Friend the Member for Wandsworth, Central (Dr. David Kerr). As my hon. Friend the Member for Wandsworth, Central said, a committee is studying this problem and we shall see what it says. It is for the coroner to decide what witnesses should be called at an inquest and what evidence is necessary for the purposes of his inquiries. The rules which coroners and procurators fiscal apply in these cases may well need reviewing in the light of the advisory group's advice.

Surgeons engaged in renal transplantation are finding it increasingly difficult to obtain organs for transplanting. It is necessary that the supply shall be increased so that more patients who will otherwise die from chronic kidney disease, unless permanently dialysed, can be given this opportunity of survival. Moreover, as I have already explained, the prospect of longer survival for a patient is enhanced if the organ to be transplanted more closely matches his own body tissues. The greater the availability of organs, the greater is the possibility of securing a good match through the process of tissue-typing.

I have been struck by the fact, recorded by my hon. Friend the Member for Halifax (Dr. Summerskill), that the risk attendant upon kidney transplants was worse or as bad 10 years ago as that now attendant on heart transplants.

It became apparent that at least one reason for the inadequacy in the supply of organs was the uncertainty in the interpretation of the law governing their use. The law governing the use of organs from dead bodies is the Human Tissue Act, 1961. This provides that a person can donate his organs for therapeutic purposes or research by a decision in writing at any time, or by an oral declaration in the presence of two witnesses during his last illness. Apart from that, the person lawfully in possession of the body after death may authorise the removal of parts of it if having made such reasonable inquiry as may be practicable he has no reason to believe that there would have been objection on the part of the deceased before death, or that the surviving spouse or "any surviving relative" would object.

Difficulties have arisen over the interpretation of the Act. An organ must be removed very quickly after death if it is to be used for transplanting, almost immediately in the case of the heart and in the present stage of technicality within about three to four hours with kidneys.

It may be very difficult and time-consuming to establish that there is no reason to believe that neither the dead person nor any surviving relative would object. The words "any surviving relative" are capable of a very wide interpretation, and the words "next-of-kin" may cause difficulty if the person named as next-of-kin by the patient is not his statutory next-of-kin. This could arise if a patient is influenced rather more by terms of family relationship and personal circumstances than may be the strictly legal position.

In view of the important problems arising the then Minister of Health, my right hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), called a conference last year on the transplantation of organs. The conference consisted of doctors, nurses, lawyers, clergy and lay people and met in March and again in June, 1968. The conclusions of the conference were made public. It concluded that if transplantation was not to be held back by a shortage of organs, it would be necessary to relax the requirements of the Human Tissue Act about consulting relatives. It considered that if neither the deceased nor his next-of-kin had any objection, it should not be necessary to seek the views of other relatives. If, on the other hand, the deceased or his next-of-kin were known to object that objection must be respected.

Where the views of the deceased were not known and no relative was present at the time of death, the general feeling of the conference was that it should be permissible in these circumstances to remove organs without inquiry of the relatives, in the absence of known objections, subject to two provisos: first, that death should first have been certified by not less than two doctors, each independent of the transplant team, and one of them being at least five years registered; secondly, that an effective system should be devised under which persons could record objections during life with certainty that these could be ascertained and would be respected.

A small number of those at the conference did not, however, think it right to remove organs without further inquiry or explicit consent unless the deceased's wishes were known and were favourable.

The conference recognised that the public was uneasy at the possibility that organs might be removed prematurely and that some nurses and doctors were also concerned about safeguards. It agreed that no attempt should be made to lay down a legal definition of death, or rules which doctors should observe in reaching what must be a clinical decision but that vital organs should not be removed until spontaneous vital functions had ceased and two independent doctors had certified that this condition was irreversible. These views were brought to the attention of those concerned in the hospital service.

With regard to the conference's suggestion that organs could be removed without inquiry of the relatives subject to the establishment of an effective "contracting-out" system, the former Minister of Health said in the House on 25th June, 1968, that he was not convinced that this system could be made effective at this stage.

Early this year, the Secretary of State for Social Services and the Secretary of State for Scotland appointed a number of those who had attended the earlier conference to be a Standing Advisory Group to advise them on any problems arising in transplantation which might be of public concern. The group, whose chairman is Sir Hector MacLennan, President of the Royal Society of Medicine, includes, as did the conference, members from the medical and nursing professions, clergy and lay people. The Secretary of State particularly asked for early advice on any amendment of the Human Tissue Act that might be desirable in the interests of transplant surgery while, at the same time, providing adequate safeguards to potential donors and the public generally.

My right hon. Friends have received advice from the group within the last few days. This advice, and the question of its publication, are being fully considered. In the meantime, it is premature for me to discuss it here, though perhaps I may say that it underlines the importance, stressed by more than one hon. Member today, of completely adequate safeguards to ensure that the interests of prospective donors are protected and that their wishes about possible use of their organs after death are respected.

Given these safeguards, it would appear that the issue will largely turn upon whether there should be a system of contracting-out, that is to say, that organs may be removed from a person after death unless there is evidence that he has objected during lifetime; or that the position should remain broadly as at present, that organs may not be removed unless a person has indicated, during lifetime, that that would be his wish, or that his next-of-kin signify their agreement after his death.

The very full and informed discussion that has taken place today will demonstrate what a very dramatic decision may have to be taken in due course by Parliament based on public opinion and well-informed opinion at that. I listened carefully to the right hon. Member for Ashford (Mr. Deedes), who pinpointed, as did others, the question of Press responsibility in this matter. It is very much a matter of balancing the position of the Press vis-à-vis competitors and responsibility for educating and informing the public.

Mistakes may have been made. On the other hand, I have no doubt that the Press has tried to be objective and in its present rôle, which I hope will continue, is doing a most important job in informing a wider public, whose opinions as to the decisions which are taken must be very dependent on how this matter is treated by such media.

My hon. Friend the Member for Willesden, West (Mr. Pavitt) dealt with the question of priorities. This is largely a matter of clinical decision in the hospitals, but I take the point that it is in the context of limited resources. They always will be limited in providing for treatment of patients, we shall never achieve perfection. There must be a two-way traffic of clinicians advising and consulting with those responsible for hospital administration.

My hon. Friend also touched upon the question of a voluntary identity card which would include certain medical information relevant to transplantation as well as other matters which may arise in a person's life. This has been receiving the attention of my Department for a long time. I wish that I was fully convinced that every hon. Member knew exactly where his medical card was. I take the point, however, because there were certain lessons to be learned from the ordinary civilian identification card carried during the war. We shall study this carefully.

The right hon. Member for Ashford also said that total secrecy was not acceptable but that there should be safeguards.

I have not said anything which conflicts with that point of view which comes within the advice of the Advisory Committee.

My hon. Friend the Member for Halifax referred to the complex space research programme of another country and the possibly more immediate requirements of medical research. My short experience in aviation led me to believe that the "spin-off" from research totally divorced from medicine sometimes produced interesting possibilities for medicine and other sciences. I will not go into the question of the definition of death, because hon. Members should have the opportunity of giving further consideration to this when more information is available.

The hon. Member for Cambridge (Mr. Lane) drew attention to the marvellous work of Professor Calne, at Cambridge. What I have said about the improved techniques in renal transplantation was a tribute rightly paid to that distinguished professor. He went on to say that there was a need for cool thinking. I am, like others, rather worried about the unnecessarily harsh phrasing of words employed by some professionals who dispute the opinions of others. On such an important matter the use of highly emotive words should be avoided.

My hon. Friend the Member for Falmouth and Camborne dealt with the rôle of legislation. I do not have to tell hon. Members how legislation must be married to informed public opinion and about the rôle that television, radio and the Press can play here. He spoke of the delicacy of proceedings where names of individuals were mentioned. I would remind the House that in the past Parliament has placed restrictions on reporting certain personal matters, such as divorce proceedings. It may well be that we shall have to think in terms of laying down certain rules which would protect the feelings of the individual. I will not be precise, because we will have to study the problem further.

We must not pay too much attention to what goes on in other countries. The hon. Member for Hertford mentioned Sweden as a country whose experiences and successes command general admiration. We have to legislate and discuss here not only what is possible, but what is the proper reaction of an informed public. That does not mean that we must abide by what goes on in other countries. We cannot afford to ignore the fact that we have certain problems peculiar to this country. If I do not deal now in greater detail with the hon. Gentleman's speech he will know that it is because much of it has been dealt with earlier, and also because it will be best to study the Advisory Committee's advice first.

My hon. Friend the Member for Liverpool, West Derby (Mr. Ogden) made a good point about not losing sight of the medical requirement of prevention as opposed to cure. My experience is that the advocates of transplants are evenly matched by those practising other branches of medicine. My hon. Friend the Member for Wandsworth, Central, whose speech, like that of my hon. Friend the Member for Halifax, had the advantage of a professional point of view, made the point about the impact of great technocratic advances on the rights of the individual.

This was brought home to me very much by an experience related to me by a leading consultant who travels frequently to America. There he actually saw a patient refusing a blood transfusion because he could not afford it. There has to be a two-way movement in the rights of the individual and the impact of public emotion. I was pleased to hear my hon. Friend refer to the application of tissue rejection and immunology generally to the treatment of cancer problems. I will see that we are informed in our Department about this. He also spoke about the alternative synthetic elements in organ replacement. I was aware of work being done on this in the United States.

I have ranged widely, but I wished to set out our general thinking. The House has been very patient with me because I have not been able to disclose the findings of the Advisory Committee. However, I have said that consideration is being given to this matter, and I share the obvious hope of the House that when the report is published we shall debate this matter again, as we shall have to do.

Mr. Brewis

I thank the Under-Secretary of State for his very full reply. We have had an excellent debate. I beg to ask leave to withdraw the Motion.

Motion, by leave, withdrawn.