§ Sir John Biggs-Davison (Epping Forest)
I beg to move,That this House notes the increasing need of human organs for transplants, which exceeds the supply; pledges its support to the campaign to be launched by Her Majesty's Government to encourage donors; and meanwhile calls for a more systematic distribution of donor cards to the public; appeals to the Press Council and the broadcasting authorities and journalists to respect the anonymity of those donors and their relatives who desire it; and requests Her Majesty's Government to institute an appropriate form of inquiry into the desirability of replacing the present system of 'opting in' by those who are willing to give organs for transplant under proper safeguards by a system of `opting out' by those who are unwilling to do so.
Incredible though it may seem, although I have had the honour to represent an Essex constituency since 1955, this is the first time that I have been successful in the ballot for private Members' motions. For some years I have been canvassing the idea that an hon. Member who is successful in the ballot should withdraw from further ballots held in the current Parliament to give others more of a chance to succeed. No Select Committee on Procedure seems to agree with me, but many hon. Members think it a very good idea. Indeed, I hasten to assure them that, although I have been fortunate in the ballot, I shall not go back on that suggestion. I should be happy for my name to be removed, if that would help other hon. Members.
Mr. Michael Meadowcroft (Leeds, West)
The hon. Member for Great Grimsby (Mr. Mitchell).
§ Sir John Biggs-Davison
Indeed, the hon. Member for Great Grimsby (Mr. Mitchell) is a case in point.
I address the House in the knowledge that there are those who have much more to tell me about the subject of the motion than I could possibly tell them. I look forward to their interventions, and am also grateful for the presence in the Chamber of the Under-Secretary of State. I speak on the subject not only with diffidence but with an inward reluctance or even repugnance. However, when I hear of someone whose life has been prolonged or whose health has been revived by an organ transplant, most of my inhibitions are removed. I think of a retired nurse who lived alone not far from Epping, with a kidney machine for company. When I saw her she would tell me of hopes raised and dashed over that which could give her back a more normal and active life.
The subject of organ transplants touches the deepest human feelings. As a Catholic Christian, I find no religious objection to the offering of human organs for the rescue or relief of others. Of course, there are those with conscientious objections to the contrary. In 1982, a public opinion survey showed that under 18 per cent. of the population had objections in principle, but, however many or few the objectors may be, they should not be reproached for holding their sincere views.
At present, the most pressing need is for kidney donors.
§ Mr. Tam Dalyell (Linlithgow)
In connection with previous attempted legislation, I went to see the late Cardinal Heenan, who made it quite clear that the Roman Catholic hierarchy had no objections at all. In fact, there were no religious objections other than from certain advisers of Sir Immanuel Jakobovits and the Board of 23 Deputies of British Jews. However, Israel has a law along the lines of the legislation that the hon. Gentleman rightly wishes to introduce.
§ Sir John Biggs-Davison
I am grateful to the hon. Gentleman for those comments. He has done a lot of work on the subject and has attempted to legislate. I shall refer to that later. I quite agree that there is no objection from the main Christian bodies. In France, the contracting-out law was passed with the approval not only of the Catholic heirarchy but of the reformed churches and Jewish and Moslem leaders. Therefore, the hon. Gentleman is quite right, and I am grateful to him for drawing that point to our attention.
According to the Secretary of State for Social Services,The provisional totalof kidney transplants in 1983was 1,160, an increase of about 13 per cent. overthe 1982 figure, itself a record. My right hon. Friend was replying to a written question from my hon. Friend the Member for Swindon (Mr. Coombs). He described the advance as "encouraging" and added:but with over 2,400 patients awaiting a transplant there remains an urgent need to increase the number still further. The limiting factor is still the supply of kidneys. We shall shortly be launching a new publicity campaign to increase public awareness of the need for transplantation and encourage the widest use of the organ donor card." — [Official Report, 20 January 1984; Vol. 52, c. 330.]I welcome that campaign, and it is to be hoped that Members of both Houses of Parliament will assist in it to the best of their ability. Perhaps an exhibition in the Upper Waiting Hall would help as a start.
The latest kidney waiting list totals 2,460, although not only kidneys are required. Of course, every surgical success means that more patients can benefit; therefore, the demand increases.
The transplant of corneas has a longer history. A corneal transplant exchange service was inaugurated last year, financed initially by the Iris Fund, a charity. Liver transplantation is becoming familiar and established, and is being considered by the DHSS for supra-regional funding.
Finding livers for small children is a distinct matter. The size of the liver is important. In this connection it is pleasant to be able to praise a television programme—Esther Rantzen's "That's Life"—which by featuring the case of Ben Hardwick did more good than another BBC programme had done harm.
The latest report on Ben Hardwick that I have received is that, with wonderful nursing, and although still in isolation, he is doing well. I thought that hon. Members would like to have an up-to-date report on a case that has attracted much sympathetic attention.
There is more controversy about heart transplants. I understand that the Department is funding an evaluation of the costs and benefits. Britain's first heart and lung transplant was carried out last year. The transplantation of heart valves, pancreases and various other organs and tissues is also being developed.
It was good sense—it was called for in this House and elsewhere—to replace the 1980 kidney donor card with a multi-organ donor card. The number of cards held by the public has increased, but it sometimes seems to me that the distribution is haphazard. Alhough more cards 24 may have been given out, I very much doubt whether they are constantly in the pockets or the handbags of the holders.
With the weakness of the system in mind, Manchester univeristy offered a computer to the north-west health region. Perhaps the Minister will have something to say about that.
I am told that not only the laity but the profession is ill-informed and uninstructed, which gives point to the campaign ahead. I have also been told that there is ignorance in one hospital of what happens in another.
March 1983 saw the publication of the Government'srevised code of practice for doctors on organ tranplantation, including guidance on diagnosis of brain death.In a written answer to my hon. Friend the Member for Rugby and Kenilworth (Mr. Pawsey), the Minister for Health expressed the hope thatthe new version will resolve any doubts about procedures and the requirements of the law.He continued:My main object, of course, is to ensure that we can treat as many patients as possible who need transplants of kidneys, corneas or other organs and that no unnecessary confusion or hesitation reduces the supply of donor organs … one of the reasons for the continuing shortage of organs for transplant is hesitancy on the part of hospital staff to identify potential donors among their dying patients and uncertainty about the procedures that must be followed to lead to transplantation. I believe the code is clear, helpful and sensitive and should increase the supply of organs for transplantation, particularly kidneys.Indeed, there has been an increase. My right hon. And learned Friend continued:The revised code emphasises the care with which relatives of a deceased person should be interviewed to establish their views. The need to maintain confidentiality is brought out more strongly. It suggests that the person who makes the approach should be senior and have experience of personal interviews of a sensitive nature. Any approaches should be made with proper sensitivity and a feeling for the relative's distress. Approaches to the parents of a dead child need a particularly high standard of sensitivity and tact." — [Official Report, 10 March 1983; Vol. 38, c. 485.]
Publicity is essential to the cause that I promote—publicity about how the public and the profession can help. My motion urges the mass media to respect the confidentiality of those involved. My right hon. And learned Friend the Minister for Health attached importance to confidentiality in the written answer that I quoted. Only a week before that statement, my hon. Friend the Member for Harborough (Mr. Farr) had been angered by the activities of the media, especially certain newspapers, with regard to a constituent who had been killed in a car accident. A heart transplant had been carried out, and the donor's family wished to remain anonymous. Yet they were harried and disgracefully treated by certain reporters. Police had to be posted and the victim's telephone made indefinitely ex-directory.
My hon. Friend called for legislation to protect confidentiality. Obviously, that is difficult. Therefore, my motion calls on the broadcasting authorities, the Press Council and the media, in common decency, to ensure that such callousness does not occur.
In announcing the new code of practice, my right hon. and learned Friend the Minister for Health referred to the notorious "Panorama" programme in October 1980 — which was as unfair to the medical profession as a more recent programme was scurrilously defamatory of the Conservative party and my hon. Friends. Doctors were condemned in the very title of the programme:Transplants: Are the donors really dead?25 That was calculated to arouse the greatest fear and disquiet. It was even suggested that brain death had been invented for the benefit of transplant surgeons. Those allegations were quickly disproved, but the effect of the programme was to reduce organ donation by about 65 per cent. of the expected level for the next six months. The British Medical Journal even accused the BBC of having deaths on its conscience.
However, some have taken comfort from the increased public awareness of the nature of brain death, but there is bound to be some lingering suspicion that, in the words of Professor Bryan Jennett of Glasgow:transplant surgeons, in their understandable impatience to deliver effective care, sometimes overplay their hands. Attitudes cannot be changed by edict or statute. It is a matter of transplant surgeons locally establishing a relationship of trust and respect with clinicians who may have potential donors. Transplant co-ordinators can be helpful. But so is taking care about practical details on site. These include ensuring rapid and courteous responses to offers, and sensitivity and skill on the part of those who come to take out the organs, and remembering to send a thank you note with information about how particular organs were eventually used. On a broader front there is need to see that details of the success rate of transplantation are known — including local, National and International figures.
§ Mr. Dalyell
Bryan Jennett, professor of neurosurgery at Glasgow, has talked to me endlessly about this. The hon. Gentleman and I face the difficulty that, if we put forward a proposal such as he suggests, we must be absolutely sure that the establishment of clinical death is accepted by the public. Does the hon. Gentleman agree that if an organ is to be taken clinical death must be established by two doctors, neither of whom is a transplant surgeon likely to operate on another patient?
§ Sir John Biggs-Davison
I agree with the hon. Gentleman. I believe that the revised code of practice is satisfactory in that respect.
The professor referred to "transplant co-ordinators". In a written answer to the hon. Member for Eccles (Mr. Carter-Jones) on 30 November 1983, my hon. Friend the Under-Secretary of State said:We are also funding as a pilot project the appointment of a number of consultants to act as part-time transplant advisers with the job of improving hospital liaison procedures."—[Official Report, 30 November 1983; c. 537.]I mentioned the lack of proper liaison, so perhaps the Minister will let us know how that pilot project is going.
Finally, there is the difficult question whether people should have to contract out of giving organs after death rather than contracting in. The present law is a combination of the two. The governing statute is the Human Tissue Act 1961, which provides that a person or institution, including a hospital but not an undertaker or the proprietor of a crematorium, lawfully in possession of a body, may authorise the removal of organs after death provided there is no reason to believe that the deceased expressed an objection while alive nor any reason to suppose, after reasonable and practicable inquiries, that a relative would object. When one translates those cold words into the agony of a patient whose only child has just been killed on the road, it is very difficult to request organs from a parent in that dreadful situation. It must also be remembered that kidneys deteriorate rapidly and soon become useless.
I have heard a different view, however. The huge public response to the "That's Life" programme has shown that many relatives felt that the saving of another's life or health by a transplant gave, or might have given, solace 26 to their grief. There were those who only wished that they had been asked. A common reaction is to say, "I should have felt that he had not died for nothing." It may be— do not know—that medical staff are more reluctant to ask than people are to agree.
However that may be, ii has been argued that there should be a contracting-out system. I pay tribute to the hon. Member for Linlithgow (Mr. Dalyell) for his tenacity in introducing several Bills to that effect. I have already described the weaknesses of the donor card system. In Austria, Denmark and France, the system is entirely one of contracting out. This perhaps reflects the difference between our own and a less sentimental nation, but the French loi Caillart was approved unanimously by both the National Assembly and the Senate in 1976. As I have said., not only Christian bodies but Jewry and Islam in France accepted the principle of organ removal to save life. There was little comment in the newspapers, and the law was well received by the public. I am told that in France, in practice, if they have an opportunity to approach relatives without adding to their distress, doctors will discuss the matter with them and will not then go against the wishes of the next of kin.
Various schemes have been suggested by which objectors to organ grafting could register their names and those of their dependants on a central register. 'The computer would always be consulted before removal of an organ from a dead body, and if the name of the deceased or his family was not recorded it would be assumed that there was no objection. That is the proposal that is being put forward.
The question is a very delicate one. Personal liberty is regarded differently here and on the Continent. It casts no slur on anyone to say that error and human fallibility cannot be wholly ruled out. It would be essential to public confidence to exclude any commercial element.
In the British Medical Journal of 3 April 1982, Professor R. Y. Calne who performed the operation that I have referred to on the small boy, said:The facts should speak for themselves. Organ transplantation is an essential part of the treatment of renal failure and other life-threatening disorders and the supply of donor organs must be improved. Britain has a proud record of generous help for those suffering and in need and this charitable tradition should be preserved.
I would be the last person to dogmatise on this matter, but I trust that my motion will be accepted in its entirety by the House, and welcomed by the Government. After the full inquiry that has been asked for, it may be possible, if Parliament approves, to adapt foreign experience and the model laws emanating from the Council of Europe to the United Kingdom, in order to relieve suffering and save life.
§ Mr. Tam Dalyell (Linlithgow)
As the hon. Member for Epping Forest (Sir J. Biggs-Davison) has recalled, I have attempted on eight occasions, through the ten minutes rule procedure, to get through a contracting-out Bill. This is a non-party matter. The Minister may be interested to know that among my first sponsors were Baroness Pike, who was at that time chairman of the Conservative party health committee, and the late Sir Malcolm Stoddart-Scott, as well as some of my senior colleagues—Lord Houghton, Barbara Castle and Dick Crossman—two of whom were at one time Secretary of 27 State for Social Services. There was therefore heavyweight support at that time for a measure such as the hon. Gentleman has proposed.
On 3 March 1978 I was lucky in winning the ballot for private Member's time, and, like the hon. Member for Epping Forest, I chose this subject. By that time the politicians had become more cautious and David Ennals—now Lord Ennals—gave a cautious and careful reply to the proposal for an opting-out scheme. It was argued that there had been some change in opinion, which made opinion more cautious. The truth of the matter — although it is improper to do so, I should like to address my remarks to the Minister and to his officials—is that in the late 1960s, in the light of the McLennan report, the atmosphere was one of acceptance of what had been done in other countries. It was my impression that Sir George Godber, the chief medical officer, and several of his colleagues—I had better be careful here as I am not at all sure that Sir Henry Yellowlees would agree with this—were of the opinion that a contracting-out Bill would be possible. It is my judgment that had a Labour Government been returned in 1970 and Dick Crossman, whose Parliamentary Private Secretary I was, still been in the job at the Elephant and Castle, such legislation would have been brought forward.
My early interest in this matter, like that of many other right hon. and hon. Members, arose out of a constituency case. A 23-year-old teacher at a school in which I worked, whose parents were my constituents, could not get a transplant and died for want of matching tissue. The point of my argument is that the people about whom we are talking often have the expectation of a full working life. We are not dealing with people who have already had the best part of their life. The people affected are often 20 or 30-year-olds who could be put right if there was matching tissue. It is vital that as wide a variety of matching tissue as possible be available. The teacher to whom I have referred—Grant Allen—was in one of the rarer blood groups. I understand that it is much more difficult to get a transplant for such people. Therefore, if a wide variety of tissue is available, it is much more likely that those who have less prominent blood groups will be able to benefit.
We must face up to an awkward argument—that of freedom. I know that, when the present Secretary of State for Education and Science was responsible for these matters, he considered one of the ten-minute Bills extremely carefully, Indeed, I think it is true to say that he agonised over it. His reluctance arose because of curtailment of freedom, on the argument that, although people have the right to opt out, they might not know of that right. The basis of the contracting-out scheme was that, through computer facilities, anyone who did not want his organs to be taken was entitled to register to that effect on a computer in Bristol. I hope that the Minister will say something about the logistics of that, and how expensive it would be. My understanding is that such registration creates no financial or logistical difficulties. However, it creates a difficulty which we should not shirk—that of the person who does not, for personal or other reasons, want his organs taken, but does not get round to opting out.
The reverse side of the coin is that, with all the good will in the world and the publicity given to kidney donor cards, most of us do not contemplate our own demise. It 28 is never this afternoon that we shall be killed in a motor-cycle accident or step under a bus. On that basis, many people do not bother to carry their kidney donor cards. The hon. Member for Epping Forest no doubt gets huge correspondence on this matter as well. Out of sheer carelessness, people may not carry their cards. It is only human to imagine that it is other people who will be killed and that it is only to other people that accidents happen. Because of that attitude, the reward in terms of organs from kidney donor cards has been disappointing, in spite of massive Government publicity for them.
There are many aspects to the argument of freedom. One is the pressure which is put on doctors. One of the arguments advanced in favour of the contracting-out scheme is that a doctor should not be asked, having sweated his proverbial guts out to save a life, to expend energy going to the parents or next of kin of a person whose life he has tried to save to ask the awful question, "Can we have the organs of your loved one?" The doctor is asking that question at a time of maximum grief.
If I am asked why I am so fanatical about this subject, the answer lies with my going with Dick Crossman to a hospital in the east end of London and seeing a doctor having to contact relatives to ask for the kidneys of, I believe, a 21-year-old lad who had been killed in a motor-cycle accident. It was a ministerial visit. I went as a Parliamentary Private Secretary and it might be recorded in the Department. If, as a bolt from the blue, one discovers that a relative has suddenly been killed, that is not the moment to have to answer an extremely personal and difficult question. I have letters from people who say that they were asked whether the organs of John, James or Helen could be taken, but of course they refused and they now deeply regret it. The decision should be taken—it is not a happy expression—in cold blood and not at a time of maximum grief.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)
I share the hon. Gentleman's opinion that doctors' attitudes are critical. Does he accept that, despite the fact that doctors have a potential donor—perhaps on a life-support machine—who carries a donor card, they still approach relatives, as they have profound feelings that the ethical considerations demand that the relatives be asked
§ Mr. Dalyell
If there is a donor card, whose decision is it? The matter raises difficult philosophical questions. There are differences of opinion among transplant surgeons. Roy Calne, with whom I have talked at great length, takes one view. The Minister's constituent, Peter Morris, with whom I talked briefly on the telephone on Saturday night and who is the professor of surgery at Oxford, takes a more cautious view. Bryan Sells and several others hold yet another view. It does our cause no good not to concede that the transplant surgeons are not united in favour of the opting-out scheme. My point is that to ask a doctor to expend energy, having gone through trying to save a life, is asking a great deal of him. On the whole, these things should be done automatically.
If a person carries a donor card, some of us would argue that it is up to the individual to decide what happens to his or her organs. I can understand that well. What worries Ministers—as it must do—is public opinion. I am sure that the public attitudes to kidney donation according to the Marplan report will be quoted by the Minister, and it 29 is right and proper that they should be. However, I am not happy about the way in which the Marplan survey was done, because the questions are highly personal and delicate.
I do not wish to be arrogant, but in the wake of the McLennan committee report and a good "Panorama" programme about the McLennan committee in the late 1960s, I spent 42 days during the summer of 1969 visiting 1,000 families in the West Lothian constituency and asking them questions about that precise problem. I did it partly because Dick Crossman was anxious that some survey should be done and partly because Sir George Godber with whom I agreed strongly, put it that those questions were best asked, not by a random surveyor, but by someone who should at least be known by name to the people being asked the questions. All hon. Members have trusted constituency relationships, people who are willing to talk freely to them. The result of the survey for the contracting-out proposal was that 364 would have agreed to any organ being taken, 312 would have preferred to volunteer first, and 116, including three state registered nurses were totally against transplantations. The SRNs all said on separate occasions, "If you want to take organs, you must make sure that you have enough money for hernias and other simple operations first." There is the whole question of the expense of transplantation surgery in relation to the other problems of the Department. The other 208 in the survey were genuine "don't knows", including some who had thought about it most.
I got the impression from that survey in industrial central Scotland that resistance to taking organs is not nearly as great as politicians have generally assumed. I am bound to say, however, that I speak of kidneys, livers and corneas—the heart may be different. We must face the fact that for many people—they may not be medically rational, but they believe this and their belief is to be respected—the heart is different. I shall sum up that feeling in the rather sweet and quiet way in which one old lady said to me, "Yes, I would go along with kidneys, corneas and livers but, Mr. Dalyell, my heart belongs to my husband and my husband is dead." That is the old idea of heart and soul, and we should not deride it. We must be careful on deeply sensitive matters to distinguish between the heart, the kidneys and corneas and the personality organs. As no one contemplates doing brain transplants yet, let us not involve ourselves with that. We should not automatically assume that the Marplan survey, which was taken by people less sensitive than me when I took my survey, is necessarily right.
I was involved in a programme called "You, the Jury". It is a BBC format, with which the Minister is presumably fairly familiar. It was about the arguments for and against transplantations. The people on the programme had to call two witnesses. One of my witnesses was Keith Castle—the longest surviving British heart transplant case. He is a symbol of hope for thousands; not only for heart transplant patients, but also for kidney and liver transplant patients. Keith Castle, those around him and the father, who shall be nameless, whose son's heart was donated to Keith Castle—the father, a well-known public figure, wrote and talked to me freely about it—were immensely glad that it had been done. They were glad because it gave hope to many people who were suffering from a defect that would lead to death unless action were taken.
I could go on and on, but I await with interest what the Minister and other hon. Members have to say. I beg the 30 Government to hold the inquiry for which the hon. Gentleman asks and to consider seriously the arguments put forward by politicians right across the party spectrum, and by people like Roy Calne, Sir Michael Woodroff and those engaged in the task of saving worthwhile lives with a prospect of a life's work ahead.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)
I thought it might be convenient for the House if I caught your eye early in the course of the debate, Mr. Speaker, to set out the Government's views on the important topic raised by my hon. Friend the Member for Epping Forest (Sir J. Biggs-Davison). The Government welcome the initiative taken by my hon. Friend in moving the motion. We welcome the tone and the tenor of what he has said and we accept almost all that the motion sets out to achieve, although I have a qualification about the opting-out system, of which I shall say more later.
I am glad that my hon. Friend's initiative has enabled the House to debate these important and sensitive human issues. I am equally glad that the hon. Member for Linlithgow (Mr. Dalyell) is present this afternoon. One of his private Member's Bills in 1978, which was introduced in the House before I was a Member, first aroused my interest in kidney transplants and the importance of carrying kidney donor cards. It was not brought to fruition in my case — here I share an interest with my hon. Friend the Member for Epping Forest in the affairs of Northern Ireland—until I visited the excellent renal unit in Belfast city hospital in 1981. I pay tribute to the work done there, and to the work in similar renal units in Britain. This afternoon, we shall discuss not only kidney transplants, but the transplant of all organs that can benefit and prolong human life.
Medical and surgical techniques have developed greatly during the past few years, and it is now possible to improve the quality of the lives of patients suffering from a variety of conditions and, indeed, to save lives by organ transplants—in some cases rather more cheaply and in many cases rather more surely than even a few years ago. We must all welcome that. Advances as rapid as we have seen in the past few years inevitably increase demand—that goes without saying—as does attendant publicity and that inevitably puts a strain on the system. Beds, theatre space and skilled staff are all necessary. But for organ transplants the main factor that limits expansion has little to do with money and everything to do with the availability of organs. Increasing the availability of donor organs is a matter of changing public attitudes. That is something to which my hon. Friend the Member for Epping Forest and the hon. Member for Linlithgow have drawn attention, and it should be the main focus of the debate. I reiterate that the organs that are so desperately needed in increasing numbers are kidneys, corneas, hearts and livers.
I turn first to the critical problem of increasing the supply of donor kidneys—a matter that concerns many hon. Members and has done for a number of years. Expanding facilities for the treatment of end stage renal failure is a priority for the Government, and we have made that clear to health authorities. But—it is a big "but"— taking that into account, and hoping for the advances that we wish to see, for most kidney patients a transplant is the 31 best form of treatment. It has the added advantage of releasing dialysis facilities for the treatment of other patients.
I am happy to say that in recent years progress on this front has been encouraging. In 1982, for the first time, more than 1,000 transplants were performed in the United Kingdom. I am pleased to report to the House that the provisional figures for 1983 suggest a 13 per cent. improvement in the numbers of kidneys transplanted, with the total reaching 1,160, which is a new record. International statistics for 1981 and 1982, which are the most recently available, show that more kidney transplants were carried out in the United Kingdom than were carried out in any other European country.
§ Mr. Tony Banks (Newham, North-West)
Despite the pleasing statistics that the Minister has just given us, can he tell us why in West Germany, which is comparable to the United Kingdom, there are about 11,000 patients on haemodialysis, whereas in Britain there are only 3,500 patients? The Minister said earlier that it is not a matter of money, but I suggest that it is.
§ Mr. John Patten
I apologise to the hon. Gentleman if I was not entirely clear. I said that the availability of organs was important in transplantation, but that the availability of extra money was of little, if no importance. Of course money is an issue in dialysis. The Government are well aware—they have been constantly reminded of it by hon. Members on both sides of the House—of the need to improve facilities. Therefore, this year we have issued a circular to all 14 health authorities asking them to consider the better provision of hospital haemodialysis and other forms of dialysis treatment. After discussions during the next few weeks, we shall set new targets that must be achieved during a finite period. However, that is a wider issue than we have had the opportunity to debate in the House on many occasions.
The waiting list for a kidney transplant is still long, at about 2,700. Experience suggests that, even if the transplantation rate is increased, as we hope, the waiting list will be a problem, since improvements in surgical and medical techniques will mean that doctors are likely to consider a higher proportion of patients than was the case two or three years ago as being suitable for transplantation.
My hon. Friend the Member for Epping Forest and the hon. Member for Linlithgow agree that the facilities for increasing the number of transplant operations already exist in most renal transplant units; what is needed now is not more cash, but more donors. In the near future, the Government, like successive Governments of both political colours, will launch a publicity campaign to try to increase the awareness of the general public of the need to carry an organ donor card, once they have made the difficult decision to carry that card and once they have discussed with their families and relatives why they are doing it. The publicity material will be sent to all health authorities, to general practitioners and to dispensing pharmacists, asking them to display it to maximum effect.
I hope that the House will be greatly encouraged, as I have been, by the positive response from other organisations which we have asked to become involved in the campaign. Those organisations include professional and commercial groups, charitable and voluntary organisations and community groups. To cite one 32 example, the National Union of Students came forward willingly to offer its publicity machinery to disseminate the idea of carrying a multi-organ donor card through colleges and universities. If people get the habit young, they are likely to continue with it. I am also grateful to a major credit card company, Barclaycard, which has circulated in its February newsletter, which reaches 3.5 million people, two copies of a multi-organ donor card. A range of other organisations have stated that they will join the publicity campaign to be launched by my right hon. Friend the Secretary of State and myself towards the end of this month.
The campaign is not just about carrying the card and the numbers of cards circulated. It will concentrate on the way in which organ donation can benefit ordinary people, and on how helpful it is to doctors and hospital staff if bereaved relatives have prepared themselves in good time for being asked for their consent to the removal of an organ from a loved one whom they have lost. That is a very difficult time, as the hon. Member for Linlithgow graphically portrayed to the House.
My hon. Friend the Member for Epping Forest said that organ transplantation is most effective if the organs are removed immediately after death. Doctors must handle the request for the consent of relatives, who are shocked and upset, very sensitively. Our hope is that more and more people will come to see organ donation as a positive act that can salvage something from the tragedy of an unexpected death, and that the act will therefore help friends and relatives at a time of bereavement rather than be a cause of concern to them.
With that in mind, I was interested to read an excellent article by Dr. Michael O'Donnell in The Guardian of 8 February. He talks abut the tragic death of a young man, David Evans — a 20-year-old geophysics graduate at Liverpool university, who donated his body so that others could benefit. Dr. O'Donnell writes:His parents, Margaret and John Evans, physicists living near Cambridge, have started an organisation to represent the views of relatives of transplant donors.Dr. O'Donnell makes the important point:Their campaign will have a powerful emotional impact, organised as it is not by surgeons or by patients who would benefit from transplant sugery, but the relatives of organ donors most of whom died suddenly and in tragic circumstances.
The article also refers to an interesting idea put forward by a former president of the Royal College of Physicians, Sir Cyril Clarke, whosuggested recently that if the death, and the chance of life it offered to another person, were commemorated in some lasting way, say by the planting of a tree or by establishing a similar memorial, the very act of commemoration would do much to assuage one element of the parents' grief. They would have a permanent memorial that their child's life was not wholly wasted, that their child's death was not a wholly negative event that had destroyed everything and achieved nothing.How right that is.
The transplantation of corneas may not have such a life-or-death element, but it still contains some elements of sensitivity. The transplantation of corneas can restore sight, and the removal of donor corneas is a much simpler procedure than the removal of, for example, donor kidneys, because in most cases donors and recipients do not need to be matched for blood group and tissue type. That is helpful in a proportion of high-risk cases.
The Government welcomed the launching in September 1983 of the corneal transplant service, which is operated by the United Kingdom transplant service. Achievements 33 in the first six months of its operation have been impressive. During that time 59 cornea transplants have been arranged but more donor corneas are needed to ensure that matched corneas are available for all who need them.
I should like at this stage to pay tribute to the United Kingdom transplant service. It keeps a register of all patients awaiting a kidney transplant and, during the past six months, a register of all those awaiting a corneal transplant, so that whenever a donor organ becomes available, it can be matched with the patient on the waiting list. The new technology to which the hon. Member for Linlithgow referred is becoming of increasing importance in that matching.
The service then arranges for the donor organ to be transplanted as quickly as possible. It also keeps records of all transplant operations and is building a data bank of expertise in the two important areas of kidney and corneal transplants. It monitors the patient's progress. That is important in the evaluation of transplant operations and in determining the efficacy of those important but advanced areas of medical science. The United Kingdom transplant service is efficient and cost-effective. It has played an important part in maintaining our good record in renal transplantation. We are pleased that we have up-to-date statistics. It means that we have helpful information about the number of operations performed and the progress that patients make. It is helping with the development of kidney and cornea transplantation.
I should also like to stress the importance of research. It is difficult to evaluate now but it may have long-term benefits, some of them flowing from the admirable work of the national kidney research fund. We hope that the long-term value of its research will be considerable.
Kidney and corneal transplantation techniques are accepted throughout the National Health Service. We move from there to where techniques are not wholly accepted throughout the National Health Service—heart transplantation and, most recently, liver transplantation, to which my hon. Friend the Member for Epping Forest has graphically referred.
Heart transplantation is still at a relatively early stage of development. We are now about two thirds of the way through the research study that we commissioned some time ago to evaluate the costs and benefits of the two important heart transplantation programmes at Papworth and Harefield hospitals. We are awaiting final evaluation of the scheme. We expect to receive the report towards the end of 1984. We shall then be able to decide the place of heart transplantation within the framework of the clinical strategy in the National Health Service in the longer term. The interim report was received just before Christmas. The findings were encouraging. They point to increased patient survival and an improved quality of life for those who have had transplant operations.
On the basis of that interim report, my right hon. and learned Friend the Minister for Health a few days ago announced continuing central funding for 1984–85 for the programmes at Papworth and Harefield hospitals. It totals almost £500,000 and will enable the work to continue until the evaluation of the transplant scheme has been completed.
The work depends on the continuing availability of donor hearts. The hon. Member for Linlithgow raised an interesting philosophical point. He talked about the problematical decisions that must be taken by the National Health Service in evaluating expenditure. I believe that he 34 was hinting at the equation between expenditure on high-cost and high-technology medicine, and lower-cost, lower-technology medicine. It does us no good, on whichever side of the House we sit, to suggest that such decisions can be made easily and that a bit more money is all that is needed. The problem is rather more fundamental. It is to the credit of successive Secretaries of State for Social Services and Ministers of Health—I think of the noble lord, Lord Ennals, of the late Mr. Richard Crossman, to whom the hon. Member for Linlithgow was Parliamentary Private Secretary, and of the right hon. Member for Down, South (Mr. Powell) when he was Minister of Health in the 1960s—that they were all concerned with expenditure but also with medical advances. That pinpoints the dilemma of reaching for the correct balance between available money and how it should be spent. Is it to be spent on the higher technology medicine at the frontiers, or can greater good be achieved by doing more lower technology operations? Those dilemmas are not easily wished away or solved solely by calls for more money.
More expenditure is not what is needed for liver transplantations, which is the last subject to which I wish to refer. There has been considerable publicity about liver transplantation during the last 10 days arising from the case of young Ben Hardwick. My hon. Friend the Member for Epping Forest referred to the television programme. It must be made clear to the House, and through the House to the public, that liver transplantation is much more difficult than kidney transplantation. At present it is performed in only three centres. The scale upon which it will be needed in the longer term is not yet clear but the scope for liver donation by kidney donors in particular is being considered by a group of transplant surgeons. I hope that as this still experimental operation is performed, the new publicity campaign will mean that more donor livers will be available to sustain such expansion of the service as is feasible within the present state of medical and surgical techniques.
We are talking about all useable organs, not just kidneys, which is why the Government set such store by an approach to organ transplantation that stresses multi-organ donation, and not the willingness to carry a card that allow only kidneys to be removed. It is because of that that in 1980 my Department replaced the kidney donor card with a multi-organ donor card on which donors show their willingness to donate any organs, although they may choose to delete any of the organs listed; for example, to opt out of giving their heart.
The campaign that will be launched later this month will concentrate upon the donation of kidneys because that is where the need is greatest and most acute, and where most good can be done most rapidly, provided that the organs are available. The need for all organs will be made clear, and we hope that the vast majority of people will sign the card. I-see, Mr. Deputy Speaker, that you have a card in your hand, and I applaud that. I hear from behind me the cry, "Where is the Minister's card?" I referred earlier to Barclaycard. Here is my National Trust card, here is my national insurance number card — hon. Members may not have seen one—and here is my donor card.
In his excellent article in The Guardian on 8 February, to which I referred earlier, Dr. Michael O'Donnell said that he had often embarrassed audiences of doctors by asking them—rather like asking whether they had given 35 up smoking—to produce their kidney and multi-organ donor cards. On several occasions he had a rather poor response. The campaign that will be launched later this month will concentrate on the donation of kidneys, where the need is most acute.
My last substantial point of principle concerns the need to convince the general public of the points that are commonly understood across the Chamber this afternoon.
§ Mr. Dalyell
Before the hon. Gentleman comes to his final point, will he explain, with the candour and seriousness with which he has been rightly answering the debate from the Dispatch box, why the central thrust of the argument of the hon. Member for Epping Forest (Sir J. Biggs-Davison) and myself — and doubtless the hon. Members for Harborough (Mr. Farr) and for Exeter (Mr. Hannam)— is unacceptable to the Department and his advisers? Why are they jibbing? Why are they reluctant to go a bit further and adopt the contracting-out scheme? Is it because of political opinion? Is it because of philosophical views about the freedom of individuals? What is now the objection in the Department and among his ministerial colleagues to going for the contracting-out option?
§ Mr. Patten
I shall be dealing with exactly that point at some length, although in doing so I shall be talking about ministerial opinions and not about the opinions of recently retired chief medical officers such as Sir Henry Yellowlees, or those of an older and riper vintage such as Sir George Godber, to whom reference was made earlier.
It is critically important to understand what public perception seems to be—according to a range of opinion polls — before I can examine fully the points about opting out. Everything that I say about public perception can be seen as a backdrop to what I am about to say concerning opting out.
A public opinion survey was undertaken by the British Kidney Patients Association. I express my appreciation of the work of that association and of the National Federation of Kidney Patients Associations in seeking to improve treatment facilities for kidney patients and to support them and their families. Those surveys were, of course, done by opinion pollsters who were paid to do the job. They may not have had great sensitivity in posing the question but they produced some interesting answers.
The most recent survey, taken only a few months ago, showed that 66 per cent. of the people questioned would be willing to donate their kidneys after death, and that only 20 per cent. would have any objection to doing so. So far so good, but—it is a very big but—the survey also showed that only 20 per cent. of those willing to donate their kidneys carry a donor card, and that as many as 42 per cent. of those willing to donate their organs, but not carrying a card, do not carry one because they cannot be bothered or because they have not thought about it. That is the attitude that we need to change.
The Human Tissue Act 1961, to which reference has already been made, allows the removal of organs after death if either the deceased person has indicated his consent in writing prior to his death or if, after such reasonable inquiry as may be practical, there is no evidence that the deceased person's relatives have any objection. A signed donor card meets the first of those requirements, but most doctors feel—here we see the 36 split in opinion between doctors and surgeons — that there is an additional ethical obligation to consult bereaved relatives before organs are removed, even when there is a signed card.
I am not saying that doctors are right in feeling that there is an important ethical consideration; they may well be wrong. I am simply reporting the feelings of a considerable number of doctors, whether they are right or wrong. For that reason alone, it is most important that people who are willing to donate their organs should let their relatives know, and the importance of that step will be stressed in the new campaign. It is critically important that people carrying a card for the first time should let their relatives know and make the signing of the card, if possible, a family event, so that everyone has taken collective responsibility within a family unit. All the members of the family would then fully appreciate and understand the gravity of the act.
§ Mr. Patten
If we can persuade people to do that, it will be a major leap forward in the course of this year's campaign.
My hon. Friend the Member for Epping Forest stressed the importance of making it possible for greater publicity to be given in a range of ways. I welcome his idea—I was not aware of it before—about having an exhibition in the Upper Waiting Hall. We shall certainly consider that suggestion.
§ Sir John Biggs-Davison
I am most grateful to my hon. Friend for giving way and for the courtesy with which he has approached the motion. Since he seems to have some doubt about contracting out, since there is a split in the medical profession, and since difficult ethical questions are involved, will he note that my motion does not call for contracting out but for an inquiry into its desirability? I hope that my hon. Friend will not close his mind to that possibility.
§ Mr. Patten
My mind is not closed. Perhaps I was at fault in not making that clearer at the beginning of my remarks. My hon. Friend's motion, I agree, includes a reference to opting out. In some European countries the law is different from our law under the Human Tissue Act. In those countries the removal of organs is permitted unless it can be established that the deceased has specifically objected. That is the exact reverse of the position in Britain.
At present, the Government do not support the amendment of the Human Tissue Act in such a way. That does not mean that we have closed our minds to the possibility of doing so in the future should our publicity campaign, to be launched towards the end of this month, prove to be of not much effect. Our whole strategy thus far has been predicated on the present system and is set within the present law. That is why it has been cast in the way it has.
The Government take their present view for three reasons, and those reasons must be set against the support of the public and of the medical profession, both of which are of supreme importance.
The first reason is that doctors already prefer to consult relatives before removing organs, even where they are not legally obliged to do so because the deceased person 37 carries a signed donor card. There is no reason at present to believe that that practice by doctors would be changed overnight by switching to an opting-out system.
Secondly, there is evidence to suggest that people are quite strongly opposed to the idea of an opting-out system, whether rightly or wrongly I am not saying; I am not giving an opinion. Our most recent public opinion polls still show a continuing opposition to opting out. That may mean that we have failed in the task of education. I am just setting out the facts as we see them. The success of the transplant programme depends heavily on public good will. I do not wish to endanger that or damage it by changing the existing arrangements.
The third of the reasons why the Government still have doubts—although we have not closed our mind—about the opting-out scheme is the practical one of experience. We feel that it is doubtful whether such a change would in practice result in an increased number of organs being made available. We have only to look across the Channel to France to see this, although international comparison of statistics is dodgy, particularly where the French are concerned. The French have had an opting-out system since 1976. There, unfortunately, kidney transplants are at a much lower level, and remain at a lower level, than here, at 15.6 per million of population compared to 19.6 in the United Kingdom. We hope that our climb upwards will continue after the publicity campaign to be launched at the end of the month.
If the campaign—which is framed within the context of the present law and the multi-organ donor card with which people have become familiar since the relaunch in 1980—is a failure, in 12 months' time we shall have to re-examine positively the possiblities of the opting-out scheme. I am happy to give that undertaking.
§ Mr. Dalyell
Can the Minister confirm that the Government's worries have nothing to do with recent coroners' decisions? In the 1970s, one of the strongest supporters of the scheme was Dr. Gavin Thurston, who was at that time a west London coroner.
It is all very well to talk about public opinion poll,, but do they not depend on the question asked? For example, if people were asked, "Do you think that it is right that an increasing number of kidneys, livers and other organs should go up in the smoke of a crematorium so that people who would otherwise be saved cannot be?" would that not lead to a different result than the kind of question that has been asked in the Marplan survey? Do not the results of polls also depend on the circumstances in which the question was asked?
§ Mr. Patten
Yes, the way in which questions are put and the sensitivity with which this is done is of particular importance in getting the most objectively based answers. All of us, in our use of public opinion polls, have to be cautious that we are getting an objective opinion and are not trying to get a certain answer. The answer to the first question, about whether or not coroners' opinions have had a great effect on the attitude of Government, is, most firmly, no.
§ Mr. John Farr (Harborough)
To what extent has medical knowledge improved so that it is possible to bank supplies of organs of the type about which we are talking? Is it still necessary to get them from recently dead bodies?
§ Mr. Patten
Mr. Speaker Thomas once told me, when he was here, although I shall not try to imitate his accent—
§ Mr. Patten
No, despite the invitation of the hon. Member for Leeds, West (Mr. Meadowcroft), I shall not do so. Mr. Speaker Thomas said, "If you do not know the answer to a question when you stand at the Dispatch Box, say so and undertake to write." I am afraid that I do not know the answer to that question about the banking possibilities of various organs and I undertake to write to my hon. Friend the Member for Harborough (Mr. Farr), although I suspect that there are not many possibilities at the moment.
An important issue is that of attitudes within the medical profession. It has been suggested that one of the barriers to increasing the availability of donor organs is that doctors who attend the death of a patient who might be a suitable donor simply allow the opportunity to pass. I was asked by my hon. Friend the Member for Epping Forest about the new work in the NHS to make sure that the opportunities are not lost to interested doctors and surgeons. Valuable work to encourage doctors to consider the possibility of organ donation has already been done by transplant co-ordinators who have been appointed in a number of transplant centres. The Department is now funding this new departure. A number of pilot part-time consultant transplant adviser posts have been created to ensure positive educative encouragement. This may be of use in helping doctors to change their attitudes. Over the course of the next year we shall see whether this scheme will have the hoped for level of beneficial results.
I am certain that the most important factor in changing medical opinion will be public opinion. The greatest force acting on medical opinion will not be exhortation from the DHSS, which does not have beneficial effects, but rather public opinion bearing down on the medical profession. If doctors feel confident that most people support the principle of organ donation, they will be ready, off their own bat, to initiate donations whenever a suitable opportunity occurs. All the organ transplant co-ordinators that we could fund would not do that. Public opinion must have the major effect on changing medical opinion. I sympathise with the difficult task that doctors face. It must be hard enough, as some of us know from our experience, to bring news to a bereaved relative, and it must be even more difficult to broach the problem of organ transplantation in the same sentence.
I am grateful to my hon. Friend the Member for Epping Forest for his contribution to the debate and for framing a motion, the tenor of which is acceptable on both sides of the House and which the Government can largely accept, with the one inhibition about the opting-out scheme. The importance of organ donation is generally agreed. I am certain that the support of the House will contribute greatly to the success of the forthcoming campaign. Publicity is critically important, but it is not just publicity to persuade people to carry cards. Publicity to influence the perceptions of people who may become bereaved relatives and of doctors is equally and critically important. It is vital that the message is got across to the three, those who choose to carry the cards, those who might be bereaved and the medical profession, all of whom have a critical role to play.
Mr. Michael Meadowcroft (Leeds, West)
I welcome the motion in the name of the hon. Member for Epping Forest (Sir J. Biggs-Davison) and his choice of topic, not least because this is, as he rightly said, a sensitive topic and one that can be repugnant. Therefore, to phrase it and introduce it as he did is to be applauded.
This is not an easy issue and some of the knock-on effects of the decisions that can be taken may be serious. There is inevitably a difficult balance between the individual and heart-rending cases that are often publicised, such as the recent liver transplant case, and the broader effect of such cases on so many people. I sometimes wonder whether the media do transplantation a disservice by emphasising the one case when it is impossible to publicise the many cases that are therefore not helped. The assessment of competing needs when resources are limited must be an exceptionally delicate task for the medical profession. The hidden cases, by definition, are not known to us or to many of those who have to make the decisions.
The debate today has an added dimension, because we are responsible for the impression of Britain that we give those in other countries who are less fortunate than ourselves. It would not do our reputation much good if we simply developed more high-technology answers to illness and thereby widened the gap between ourselves and other countries.
I recollect a moving experience some time ago when I chaired a meeting in Leeds addressed by Amilcar Cabral, who was the leader of his people fighting against Portuguese colonialism in West Africa. Thousands of people there heard him say that many people write off liberation movements in Africa because they are merely youth movements. He said that it was difficult for them to be anything but young people's movements when the life expectancy in his country was only 35 years. If we merely develop the brilliant techniques and have no regard to the needs of those in other parts of the world, we shall do a disservice not only to those people but to our own constituents.
We have to consider not only whether we improve the quality of life for some, but whether we consider aspects of health care that improve the quality of life for many more. The changes that have brought about the greatest improvements in the quality of life have not always been technological or medical; many improvements in public health have led to the curing of diseases that killed people early in life.
Heart transplants raise particularly difficult issues. The evaluation to which the Minister referred is crucial and the results must be published as soon as possible. I regret the fact that neither the Minister's comments nor the recent statement by the Minister for Health included any reference to the effect of heart transplants on other medical work. The Minister for Health's statement spoke only about the value of heart transplants to the patients involved, in terms of whether they were living longer and enjoying a better quality of life. It is important to take into account the criticisms that have been made about the effect of heart transplants on other heart surgery and medical work in or around heart transplant wards. It is sometimes suggested that the emphasis on the glamorous heart transplant operations has a deleterious effect on other work.
§ Mr. John Patten
The statement of my right hon. and learned Friend the Minister for Health referred to interim funding based on an interim evaluation of the efficacy of the heart transplant programmes at Papworth and Harefield. The final evaluation of the full report, which is expected towards the end of the year, will encompass all the points to which the hon. Gentleman has rightly referred.
I am grateful to the Minister. It is obviously crucial to allay the fears of those carrying out other work.
If the evaluation were not taking place, there would have to be a question mark over the continued devotion of resources to heart transplant work, as opposed to renal transplants and dialysis, for which, at present, the prognosis is better.
A hospital social worker told me, during a conversation about the availability of organs, that she carried a card saying that she was happy for any part of her body to be used after her death except her heart. She excluded use of her heart not for the touching reason mentioned by the lady referred to by the hon. Member for Linlithgow (Mr. Dalyell), but because she believed that the justification for heart transplants was not sufficiently strong.
The need for a medical audit as well as a financial audit is crucial, but financial considerations are inevitably significant. The figures on renal dialysis and transplants make interesting reading. The 1981 figures from King's college hospital show that the cost for one year's treatment on hospital dialysis was £9,800, compared with £6,450 for home dialysis and £4,700 for transplants with a one-year follow-up with functioning kidney. I was surprised to see that the balance was so much in favour of transplants.
It is clearly crucial to look at the costs of dialysis in capital as well as revenue terms. It is often not realised by those who rightly campaign for more dialysis to be made available that, although a machine costs only £6,000 to buy, the operating costs are between £8,000 and £12,000 a year. It is inevitable that financial considerations will largely determine what work we can carry out.
The Minister referred to the figures that showed an encouraging increase in the number of transplants, but there are still few centres in this country where such work is carried out. A leading article in the British Medical Journal on 22 October last year, signed by Mr. A. J. Wing, consultant physician at St. Thomas's hospital, said:Limited facilities for treatment have made it necessary for British physicians to practise selection to a degree which seems strange, even barbaric, to our colleagues in other civilised countries. We have only 1.1 dialysis and transplant centres per million of the population, in contrast to comparable figures of 5.9 in Italy, 4.4 in the Federal Republic of Germany, 4.3 in Spain and 3.7 in France. Even Eastern European countries have more centres—3.0 in Yugoslavia and 2.8 in GDR.Clearly, we need to provide more centres.
Another aspect that needs to be dealt with is the suggestion, which was made as a prediction before the seat belt law was introduced and has been repeated since then, that the advent of the compulsory wearing of seat belts would reduce the number of kidneys available for donation. A consultant has told me that has not proved to be the case, because the majority of kidneys become available as a result of motor cycle accidents, rather than accidents involving front-seat passengers in cars.
§ Mr. John Patten
I apologise for intervening in the hon. Gentleman's speech for a second time, and I am glad 41 that he has allowed me to do so, because it gives me the opportunity to say that the suggestion that the introduction of compulsory wearing of seat belts had led to a drying up in the supply of kidneys suitable for transplant is completely wrong. It is a myth which needs to be knocked on the head very quickly. There is no such evidence.
That is precisely the point which I was seeking to make, and I am glad that the Minister has emphasised it.
The hon. Member for Linlithgow rightly said that we could not avoid facing up to the difficult question of freedom. If opting in has not produced a sufficient response and if the Minister's campaign does not succeed in improving the position, opting out will become much more attractive. However, although it may be acceptable and sustainable for adults, there is a separate question regarding consent for children. It is a more difficult problem and will cause particular difficulties in specific cases. As the Minister said, the livers of young people are particularly important for transplant work.
Whether we have opting in or opting out, bereaved relatives will have to be approached. Even with an opting-out system, we cannot remove from the medical personnel involved the responsibility for talking to the next of kin in traumatic circumstances. One may well have to tackle this in a different way, but I suspect that opting out helps rather than hinders the approach to a case.
There has been another change in attitude recently. The attitude demonstrated by somewhat fraught discussions on television about the nature of death, the problem of brain stem death and how one determines and defines health, appears largely to have gone from the public mind. Little concern is expressed now about the possibility of people not being dead at the time at which organs are required. If that is true, the case of the hon. Member for Epping Forest in favour of contracting out is that much more powerful. I suspect that there is more confidence, therefore, in the determination to move towards a greater acceptance for opting out.
Psychological aspects and emotional feelings are of great importance. Like the Minister, I was much moved by the suggestion by Sir Cyril Clarke of a memorial to those people who have accepted that the organs of their loved ones be used in this way. It would have been helpful if the Minister had continued the quotation from the article in The Guardian. The article, I think significantly, quoted the parents of the child from whom the liver was taken in the case that came before the television cameras:John and Margaret Evans are attracted by Sir Cyril's idea of some form of permanent memorial that would acknowledge the contribution a death had made to another's life.If the people in that situation were prepared to go public and to be quoted, there is clearly much to be done.
Other cases will need to be considered by the medical profession involving other organs for transplant. One such case is the transplant of the pancreas to help diabetics. It may not be possible to devise rules and regulations to cover the various kinds of transplant. However, I hope that will not inhibit us from tackling the question now under consideration, and that there will be no question of trying to delay the determination of ways to deal with various cases because new and as yet unknown problems lie ahead.
I congratulate the hon. Member for Epping Forest again on raising the subject. I wish him the success that the 42 motion deserves, because of the way in which it is phrased, and I encourage him in his efforts to enlist the assistance of the Under-Secretary.
Mr. Jeremy Hanley (Richmond and Barnes)
First, I must declare an interest. I am the recipient of a transplanted organ. I received a cornea. Had I not received the cornea, I should have lost my right eye. My feelings of relief are outweighed only by my gratitude to the donor and to the next of kin. I shall never forget that altruistic act of the donor and of his or her family—for I know not which it was. Every day of my life I remember the donor. Every time I look out of my eyes, I think of the donor, because the pain has gone, and my sight has come back. I hope that I shall not be a recipient again, but that in my turn I shall be a donor.
I well remember the autumn of 1979 when I had my operation. As I passed out under the anaesthetic, I was listening to the hon. Member for Linlithgow (Mr. Dalyell) who was speaking, I believe, on London local radio. I assure the hon. Gentleman that I need to be anaesthetised to pass out when he is speaking! I was grateful for the stand that the hon. Gentleman took in 1978–79. That gratitude is matched only by my gratitude to my hon. Friend the Member for Epping Forest (Sir John Biggs-Davison) for having moved the motion.
I believe that the motion is temperate and sensible and that its aims are greatly to be desired. Receiving an organ is touch and go. I was put out under anaesthetic and came round some hours later. I had not had the operation, because the cornea had been rejected—as I understand it, for administrative, and not medical reasons. Much delay, particularly in corneal transplantation, is caused by administrative problems. I am grateful for the Government's attitude in trying to speed up the process.
A further delay is caused by next of kin. I carry a donor card because I want my organs, if they are suitable, to be used after my death. It is only by contracting out that people who do not want their organs used for transplantation can guarantee that they shall not be so used. By carrying a card, I cannot guarantee that my wishes will be carried out. The motion therefore strikes the right balance. I join other hon. Members in calling on the Government to instigate some form of inquiry into whether people's minds have changed in this difficult area.
I end my brief speech by thanking the donor again. 'The donor never knew what he did after his death, and I never knew who he was. Most people who, as an altruistic act, fill out a card hope they will never be giving benefit to others. Let us face it, we do not wish to donate our organs before we have lived a long and healthy life. I know only that some such person has given me my sight. In thousands of cases, people lead a better and healthier life, and something positive comes out of something so distressful. On behalf of all recipients, I thank my hon. Friend for having moved the motion.
§ Mr. Tony Banks (Newham, North-West)
I have great pleasure in following the speech of the hon. Member for Richmond and Barnes (Mr. Hanley) who has demonstrated eloquently how vital it is to facilitate the transplanting of organs by carrying a card whereby, in the event of some sad or even normal event, organs that are worthy can be passed on. I would take much pleasure in knowing that 43 there are still bits of me circulating when I have gone to the upper chamber in the sky. Indeed, if bits of me were left for others to use, some unkind people might suggest that was the only decent thing I left to the world.
I wish to make a wider point on the question of organ transplants. This is not a subject to which I have given much attention in parliamentary terms. My intervention will therefore be relatively brief. As the Minister will doubtless recall, I have tabled a number of questions on the subject. I have been moved by recent stories in the newspapers about the purchase of organs from abroad and their importation into this country. Given that the debate is concerned with demand outstripping supply, it is essential to raise some of these points, because there are dangers inherent in going somewhat wider in the search to match supply to demand.
I read a story in The Observer in the middle of last year which suggested that kidneys were being purchased in the United States for import into this country. I believe that the then going price for a kidney was $4,600. The Observer story suggested that kidneys were available because patients in the United States could not afford transplants under that country's medical schemes. It struck me as hideous that, because this country has a more enlightened approach to medicine, it might purchase kidneys from a country where patients are waiting for those kidneys, but cannot afford them.
In a written question on 16 January I asked the Minister how many kidneys had been purchased by the National Health Service from the United States, how much on average each kidney cost and what information he had about the number of patients waiting for kidney transplants in the United States. In his reply on 20 January the Minister said that he was not aware that kidneys had been imported from the United States for transplantation into National Health Service patients. I was glad to read that he added:It would be contrary to Government policy to purchase kidneys or other organs on commercial terms but payment might be made to cover transport costs and costs incurred at the donor hospital."—[Official Report, 20 January 1984; Vol. 52, c. 336.]In reply to my question asking how many patients in the United States were awaiting kidney transplants, he said that the corresponding figure was not readily available.
When I contacted the United Kingdom kidney centre, I was told that there were between 15,000 and 20,000 patients in the United States awaiting kidney transplants. That information was available, but unfortunately it did not appear to be available to the Minister.
However, I am still not satisfied with the hon. Gentleman's reply. I am not suggesting that the Minister is trying to hide the facts, but I do not believe that sufficient care is being taken and that sufficient safeguards are built into the system to assure that there is no abuse.
On 27 January, I asked the Minister what information he had about the importation of organs for use in the private medical service and what were the countries of origin. I began to get more information. The hon. Gentleman replied:Information about arrangements made privately to import organs is not usually available to the Department."—[Official Report, 2 February 1984; Vol. 53, c. 350.]44 But he added to his previous answer by saying that he had since been informed that three kidneys had been imported from the United States for use in the private sector and had been used subsequently in the National Health Service.
I am afraid that that again is incomplete information. Since then I have received a letter from the British Kidney Patients Association saying that not three but nine kidneys were imported from the United States in 1983. My fears increase, given what appear to be some gaps in the information available to the Minister's Department.
I asked about countries of origin. That is very important, as I shall explain. The Minister quite rightly said that it was not a matter for him because it was dealt with by another Department. I ended up directing a question to the Department of Trade and Industry asking whether it kept records of imported organs. Unfortunately, the answer was not particularly helpful. The Minister responsible said that human organs for therapeutic purposes were not separately identified in Overseas Trade Statistics of the United Kingdom.
I find that worrying. It was my hope that I could be told instantly exactly how many organs came into the country, which were the countries of origin and what was their destination — the National Health Service or private health service. I put those questions to the Minister not to be annoying or tedious, but because of my concern that there appeared to be insufficient controls.
§ Mr. John Patten
I wanted to intervene earlier, but I sensed that the hon. Gentleman was about to take us through a sequence of events. I have to admit that they are events from which I have learnt one or two facts of which I was not aware previously. I shall be conducting an in-depth examination when I get back to the Elephant and Castle among the civil servants responsible to discover why I was not aware of one or two of those facts. But let me make it unequivocally clear to the House that the National Health Service has not purchased and will not purchase from any source—whether abroad or at home —any organs for transplantation, although the National Health Service has been and will be willing to pay transport and handling costs for organs which are switched from one country to another to meet the tight matching of organs when we do not have adequate organs at home. That has been common practice among French, German and other clinicians in recent years.
§ Mr. Banks
I am grateful for that intervention and glad that I have been able to assist in a small way in rounding up the information that the Minister will be receiving in future. Although I accept unreservedly the hon. Gentleman's assurances, there are still moral issues involved. If we think about the United States, it could be that the safeguards mentioned by the Minister were applied, but that those organs were still diverted from patients in the United States who, because of their medical system, could not afford to have those organs put into their own bodies.
I accept that there will not be a spot market for organs in Amsterdam and that we shall not start reading about them in the Financial Times. But there is still a moral issue. We must be sure when we accept organs from the United States that they are genuinely surplus. to requirements or cannot be matched into any patients in the United States. Given the figures that I have received, it is 45 clear that that is not what happens, because between 15,000 and 20,000 patients are waiting for such transplants in the United States.
I accept what the Minister said, but he missed out one important factor, and it was my hope that he would go on to deal with it. He gave us a categorical assurance about the National Health Service. I hope that right hon. and hon. Members in all parts of the House want the same categorical assurance about the private medical service. It looks as though that is where the growth in transplants will come if greater accessibility to organs is allowed.
I come finally to the most worrying story of all that I read in the newspapers about organ transplants. It is the allegation — that is all that it is; I have no way of proving it, and I hope that the Minister will use his good offices to discover the facts—that American doctors were purchasing organs from live persons—not cadavers —in Third-world countries. I find that horrific. It is a form of cannibalism. It is horrifying that someone from the money-rich United States could go to a Bangladeshi or Indian peasant and offer money to purchase one kidney or some other internal organ. It would be exceedingly tempting. That organ would be taken back to the United States for use in the private health service there. I find that horrific. What is even more worrying is that what happens in the United States often happens here a little time afterwards.
I want a further categorical assurance from the Minister that in no circumstances will the Government allow the purchase of organs from Third-world countries for use in the private medical service here. We must be firm. The Minister's undertaking must be precise. We must not confine our concern just to the National Health Service. It must be extended to all medical services. I hope that that assurance will be given. If the story that I read is true, it is the worst form of cannibalism that I can think of, and we must stamp it out.
§ Sir John Biggs-Davison
What organs does the hon. Gentleman think would be usable after being transported from Bangladesh to the United States? I share his horror at such a story—if it is true—but it seems unlikely to be true because of the uselessness of such organs.
§ Mr. Banks
I readily admit that I am no expert on the subject. But since organs are being moved from the United States, I assume that it is not impossible, with the aid of modern technology, to move them from Bangladesh, India, or any other countries.
What worried me more than anything else was -that no Minister would accept responsibility for or admit knowledge of organs coming into this country for use in the private medical service. I was in half a mind to test the matter myself, by getting a bunch of chicken livers, taking them to France, and sending them back here. If no one in the Customs pays any great attention to organs coming into the country, there is clearly a loophole that responsible Ministers should plug.
§ Mr. John Patten
Perhaps before the hon. Gentleman resumes his seat he will allow me to point out that one important check on the growth of what would be a perfectly horrifying trade—were it to spring up, and there is no evidence that it has sprung up in the way suggested in The Observer—is that we are safeguarded by medical ethics. Does he realise that the medical profession 46 in this country simply would not tolerate the trade in organs that the hon. Gentleman suggests? We can rely on the medical profession.
§ Mr. Banks
I should he ready to accept what the Minister says as a safeguard, but, frankly, where there is demand, there will be supply. After all, that is what we are told daily in other spheres by the Conservative party. I am afraid that the growth will take place in private medicine. I do not seek to be alarmist. I merely seek from the Minister a shred of concern — which he has undoubtedly expressed—and a willingness to ensure not that the practice does not become widespread, but that it does not even start. That is what I seek.
§ Sir Philip Goodhart (Beckenham)
The hon. Member for Newham, North-West (Mr. Banks) painted a rather improbable international scene of transplants. I shall follow him overseas just long enough to point out that Mr. Andropov died of renal failure. Some doctors in this country have asked why he did not have a transplant. Perhaps he did have a kidney transplant and it did not succeed. The Soviet Union likes to keep these matters secret. We do not know much about the medical condition of their leaders and ex-leaders, and we shall probably never know whether Mr. Andropov had a transplant that failed. I do not know how many kidney transplants take place in the Soviet Union. The medical statistics that we have about that country are sketchy, and few and far between.
We know that the demand for transplants in this country has been growing and shows every sign of continuing to grow. My hon. Friend the Member for Epping Forest (Sir J. Biggs-Davison), who opened the debate in a constructive manner, reminded us that the number of kidney transplants in this country reached 1,100 last year, and that the number of transplants that take place here is greater than in any other European country.
No doubt the development of new drugs and new administrative methods, and perhaps the adoption and passage of new laws of the type advocated by my hon. Friend and by the hon. Member for Linlithgow (Mr. Dalyell), will increase the number of successful transplant operations of kidneys that come from corpses. At present, there is no doubt that a kidney donated by a live relative offers the best chance of success. The latest figures that I have seen show that the percentage of successful renal transplants after one year is 80 per cent. when the kidney has come from a brother or sister, compared with a success rate of 55 per cent. for the transplant of a kidney from someone who has just died.
I am well aware of the strains and stresses that a transplant can impose on a family. A great friend of mine recently volunteered to donate one of her kidneys to her youngest sister, and tests are now being carried out to see whether her kidney will be compatible. Of course, her sister is delighted at the prospect that her life will be prolonged, but other close relatives fear that my friend's health will suffer. She herself has the greatest confidence in the advice that she receives from the doctors and specialists who are testing her, but her immediate family are well aware that all those involved in the testing operation are anxious for the transplant to go ahead. There is a natural fear among some of her relatives that the after-. effects of donating a kidney are being underplayed.
47 I am sure that all the doctors involved present the facts as fairly as they can, but the potential donor needs more information from other donors about their experiences Sometimes, potential donors can be put in touch with someone who has already given a kidney. However, there seems to be a shortage of reliable, non-professional published material about the effects of donating a kidney. What is lacking at present is a pamphlet setting out the experiences of donors. Such a pamphlet could be read by potential donors before they are emotionally committed, and it could deal with the speed of recovery of the donor and possible side effects.
I note that in May 1982, a questionnaire was sent out by the National Federation of Kidney Patients Associations to a substantial number of its members. It reported that almost all of the nearly 300 people who replied said that they would have liked more information about the operation, and only 40 of the people who replied had been given any written information. The national federation said:Patients need information. They do not get enough. Written information is highly desirable to back up what people are told.The people to whom the questionnaire was sent were almost all patients who had received kidneys, rather than those who had given kidneys, but it is more important for donors to have information than for patients who receive kidneys to have information.
§ Mr. John Patten
I hope that my hon. Friend will be pleased to know that, as part of our publicity campaign at the end of this month, we have produced just such a booklet, giving the case histories of a number of people who have donated their kidneys, and examining all the problems that are associated with that donation.
§ Sir Philip Goodhart
I am delighted that my hon. Friend should have answered my request before I have even made it. I am sure that the booklet will be of great benefit and interest to my friend, and to the many hundreds of potential donors who are contemplating this most courageous act.
§ Mr. Laurie Pavitt (Brent, South)
I apologise through you, Mr. Deputy Speaker, to the hon. Member for Epping Forest (Sir J. Biggs-Davison) for the fact that I have been unable to hear the whole of the debate. However, I have been deeply involved in this subject for a long time. I have had the privilege of sponsoring every private Member's Bill that my hon. Friend the Member for Linlithgow (Mr. Dalyell) has introduced on it. The point made by the hon. Member for Beckenham (Sir P. Goodhart) about information is extremely important, and the Minister immediately acknowledged that.
We are discussing the transplanting of kidneys, corneas, livers and hearts, and my hon. Friend the Member for Linlithgow made a moving point about the need to understand the reaction to heart transplants, in particular. However, I shall concentrate my remarks on kidney transplants. A kidney transplant invariably follows a period of dialysis. The Minister made it clear that the debate centred on organ transplants, but dialysis cannot be divorced from that. It is part of the transplant process.
The special relationship between a renal unit and a patient undergoing dialysis should be fully understood by 48 anyone interested in the subject. Renal nurses are perhaps the most dedicated of nurses, although I pay tribute to all sections of the nursing profession. Renal nurses have to use their technical skill in inserting the shunt and so on, and in preparing the patient for what they hope is a matching kidney. They also have to inspire confidence and build up a personal relationship with the patient.
Every time dialysis takes place, the renal nurse is literally holding the patient's hand. The patient may be scared, and the nurse uses all her skill and provides all the information that she can— a point made by the hon. Member for Beckenham — to give the patient confidence. The staff are dedicated, and need to be, as inevitably some cases are lost and some are won. A nurse may spend months looking after a patient who has his blood changed regularly three times a week. She may nurse him through the trauma of preparing for the transplant only to find that the kidney does not match and that the patient may die. Therefore, such nurses should be singled out for commendation, because they carry a special responsibility.
The Minister has made it clear that the important factor in carrying out transplants is not money but the number of organs that we can obtain. However, one of the difficulties is that the DHSS needs money to clear a bottleneck. Renal technicians, nurses and experts are in short supply. There is a bottleneck in their careers. The nurse's skill is highly specialised. She can find herself on duty on a Friday when a transplant is flown in from Rome, Paris or Scandinavia. As it is impossible to find staff for the rest of the weekend, she might have to do a 48-hour stint, nursing the patient. Therefore, such work is highly demanding. I hope that the Minister will consider the whole career structure which applies once a nurse has specialised and has become a theatre nurse or renal expert. She then tends to drop off the promotion ladder. A nurse does not want to be an administrator, and a nurse who has specialised in renal dialysis and transplants is proud of her skill. Therefore, it should be possible for the Department to find a way of ensuring that such people are not left at grade six or seven in the hierarchy, but receive a special reward for their special skills.
When Lord Ennals was Secretary of State and the Labour Government rightly gave a lot of money for more kidney machines, I argued that it was all very well having the hardware, but that it was no good without the people to operate it. We need both the staff and the machinery if we are to have a successful transplant system. There must be, all the way along, that personnel back-up. Where there is a shortage of personnel, incentives must be provided to end it.
My hon. Friend the Member for Newham, North-West (Mr. Banks) told a horrifying story. I share the general concern, but believe that the case was an extreme one. However, we legislate not for the 99 per cent. who are good, but for the 1 per cent. who are bad. I shall cite an example where a slip-up could happen. There is often a medical tie-up with the technical assistance programmes in the Third world, where there is also a lot of deafness. Research carried out at the John Hopkins university in Baltimore made use of a fine overseas aid arrangement whereby professors were provided to train consultants in otology and audiology—or otorhinolaryngology, to give it its full name — and in exchange, the university received thousands of temporal bones for its research into the cochlea and the way in which deafness occurs.
49 Some of the finest research into deafness is carried out at that university. Therefore, although I think that such cases are unlikely, I also believe that unscrupulous people could make use of such arrangements if there was money in it. However, I noticed that the Minister shared our concern and will ensure that safeguards are adequate.
We are not sufficiently proud of the initiatives and breakthroughs achieved by the NHS. We are inclined to decry the NHS and never to give it credit. However, the NHS has been a world leader in renal transplants and dialysis for a long time. Last year, I had the privilege to attend the European conference for renal nurses and doctors at the Barbican, which was opened by the Secretary of State. People came from all over the world. I pay tribute to the pioneering way in which Britain has led the world in matching tissues, in the research carried out at the London hospital, which was then transferred to the organ-matching unit at Bristol.
Bristol has pioneered a computerised system that operates worldwide. On receipt of a telephone call or telex, an organ can be matched up, via the computer, with a patient. The organ can be flown into Heathrow, and the police will take it to the necessary hospital, whether it is Guy's, Bart's, Manchester, or wherever the transplant takes place. The point is that the NHS took the initiative and has led the world. Therefore, people who are inclined, from time to time, to think about what is wrong with the NHS and to discover all its faults and failings, should also pay tribute to what has been done.
Tribute should be paid to the way in which information has been given on home dialysis. The first hospital to do so was, I believe, the Royal Free in London, but it is now widespread. We have led the world in this regard, and I pay tribute to the arrangements that the Department has made over the years to enable home dialysis to take place until such time as a matching kidney arrives.
We should be proud of the way in which we have pioneered home dialysis. In addition, we should praise the local authorities and the organisational help given by Government Departments, not only in respect of kidney machines but also plumbing. In particular, we should pay tribute to the relatives of the patients—the mothers, fathers, sisters and brothers, who have co-operated to help them over the hump.
§ Mr. Dalyell
While paying tributes, should we not also pay tribute to the kidney associations throughout the country that have done a great deal to help fellow sufferers?
§ Mr. Pavitt
I am grateful to my hon. Friend. That is so.
I congratulate the hon. Member for Epping Forest (Sir J. Biggs-Davison) on initiating this debate. Some Labour Members have been trying to debate this subject for a long time, and I am grateful to the House for its courtesy in allowing me to say a few words.
Mrs. Edwina Currie (Derbyshire, South)
This time last year, as well as having my finger in the housing benefits pie in the city of Birmingham, I was also chairman of the Central Birmingham health authority — the teaching authority for the west midlands.
The Queen Elizabeth hospital, part of that authority, is now one of the main centres for kidney and liver 50 transplantation. The Birmingham children's hospital, also part of that authority, has been recommended by the regional health authority for the transplantation of bone marrow in children. Therefore, I have some direct experience of the subject.
Like many hon. Members, I also have the fear in the back of my mind that at some time I might need such care, as my grandmother died of Bright's disease in the days before the second world war, when the sort of things about which we are now talking were thought of as magic and absolutely impossible. Bright's disease is, of course, renal failure.
It should be read into the record that the United Kingdom's experience of kidney transplants is the best in Europe. We are well ahead of all our European partners. Indeed, the figure of 1,160 kidneys transplanted in the United Kingdom last year is absolutely first class, and we should say so.
However, a slight problem arises when the pattern of kidney transplants is compared with the size of our population. Although certain smaller countries, particularly the Scandinavian countries, transplant fewer kidneys, they have done rather better than us when population is taken into account. In recent years it has been twice as easy to get a kidney transplant in Israel, and three times as easy in Norway, as it has been in this country.
The figures for the entire kidney programme show that there are some gaps in the United Kingdom. In most other European countries, the main programme is based on dialysis rather than on transplantation. I think that we have got it right and believe that the programme should be based on transplantation.
The figures for 31 December 1981—the latest that I have been able to obtain, although the Minister may have more up-to-date information—show that in Belgium the total number of patients dialysed and receiving transplants represented 183 patients per million of the population, in Germany it was 200, in France it was 206 and in Italy it was 190, whereas in the United Kingdom it was 93. In other words, a patient had twice the chance of receiving some kind of kidney treatment in those countries. Indeed, we were 17th in that table of European statistics.
Although our transplantation programme is active and successful, it seems that we are selective about who is accepted on some sort of programme. I urge the Minister to look at the programme as a whole. Those of us involved in taking decisions on how much money should go into the different parts of the programme have come rapidly to the conclusion that it must all fit together and that the various parts should not be regarded as competing for resources.
The United Kingdom's transplantation record is improving fast. The 1983 figure shows a 32 per cent. rise in the last two years. Ten years ago we transplanted 547 kidneys. In other words, the number has doubled in the last 10 years. I hope that it will not be another 10 years before it doubles again. About 2,500 people are now waiting for kidneys, but only about half can expect a transplantation with in a year according to an earlier comment by the hon. Member for Linlithgow (Mr. Dalyell). In fact, patients with the commonest blood group—the "O" blood group —must wait the longest, perhaps because the surgeons and consultants dealing with a patient who is dying and who has a rare blood group are much more likely to ask for the kidney to be donated. I am not entirely sure about that, but the fact remains that the commoner one's blood group, the longer one will have to wait.
51 I should like to read into the record a letter that I received from a constituent in Chellaston, Derby, who said:ten years ago last month I had a kidney transplant, after being kept alive on a kidney machine for 3½ years. I was the second patient to arrive, in 1970, on to the Derby City Hospital Renal Unit (now I'm the longest surviving …). That unit was only opened after a public subscription had raised half its cost … Patients do not always end up as lucky as me. I have (and am doing) returned to a useful place in society"—he works at Rolls Royce—and have repaid the expenditure … I have paid an enormous amount of tax in various ways. The Government has had its whack back from me.He ends by inviting me to join him on the Derby marathon on 3 June, an invitation that sadly I intend to refuse.
Other constituents will continue to need dialysis. Therefore, it is important that the programme be seen in its entirety.
Many patients suffer temporary kidney failure as a result of an accident or post-operative problems. Many will not benefit from a kidney transplant, unless they are reasonably fit. Therefore, we must get patients reasonably fit. Sadly, many will suffer some form of rejection. They should at least have the opportunity of leading a useful life until they have a second chance or until, like a diabetic or asthmatic, they accept that they will always be dependent on medication.
In a written answer, my hon. Friend the Minister is of the firm opinion that our system, in which transplantation is the main thrust, is easily the most cost-effective. He suggested that taking into accountstaffing and consumables; the value of machines, equipment and home conversions … and average costs incurred as a result of medical complications"— [Official Report, 25 November 1983; Vol. 49, c. 345.]a successful transplant would cost between £5,600 and £6,450 in the first year, with an annual maintenance cost of less than £40 a week thereafter. The figures also showed that home dialysis would cost between £8,000 and £10,000 a year and that CAPD — continuous ambulatory peritoneal dialysis—would cost up to £11,000, although in my experience it is cheaper than that in practice and is likely to get cheaper as time goes by. Hospital haemodialysis can cost anything up to £15,000 a year. Therefore, we can transplant three kidney patients for the cost of keeping one on a kidney machine in hospital.
As my constituent has pointed out, the maintenance cost of keeping someone after transplant at home is probably a darn sight less, and he is paying for it in tax anyway.
Any reasonable economic view of the NHS should take account of that costs-benefits pattern. In recent years, all the priorities developed in the NHS—and I have agreed with them—have been for the benefit of the elderly, the mentally handicapped and the mentally ill. I have a feeling that the middle-aged man who was likely to get back to work and to repay the cost of his treatment has been somewhat neglected.
In mid-1982, I remember walking into the Queen Elizabeth hospital in Birmingham to find the whole place a buzz. I asked what was going on, and was told that the remarkable transplant surgeon, Paul McMasters, had decided to do a liver transplant. For the next fortnight, the entire hospital revolved around that patient. At that time 52 only seven centres in the world were carrying out liver transplants, although it is now 21 years since the first was carried out in Denver, Colorado.
The only centre in this country at the time was the Addenbrooke's hospital, in association with the Royal Free and King's in London. It required two teams of surgeons—one to sort out the donor and the other to sort out the recipient. Nurses worked all night. The patient needed 42 pints of whole blood. The laboratories had to be kept open 24 hours a day for several days because the blood chemistry had to be tested every 15 minutes. The intensive therapy unit was completely taken over because the patient required barrier nursing, which involved two teams of nurses.
The only howl of rage came from a distinguished heart surgeon whose bypass operations had to be cancelled—not because the theatre was booked, but because the ITU was booked solid for days. The heart surgeon felt that the bypass operations were also valuable. It was also the only occasion on which a surgeon has said to me that the operation was successful but, sadly, the patient died.
Liver transplants in this country have become increasingly successful. The Queen Elizabeth hospital has carried out nine in two years, and seven of the patients are still alive and leading a normal life. That is a success rate of 77 per cent. Recent experience in Colorado shows that 63 per cent. survive the first year and 42 per cent. for five years. That must be a good record. Addenbrooke's has carried out 150 liver transplants, with a 50 per cent. survival rate at the end of one year. So liver transplants appear to work.
I have always been hesitant about high technology—the high-flown magic that masquerades as medicine. But I have made careful inquiries about this subject, and been repeatedly told that liver transplantation for the right patient does work. It is especially satisfactory for children, particularly if there has been an umbilical infection.
I wish, however, to draw my hon. Friend the Minister's attention to the problem of costs. Pittsburgh estimates that the cost of a liver transplant is about $70,000. We do not yet know the cost in Britain. The cost of the blood required, the missed opportunities for bypass operations and so on would be difficult to compute. Two of the nine patients treated at the Queen Elizabeth came from overseas. The only charge that could be made either to them or to their Governments was the private patient cost of a bed. In a teaching hospital, that is about £100 a day. The remainder of the cost had to be borne not by the DHSS or the regional health authority, but by the local district health authority out of the unit budget that had been allocated to that hospital.
If something works, it is worth recognising that it works. I plead with my hon. Friend the Minister to take into account the requests that have been made to recognise liver transplantation as a regional specialty and that it should be properly funded, albeit on an experimental basis.
§ Mr. Dalyell
The hon. Lady mentioned certain figures. Does the Minister accept that renal dialysis costs £14,000 to £16,000 per annum? What is the Department's estimate of the cost of a transplant?
Perhaps the hon. Gentleman will allow me to continue with my speech, which is coming to an end.
53 I wish to make a few remarks about contracting in and contracting out. I was a member of the Birmingham area health authority that tried hard to set proper guidelines through the mid-1970s so that we could guarantee the relatives of patients that there would be no question of the patient not being dead. The matter is straightforward in setting out what the medics should do. However, in practice — as has been said several times this afternoon—most consultants consult patients' relatives. The time has come to test the water for contracting out. The Human Tissue Act 1961 is not working in the way that was intended, for a variety of reasons.
As part of the preparation for contracting out, we need an active publicity campaign, and so I warmly welcome the statement of my hon. Friend the Minister. Will my hon. Friend draw attention to the need for corneal transplants? In 1982, there were 500 kidney donors in Britain, but virtually none of them donated corneas. The educational aspect must be directed not just at the public generally but at those working in the hospitals who ask for a kidney but never think twice about asking for a cornea.
§ Mr. John Patten
Is my hon. Friend aware that in the forthcoming publicity campaign we intend to concentrate on the important point that she raised about the need for more corneal grafts? Is she further aware that the figures that she gave earlier about the relative costs of hospital haemodialysis, of CAPD and kidney transplants, with the associated maintenance costs for a patient having received a kidney transplant, are broadly correct?
I am aware that they are correct. Indeed, I quoted my hon. Friend's written answer of 25 November 1983.
If we are to go hell for leather for transplants—and that is the right direction with kidneys — several things will be needed. We will eventually need more money because some of the kidney transplant units are coming close to the maximum number. We could not double the number of kidney transplants being carried out at the Queen Elizabeth because it does not have the capacity. That must be recognised sooner or later. Calculations must be carefully worked out on which transplants will be cost-effective, on which patients they will prove most cost-effective and what else we could do with that money. A proper opportunity-cost calculation must he carried out. We need a publicity campaign, and that must be directed at the doctors as well as at the public. I also firmly believe that we need changes in the law.
§ 6.6 pm
§ Mr. Frank Dobson (Holborn and St. Pancras)
I thank the hon. Member for Epping Forest (Sir J. Biggs-Davison) for raising this topic. The Opposition support his motion. I hope that the hon. Member for Derbyshire, South (Mrs. Currie) will not be offended if I congratulate her on her speech—with 99 per cent. of which I agree.
As several hon. Members have waved their donor cards, I had better explain my position. Because I have had jaundice, the national blood transfusion service will not take my blood. I understand that no one would want one of my organs. While they may be in sound condition, they would always carry with them the possibility of giving someone hepatitis—which is not the object of organ transplants.
54 Organ transplants pose a difficult problem for almost everyone. Although some may think that it is a straightforward matter, most people have mixed and powerful emotions about the whole issue. Such emotions affect everyone involved. The relatives of a deceased person sometimes have generous feelings on the sudden death of that person. They might feel upset because, despite all the love and affection they they have given that person, he has died, so they want to do something positive. They may think that it would be worth helping someone else to live because the life that they held so precious was suddenly snuffed out and they could do nothing about that.
Most people also feel a great reverence for a dead body, and that is common to most societies. Doctors involved in organ transplants know that a sudden bereavement makes it difficult for relatives to cope not only with that bereavement but with a request for an organ for transplant. Doctors also feel strong emotions, and we should not discount them. A doctor may feel bitterly disappointed that, after trying to preserve the life of a patient, that patient has died, and he finds it difficult to ask the relatives for an organ.
There are very proper feelings of urgency among doctors who wish to carry out transplants and they are sometimes in conflict with the doctors who are trying, however desperately and in a sense hopelessly, to preserve a life. That, too, should not be discounted. There is also the urgent desire for a new organ on the part of the person needing it and that person's family — a feeling that I well understand. When I was a boy I watched my father die because his kidneys had stopped working. There was nothing else wrong with him. I should have done anything to get his kidneys working again or to find a substitute for them. That powerful feeling must characterise all those with relatives in whom an organ has failed and threatens to bring down the whole edifice.
Reference has been made to the ethical problems of defining death and who may certify death. I think that everyone welcomes the new code introduced in March last year as a step forward in controlling what was going on and, perhaps more important, stilling public concern about the problems of defining and certifying brain death. In considering the Government's proposals for more publicity, for more encouragement to people to become donors and the possibility of an opting-out system., we should bear in mind the fears that hang about in the backs of people's minds. One can think of extremely sick societies in which an abominable dictator facing renal failure might have a donor sought out and killed. Abominably rich criminals might do the same in some societies. I believe that fears of that kind may still lurk in the minds of some people here. We do not live in that kind of society. Last year's code of practice and the history of organ transplants in this country are an affirmation that we maintain human and humane values and reject the attitudes that I have described.
We should also not forget that there are practical problems in finding donors and matching tissues and that there are still severe practical problems in carrying out transplant operations. The effort and skill needed to carry out a successful transplant are still great and the difficulties should not be underestimated just because the success rate has been so high especially in kidney transplants.
As the hon. Member for Derbyshire, South pointed out, there is also the problem of resources. Organ transplants cannot be considered in isolation from the demands for 55 resources of the rest of the medical system. In some sectors, the transplant option cannot be separated from the various other possible treatments. Moreover, it is not just a matter of long-term resources or more money being made available. As the hon. Lady amply showed in relation to the Birmingham hospital, a major transplant operation can immediately tie up vast resources intended for other purposes. That poses severe problems for all those trying to manage and operate the NHS in such a way as to maximise the benefit to the maximum number of people.
I welcome the Government's proposals to step up publicity. To the extent that the Opposition parties can do anything to help, I am sure that we shall do all that we can.
So far as I know, the supply of corneas is not a major restraint on corneal graft operations although there is sometimes a shortage. The supply of hearts and livers is sometimes a restraining factor and sometimes not. The supply question is most controversial in relation to kidneys. The Under-Secretary of State said that the restraints on kidney transplants had nothing to do with money, but that view is not shared by all renal experts. Stewart Cameron, professor of renal medicine at Guy's hospital, writes as follows:At the moment we treat about 1,500 new patients each year … However, out of a total of over 7,000 patients who die each year of renal failure it is quite certain that at least 3,500 and possibly more patients are eminently suitable for treatment. That means that 2,000 people are dying every year unnecessarily".He goes on to state:the real problem is facilities for people who either have failed transplants already or cannot have them, and who cannot use a medicine or some other form of dialysis treatment at home. The bulk of these patients are older, or in the young group with complications such as diabetes. For this group we give woefully poor treatment, which results in our total performance being abysmally poorer than every other Western developed nation. In fact, out of all the European countries (in which the number of people dying from kidney failure is roughly the same in proportion to population) we rank lower than every one except Portugal—behind countries as relatively poor as Greece and Spain. In fact, the Italians do very well, and it is interesting and ironic to note that in the island of Sicily alone, the poorest part of one of the poorer members of the EEC, there are more Dialysis Units … and more dialysis places … than there are in the whole of England!I do not wish to labour that point, but it is worth noting that we cannot consider kidney transplants in isolation from the whole range of treatment given to people with acute renal problems.
§ Mr. John Patten
I do not dispute most of the contents of that letter, but to pray it in aid to suggest that my introductory remarks to the effect that the major constraint on transplant surgery was the supply of organs and not cash was wrong would be quite unfair. Nothing in the professor's letter contradicts what I have said. I hope that the hon. Gentleman accepts that the professor's letter deals with the general picture in relation to dialysis, an area in which the Government are doing a great deal in the coming year to improve the situation.
§ Mr. Dobson
I am not sure that the professor would entirely agree. I did not bother to quote his comments about the Government's response, that theywould do what they could to increase the supply of cadaver kidneys.He said:Whilst this was a laudable effort … the real problem is",56 and so on, as I have already quoted. Nevertheless, if the Minister wishes to differ from me on that, I am happy for him to do so.
It is worth noting that although we have the highest rate of transplants in Europe our dialysis rate is very low. I have figures, which so far as I know are reliable, on the number of patients receiving treatment of any kind for renal failure. The figure per million of the population is 162 in the United Kingdom, 278 in West Germany, 290 in France and 228 in Italy. Of those, the number on dialysis is 103 in the United Kingdom, 248 in West Germany, 241 in France and 219 in Italy. It is our good performance in transplants, about which I am very glad, that brings up our average performance.
The hon. Gentleman clearly has more up-to-date figures than I managed to dig out without the resources available to Front Bench spokesmen. Does he agree that the difference between the figures that he has given and the figures that I gave for 1981 shows a rapid growth for the United Kingdom in contrast with the rather sluggish growth in the other countries that he mentioned?
§ Mr. Dobson
This may show how much help is available to Opposition Front Bench Members, but my figures also refer to 1981. I will give the hon. Lady the document after the debate. I leave it at that.
Transplants are an alternative to dialysis in some cases, but they cannot be carried out unless dialysis facilities are available to keep people going until they have had a transplant, and facilities to look after them afterwards, and help them over bad periods. If a transplant fails, dialysis is also necessary. The supply of organs is not the only constraint on the proper treatment of kidney failure in this country.
We also welcome—although the Government did not —the idea of an inquiry into the replacement of opting in by opting out. I will not trouble the House by describing the situation, but those who are totally in favour of opting out should remember that great care needs to be taken that it is not instituted in such a way that something happens that totally offends public opinion and causes people to shy away from agreeing to donate organs. For example, a child or young person who had been seriously injured in an accident might be taken to hospital and pronounced dead and, by the time the parents had arrived on the scene, organs might have been removed from that child. In such a situation there would be a grave danger of public revulsion. Opting out would have to be introduced with great care.
I welcome the idea of an inquiry into opting out but, even before embarking on an inquiry, we need to take great care to make sure that no changes take place that might damage the progress made to date. Nothing must be done to damage public good will towards the transplant programme.
The possibility that anyone was making money out of human organs or conducting a trade in them would also damage good will. There is no such suggestion at the moment, but if such a trend were to develop or if people were to have well-founded suspicions, there would be a grave danger of the voluntary supply of organs drying up again.
I did not expect to mention that point until last Friday, when I sat in on a debate on welfare services and benefits. I was disturbed by a suggestion made by the hon. Member for Mid-Sussex (Mr. Renton). He said: 57A consultant in my constituency suggested to me at Christmas that we should examine the thought that the NHS should publish a list of standard drugs and operations that were available effectively free throughout the NHS, and every year the list would be up-dated. But beyond that, the more exotic modern operations, such as organ transplants, and exotic new drugs should not he available free within the NHS." — [Official Report, 10 February 1984; Vol. 53, c. 1153.]
I hope that that is not a development in Conservative thinking that commends itself to other Conservative Members. One of the merits of our present system is that it has been conducted wholly within the NHS. It therefore commands a great deal of public confidence, and questions about the development of a trade in organs do not arise.
My hon. Friend the Member for Newham, North-West (Mr. Banks) mentioned the possibility of an international trade in organs. That also would be extremely damaging to the transplant programme in this country.
Ministers may be already aware of what is happening, they may need to make further inquiries, or the law may need to be changed. If they feel that changes in the law are needed to prevent the purchase or sale of human organs, they should come to Parliament. They would get such a change through Parliament very quickly. They owe it to everyone concerned in the transplant programme, including potential beneficiaries and donors, to do so. Furthermore, their concern should not be restricted to this country. They are under no obligation to attempt to stamp out any such trade before it develops anywhere in the world. It should be Britain's task, in any international body, to make sure that it does not become possible for rich people to buy organs from poor people in other parts of the world. That would be a desperately bad development.
However, I hope that neither of those developments will arise or will characterise the transplant scene in this country. I hope that the Government's proposal for stepping up publicity for the donation of organs will be successful. We wish it well. We hope, with the hon. Member for Epping Forest, that if the proposals that they have put forward over the last month or so do not work, the Government will be prepared to undertake an inquiry into the possibility of opting out.
§ Mr. John Hannam (Exeter)
I am sure that the whole House is grateful to my hon. Friend the Member for Epping Forest (Sir J. Biggs-Davison) for initiating a debate on this important topic.
For me, the debate is opportune for two reasons. First, I have just glanced at my donor card and found that the telephone number on it is totally out of date. Secondly, it was only last week that Elizabeth Ward of the British Federation of Kidney Patients Associations spoke at the all-party disablement group meeting in the House. We were horrified by what she had to tell us. We heard stories of people who had been turned away from kidney treatment not because they were unsuitable but because doctors were being forced to choose who should receive treatment, because of a lack of resouces and facilities for the types of dialysis required in the hospitals.
Throughout my years of work on disablement, I have seen — as many other hon. Members have done —changes in attitudes and developments. We have moved towards concentration on preventive care and research into the causes of disability. However, the number one priority has always had to be the saving of life.
58 Every year, people die of kidney failure. Large numbers will die this year if they do not receive treatment. According to the British Federation of Kidney Patients Associations, some 3,000 people will die this year and next. They are dying not through end-stage renal failure but essentially — I do not refer just to the present Government but to all Governments with whom I have had dealings — through neglect. Patients are being denied treatment which they require and which it is within our technical resources to provide.
We cannot allow this to continue. The problem has been with us for so long we are becoming blasé about it. Some hon. Members have referred to the problem of the numbers who are and are not receiving treatment. But it is only every five or six months, when a drama erupts and we see on our television screens a weeping wife whose husband, though not old, has been in effect sentenced to die because of the failure to provide treatment for him, that we realise the importance and seriousness of the problem. This is an immensely valuable debate as it makes us have another hard look at a problem of danger to life.
Some of the people who are being sentenced as I have described are elderly and disabled. Elizabeth Ward gave us examples that showed that it is not just the elderly or sick who are being denied treatment. Some young people with social handicaps are denied treatment because doctors are influenced by such factors and are able to afford treatment for only one patient. I do not want to go into great detail on this vast subject but I should like to highlight three principal areas of anxiety. The first is the disparity in the number of patients which regional health authorities treat. The second is our poor record of treatment in comparison with our European counterparts. The third is the range of treatments for patients with renal failure. I shall deal with the last first.
The number of transplants in Britain has compared favourably with our European neighbours. Britain has treated 42 per cent. of patients as compared with only 9 per cent. in West Germany, 12 per cent. in France arid 28 per cent. in Belgium. I strongly welcome that success story. There can be no doubt that successful transplantation enables a patient to lead a much more independent and fulfilling life than does dialysis. Moreover, as has been said, it is the most cost-effective method of treatment.
My hon. Friend the Member for Derbyshire, South (Mrs. Currie) gave, from her own experience, details of what has happened in that area. It is ironical that my view is slightly different from hers. Our over-dependence on transplants has contributed to the large number of people who are dying through lack of dialysis and other treatment. In the past 15 years we have relied on transplants and have not invested to the same extent as most other western European countries in dialysis facilities. I shall give figures for 1981. In West Germany, 90 per cent. of kidney patients were on dialysis. In France the figure was 8'7 per cent. and in Italy it was 91 per cent. Because of the accent on the transplant scheme in Britain, only 55 per cent. of our kidney patients were on dialysis.
In 1982, Britain carried out more transplants than in any previous year. We can be proud of that, but the number of patients awaiting transplants is increasing steadily. In 1982, 2,225 patients were waiting for a transplant. That number has increased by about 20 a month. I understand that 2,443 people were waiting for a transplant in 1983 and my hon. Friend the Member for Epping Forest said that 2,600 people are waiting for transplants this year. 59 Therefore, although the number of transplants is increasing, the number of people waiting for them is increasing faster.
Because Britain treats only about one half of its kidney patients, about half of those 2,000 or so patients will receive the necessary treatment, the rest being turned away with little hope of a cure for a disability that is perfectly curable. As I have said, it requires a television programme to isolate one or two cases to bring home the tearful reality of it all.
The number of patients accepted for treatment depends heavily on the supply of kidneys. We cannot, as my hon. Friend the Minister pointed out, allow that imbalance to continue. Every effort is being made to increase the number of donors. However, although the number of patients requiring treatment is rising, the supply of kidneys is not. It is known that the supply of kidneys has fallen since the introduction of the compulsory wearing of seat belts. I am not convinced that the answer lies entirely with the donor card scheme as presently constituted or possibly proposed. If the scheme does not supply enough kidneys and even if there was a sufficient supply, extra finance and capital investment would be required to carry out alternative treatment.
I have always carried a kidney donor card. Unfortunately, far too few other people carry them, as the figures have shown. A recent survey showed that 66 per cent. of the adult population were willing to donate kidneys but that only some 20 per cent. of them carry a card. I am pleased that the Department of Health and Social Security is planning a big new publicity campaign for 1984. I warmly welcome it but regard it as only a small step in a morass of problems.
§ Mr. John Patten
I pay tribute to my hon. Friend's work for the disabled and his long-lasting and far from superficial interest in these matters. Perhaps I can take a second opportunity to knock on the head a myth that seems to have grown up in the Chamber and in the popular press—that since the introduction of the compulsory wearing of seat belts in motor cars, something of which I was strongly in favour, the supply of kidneys has declined. The precise reverse is the case. The supply increased during 1983.
§ Mr. Hannam
I am grateful to my hon. Friend for correcting me. I hope that evidence on the House making the wearing of seat belts compulsory will lead us to take similar action when considering opting out rather than opting in. It is possible that, an inquiry having been held, the Government might decide to give a similar three-year trial for a contracting-out scheme to see whether it produces the benefits that we can now see resulting from the seat belt legislation.
I do not believe that the donor scheme and the transplant scheme will produce the answer to the many major problems that we face. We must find some way in which to create resources to produce the dialysis treatment which will save the thousands of lives that are lost each year. I put it to my hon. Friend the Minister that we must establish priorities. We have difficulty identifying which are the good and which the bad regional health authorities, but we know that there are large variations in their provisions. It is clear that they are establishing different priorities. The priority must be to save life.
60 I have always supported developments such as bringing the mentally handicapped out into the community, but if we must make a choice between spending money on community care for the mentally handicapped, along with various other schemes which affect their well-being and which are desirable in the long term and the saving of life, we must make saving life the highest priority. We have developed the techniques, the expertise and the ability to do that and it must receive the highest priority.
I should like my hon. Friend the Minister seriously to consider reappraising the priorities. I fully understand the problem of overall resources and the difficulties that regional health authorities face, but Parliament and the Government must set the number one priority which exists so clearly in our minds. I ask him to re-examine the use of resources and the imbalance between health authorities and to try to give the highest priority to ending the loss of thousands of lives each year.
§ Mr. John Farr (Harborough)
I congratulate my hon. Friend the Member for Epping Forest (Sir J. Biggs-Davison) and colleagues on both sides of the House on an interesting debate. I also congratulate my hon. Friend the Member for Epping Forest on his motion. There are a few key words in lines 5 and 6—appeals to the Press Council … to respect the anonymity of those donors".
No doubt the House will agree with my hon. Friend's motion but I can tell him from bitter experience that it is no use appealing to the Press Council. It has little intention of doing anything about bringing offenders into line and no real power to do so. Nearly four years ago there was a tragic incident in my constituency. A young girl of 17 had a donor card on her and was killed working at a petrol pump. Written across her donor card in large letters was the word "Anonymous". Her heart was transferred to Papworth hospital at night. At some point the information was leaked, and the next day all the ghouls of the Fleet street press descended upon the little village in my constituency and harassed the anguished parents. Time does not allow me to tell the House exactly what happened, but some newspapers were especially bad. Worst of all was the Daily Mail, whose reporters went into the adjacent house and tried to get a photograph of a school group showing the dead girl from the daughter of the family living there so that it could be published. One or two other newspapers behaved well. The Guardian had a photograph which it declined to release, and BBC radio Leicester also declined to give publicity to the matter, because the family had agreed that Carol should have a donor card provided that the whole set-up was anonymous.
As a result of the incident I introduced a Bill in 1980 under the ten-minute rule procedure, which received the consent of the House, requesting that a form of anonymity be guaranteed to would-be donors, not only of hearts, but any other organ.
Since 1980, when a heart transplant was an event, transplants of more sophisticated organs than hearts are taking place more frequently. The law has been tightened a tiny bit, but I do not believe that there exists the guarantee of anonymity on which a donor and his or her family may occasionally wish to insist. After that tragic case involving Carol, which received so much publicity, her parents had to have police protection, and had to have their original telephone disconnected and an ex-directory 61 number given to them. After that bad publicity, the supply of organ donors slumped for several weeks. It is part and parcel of an effective organ donor system that we should have an effective system of anonymity when it is required.
I complained to the Press Council in conjunction with Carol's parents and after much correspondence our complaints centred on the scandalous behaviour of the Daily Mail correspondents. All that the Press Council could do was to send me and her parents a letter expressing its dislike and distaste for what the Daily Mail had done. It is time that the Press Council put its house in order, and awarded itself the ability to admonish and, if necessary, fine or remove the union card, or whatever they have, from not only journalists but editors when they have been guilty of especially bad behaviour. There are rogue reporters and rogue editors. I hope that the Press Council will, sooner rather than later, do something to tighten up its system. Then instead of wringing its hands and sending a letter of apology, it can at least bring home its displeasure in a more unpleasant way to those who have been responsible for boosting circulation by distasteful means.
§ Mr. Patten
I did not realise that timetables existed in the Chamber, any more than do planted questions, but no doubt that will be expunged from the record tomorrow by Hansard's eagle eye.
Does my hon. Friend agree that it is peculiar that when my right hon. Friend the Secretary of State announced on Friday 20 January the fact that there had been a record number of transplants during 1983 — which I also reported to the House this afternoon—not one national newspaper thought that that was a worthwhile piece of news to carry?
§ Mr. Farr
I am glad that I gave way to my hon. Friend, because he has hit the nail on the head. His remarks illustrate what I have been trying to put before the House.
I fully support my hon. Friend's motion. I am not happy about the idea of a system of opting out, because it could cause anguish in some families which, for reasons of their own, do not wish to be associated with organ donation. I should prefer the avenue suggested by my hon. Friend the Minister: the launch of an intensified publicity campaign to encourage more voluntary donors.
What about those who do not have donor cards with them? We all wish to be donors, and each member of Leicester city and county councils received donor cards years ago. However, I am afraid that I have lost mine. Since the need to know whether a person is a donor can occur in a split second, perhaps we could have a more permanent and meaningful identification. There could be a stamp on one's tax disc on a vehicle saying "donor" or "donor (anonymous)", if anonymity were requested. We could put a similar stamp on driving licences, which are always carried. In today's busy world, with so much correspondence, papers, credit cards and bills, the organ donor's card, which should be the most important of the documents that we carry, is shoved to one side and overlooked.
With those minor suggestions, I welcome my hon. Friend's motion and I hope that he is successful in having another debate on this important subject soon.
Mr. Richard Tracey (Surbiton)
It is a great privilege to speak in this important debate, which was so sensitively introduced by my hon. Friend the Member for Epping Forest (Sir J. Biggs-Davison). I am glad to be able to join hands with colleagues on both sides of the House in reaching out to educate and inform the public about the need for donors and the need to make transplants possible and to allow them to increase.
I also have the privilege of being the Member of Parliament for the dedicated and persistent parents of little Ben Hardwick, aged two, who has successfully — the news would appear to show this — undergone a liver transplant in Addenbrooke's hospital, Cambridge.
Not many years ago, when I was a reporter at the BBC, I interviewed Professor Christian Barnard just after he had performed the first heart transplant operation. I remember thinking that he was a miracle man who had acquired the power of laying on hands and healing those who, a few years before, would have been in dire straits. It is not that many years since the sensation of heart transplant operations was in the news; but now we hear —it has been mentioned several times this afternoon—of 1,000 kidney transplants in a year. There is an unfortunate queue of almost 2,500 people who need such transplants, but Britain leads the world in this miracle of surgery, as it does in so many other matters.
As my hon. Friend the Member for Epping Forest and the Minister said, demand seriously exceeds supply. We as Members of Parliament and, I hope, the wider world of press and broadcasting listening to us, must educate the public in the need for more and more donors. It is perhaps reasonable to hope that people might consider the donation of their heart, kidneys, liver or corneas in the same way as so many thousands of people consider the donation of their blood. I know that it seems smaller within the total of human knowledge and experience, but our target should be to see that the public have this knowledge and perspective of the need to donate those parts of the body which can save lives. As has been mentioned, doctors are afraid to approach the parents or next of kin of victims of road or other accidents — the kind of people whose organs could be donated for transplant.
In his wise way, my hon. Friend the Member for Harborough (Mr. Farr) has put his finger on one of the root causes. It is, as I have to admit as a former member of the press corps, the unfortunate way that the press can sometimes harass people for photographs of their dead relatives. That is part of the education. My hon. Friend was right when he said that our hon. Friend the Member for Epping Forest was perceptive in including in his motion the way in which the Press Council and Fleet street should treat these cases and that the donation of organs and transplants should not be regarded as sensations in the news. It is a most important and sensitive area of surgery, and must be treated as such.
I suppose that people have a fear of filling in the donor card—they do not want to look forward to their own death—but we must recognise—I am as guilty as many others because I have not yet filled in the donor card—what a valuable gesture we can make towards saving lives. The third problem, of which we have heard from some hon. Members, is that people have filled in a card, and then lost it.
63 I want to discuss education, and some of the figures that have been bandied across the Chamber. I mentioned Ben Hardwick, the son of my constituents. For those who were unable to see the sensitively handled BBC television programme "That's Life", perhaps I could go over some of the problems that faced his 22-year-old mother.
Ben Hardwick suffers from a complaint called billiary atresia, which is a blockage of the bile duct. It is suffered by one in 14,000 children. It was first diagnosed when he was three weeks old, and it was confirmed when he was five weeks old. One can understand the sheer horror felt by that young mother, then aged 20, when she realised that her child was likely to die. She is a most persistent and dedicated mother, to whom I pay tribute. She read that it was just possible that a transplant could save the life of her young son.
After two months Ben underwent major surgery, in which his bowel was attached to his liver to create the necessary loop to draw the bile to a bag outside his body. It was still plain to the mother that that would be only temporary. Since then, and since he went into Kingston hospital last autumn, when it was believed that he would die, she has said that she went practically berserk, as I am sure all hon. Members would understand.
Mrs. Hardwick did not give up. The problem was that there was no donor. No matter what inquiries were made by the hospital staff, in Kingston and further afield, they could not find a donor. Mrs. Hardwick decided to use the media in a most positive way, as she wrote to Miss Esther Rantzen of the "That's Life" television programme. Those of us who have seen the programme will be aware that for three or four weeks details were given with great sensitivity to the public. It illustrated one of the best uses of community television.
The way in which the donor was found is interesting. It was not, as one might have expected, a doctor who saw the programme and went to the relatives of a terminally ill child. In fact, the programme was seen by the wife of an anaesthetist at a Nottingham hospital. When he arrived home from his duties at the hospital, his wife happened to tell him that this programme had appeared on BBC television. Being quick-thinking, he fortunately realised that there was a child in the Nottingham hospital who had 64 a slim chance of living. He went to the parents of the child, Matthew Fewkes, and they were only too happy to say that if their child died — unfortunately he did in the following few days—his liver could be donated to save Ben Hardwick. That rounds off a wonderful story of parental dedication, and great feeling by the parents in Nottingham.
What emerges from the debate and the news stories, and interviews with the parents in Nottingham, is that doctors need not fear asking parents to donate their children's organs in such sad cases.
I have been privileged to have been sent some confidential letters which were written to the "That's Life" programme. I wonder whether I might quote some lines without identifying the parents. One says:Three months ago our baby son died, he was two months old.… What a blessing it would have been to a baby like Benif their childhad also been a donor to save another life. To us it would have meant that we hadn't lost him totally and part of him, however tiny, would have lived on.
Another letter of great feeling said:We lost our little boy through a cot death three weeks ago. No words can describe how we feel, and at the time of his death it was hard to take in what anyone was saying, but if only we had been asked if we would mind them taking his liver or any other organ I think it would help some of the pain we are feeling now.
Those are samples of the hundreds of letters that Miss Esther Rantzen and her production team are receiving. The production staff of the programme have asked me to put across two messages. The first is to urge doctors and nurses not to fear approaching the parents of children or others in intensive care wards. The parents and next of kin concerned will probably be only too pleased to be asked; indeed, they cannot understand why they are not asked. They are very unhappy and sad, months later, when they feel that they could have done something to help.
There is a belief that psychiatric advice should be available in case people wish to consult a psychiatrist about the matter.
The second important point made by the "That's Life" team is that the donor should be registered—
§ It being Seven o'clock, proceedings on the motion lapsed, pursuant to Standing Order No. 6 (Precedence of Government Business).