TRANSPLANT OF HUMAN ORGANS BILL (Hansard, 11 December 1974)

§ Mr. Tam Dalyell (West Lothian)
I beg to move, That leave be given to bring in a Bill to allow hospitals to take the organs, such as kidneys, of any patient, once clinical death has been established, other than those of a deceased person who has contracted out during his lifetime by registering, on a central computer, his desire not to donate organs. This is the fifth time since 1971 that I have sought the leave of the House to introduce such a Bill, in the light of the report of the committee under Sir Hector MacLennan. Sponsors have included two former Secretaries of State for Social Services—

§ Mr. Russell Kerr (Feltham and Heston)
On a point of order, Mr. Speaker. Some of us are very interested in the Bill. May we have some "shush"?

§ Mr. Speaker
I am obliged to the hon. Gentleman for that suggestion. Will the House please comply?

§ Mr. Dalyell
The sponsors have included in the past two former Secretaries of State for Social Services—the late Dick Crossman and my noble Friend, Lord Houghton, then Mr. Douglas Houghton; seven members of the present administration, including both Ministers of State at the Department of Health and Social Security—my hon. Friends the Members for Rotherham (Mr. O'Malley) and Plymouth, Devonport (Dr. Owen); and such distinguished members of the Opposition as Miss Mervyn Pike and the late Dr. Sir Malcolm Stoddart-Scott, Dr. Anthony Trafford, a renal surgeon, and—I am glad to see him here—the hon. Member for Cambridge (Mr. Lane), late Undersecretary of State for the Home Department.
The Bill is prompted by the fact that 450 kidneys are transplanted in the United Kingdom each year, whereas 2,000 or more people a year need transplants. That figure does not include many young and middle-aged patients who are dying without even so much as the offer of dialysis or transplantation. For want of matching tissue, several transplantation centres have virtually 513 ceased work. I understand from Sir Michael Woodruff, a professor in Edinburgh, that there is not a single unit in the United Kingdom which is working to full capacity or anything like it.
The question arises why we are so short. The most important factor is the attitude of most members of the medical profession. One small district general hospital, where keen young medical staff have transplantation in mind, provides an average of half-a-dozen donors a year —12 kidneys. Yet many of the largest teaching hospitals, with active transplantation units, including some of the most prestigious in Britain, have provided not a single kidney for transplantation.
It is altogether too easy to blame the doctors. The argument behind the Bill is that if they saw the law in a different light, if it were altered in the direction of contracting out, doctors would be less uneasy and more willing to make organs available.
First, as things stand, a doctor or surgeon has to contact the next-of-kin at the time of maximum grief and to put this awful question "Can we have the organs of your loved one?" How many of us, if we were doctors, would have the heart to put to a shattered mother or father or a young wife such a question within minutes of their hearing, for example, of a motor smash? Yet if the question is delayed, the organ deteriorates and become less useful to someone in need. After an hour, the kidney becomes completely useless.
It is pertinent to add that four of our most distinguished renal surgeons— Barnes, Calne Hopewell and Sells—say that the poor quality of kidneys transplanted in the United Kingdom is well known on the Continent, because of the relatively high proportion of organs damaged by ischaemia, as a result of doctors waiting to obtain permission to transplant them.
In a contracting-out situation, as envisaged by the Bill, a telephone call to the computer in Bristol could determine whether a victim had willed "Do not take my organs." Delay and deterioriation could then be cut to a minimum. All transplant surgeons can cite cases where the relatives at first refused permission and then changed their minds when it was too late. The present system dis- 514 courages even the most public spirited. It is distressing for the relatives and difficult for the doctors, and it stops lives being saved.
Secondly, doctors often fear that by being involved in an organ donation they might in some way be contravening the law, with its present uncertainty of interpretation. Despite the issuing of donor cards, very few kidneys have been taken from donors or potential donors carrying cards. Even the carrying of cards became less popular after their legality was questioned in the House, if he will forgive me saying so, by the right hon. Member for Leeds, North-East (Sir Keith Joseph). I never had any great hope of the donor card system in the first place, for the very human reason that accidents are things that happen to other people, not to any of us, and therefore many of us forget to to carry a card, even if we have one.
Besides, doctors are understandably nervous of the contrasting attitudes among coroners. The Bill takes the view of the Inner West London Coroner, Dr. Gavin Thurston, who says that there is seldom difficulty in telling whether a body is likely to be investigated because of the possibility of murder or manslaughter. He argues that in such cases organs should not be removed, as the removal of clothing would interfere with the taking of photographs, which might constitute important evidence. However, in his experience, most cases do not fall within that category. Dr. Thurston considers that coroners could give permission for organs to be removed in the majority of accident cases, including those which lead to prosecution for causing death by dangerous driving.
Thirdly, doctors do not want to be accused of hastening the death of a potential donor. The Bill makes it clear that, before any organ could be removed, clinical death or brain death would have to be certified by two doctors, neither of whom was a member of the transplant team.
After I last introduced such a Bill in February and May, a number of colleagues on both sides of the House told me, "I could go along with the Bill, but I am not sure I could sell it to my constituents." A survey by me in West Lothian in 1969 showed that 364 people out of a thousand could go for 515 contracting-out and 312 for contracting-in, with 116 against, and the balance of 208 being "Don't knows". But there seems to be a shift of opinion towards kidney donation.
In the spectacular heart operation, public opinion is concerned with the old concept of "heart and soul", which is altogether more difficult. The Bill is basically concerned with kidneys.
Determined opposition has come from only one source—the Chief Rabbi and his staff, who would go for contracting-in but are passionately opposed to contracting-out, on grounds of freedom. I do not want to make a cheap debating point to the Rabbi or the Jewish community, but the most free form of contracting-out in Western Europe is in Israel.
Perhaps here we have the example of a legislature such as our own which has rather fallen behind medical progress.
Of course the wishes of the bereaved must be respected, particularly at a time of extremely emotional strain. On the other hand, we must realise that every individual refusal could prejudice the lives and futures of two other people who are for the moment still alive but seriously ill. I suspect that the Department is over-concerned with what it thinks may be the wishes of the relatives and under-concerned with the desperate plight of families in need of kidneys.
May I briefly refer the Secretary of State to her own revealing contribution to The Sunday Times of 10th June 1973, entitled, Barbara Castle on Mandarin Power when she complains that one of her own permanent secretaries, the late Sir Andrew Cohen, would come to her seven times a day and say, "Minister, I know that the ultimate decision is yours, but I would be failing in my duty if I did not tell you how unhappy your decision makes 516 me." May I ask the Secretary of State to be cautious of the pressures of Alexander Fleming House and to challenge their arguments in depth.
Let us put ourselves in the position of having a child or teenager who will die in the absence of matching tissue. Would not every one of us, as parents, be desperate to find matching tissue for a child of ours? It is for the young and middle-aged men and women and their relatives, with the prospect of useful working lives ahead of them, that I ask the Government to look sympathetically on the substance of the Bill, and the House to give the Bill a Second Reading.