§ Mr. Hanley
I beg to move amendment No.2, in page 2, line 13 at end insert—
'(4B) Whenever the person lawfully in possession of a body is a health authority and the deceased person's relatives are asked by that health authority for permission for an autopsy to be performed upon that body, they shall at the same time be asked if they object to the removal of the deceased person's eyes for therapeutic purposes or for the purposes of medical education or research.'.This is a different matter. When we went through the Bill in Committee we were mindful not only of bureaucracy but of the fact that because of the problems associated with the bereaved a number of corneas cannot be removed even though the deceased had wished them to be removed.
Perhaps I might outline my own experience. I cannot speak too highly of Moorfields hospital and the way that it cares of for its patients, many of whom are in extreme pain, because our pain is fairly unique. I was told that I was to receive a transplant cornea under the National Health Service and I was taken to the operating theatre and given a general anaesthetic. I came round some hours later and found that the operation had not taken place. The reason was that although a transplant cornea was available still intact in an eye, the eye was demanded for autopsy as part of a general autopsy into suspicious circumstances surrounding the death of the donor.
The deaths of many donors are not suspicious. They are, regrettably, caused by road accidents, and there is no need for an autopsy for which all the organs must be stored and investigated. However, in the case of my donor there was a need for further investigation. I was assured by medical staff that the autopsy was a matter of procedure and would not provide any extra information to the people carrying out the autopsy.
When coroners look into matters and receive expert advice, or carry out their own investigations, the detail they receive from the investigation of the organs can be vital in determining the cause of death. However, the information that they receive from the eye, if any, is not as important, and I seek to ensure that the wishes of those who want the corneas of their loved ones to be transplanted are carried out.
The period between the death of the donor and the time when the eye is available for the cornea to be removed can be so long as to damage the tissue. Fourteen hours is regarded as the maximum time within which corneas can 1158 be removed, and in the 14 hours following death many things happen. For a start, in the vast majority of cases the donor has unexpectedly lost his or her life. That is a traumatic experience for the family of the deceased. One has to trace the family after the deceased has been identified, and there are many matters to be taken into account.
It is sometimes a miracle that any organs are successfully removed for transplantation, but millions of people in Britain carry cards to show that the waste and futility of death should not be total, and that parts of their bodies, should they be of benefit to others, should be used for transplantation or for any other therapeutic or research purpose.
I admire the next of kin as much as I admire the deceased. They are suffering from their bereavement and for them it is an extremely difficult time. Such people may be considering the life of the person they have created, their own child, and they are being asked to sanction what might be regarded as a defilement of the body. However, instead of thinking that it is a mere body that will be destroyed in time, one should bear in mind that life can be enhanced by something in that body, and that adds comfort to the next of kin. I know from personal experience how next of kin can feel great benefit because something of their deceased, loved one will continue to give life and continue to add to the mystery of life.
A doctor often finds it the most difficult part of his job to speak to the next of kin. He often finds it extremely traumatic, both for him and for the next of kin. At that stage, the doctor having plucked up the courage, based on the special training he has received and the care and dedication that is inherent in those who take up that profession, it would be far better for him to ask the next of kin whether at the time of the autopsy they would like a certain part of their deceased loved one to be used in transplantation. That would help to increase the numbers. The amendment says:they shall at the same time be asked if they object to the removal of the deceased person's eyes".As we said in Standing Committee, that is the right attitude to take. We are all put on this earth for a purpose, and what has been put on the earth should not be wasted at death. Therefore, the wishes of most individuals would be upheld if their bodies could be used for legal and limited transplantation unless the next of kin or the person himself objects, particularly if that person objects through the opting out process. That ought to be discussed on Third Reading.
§ Mr. Hannam
Amendment No. 2 is especially interesting to me, as it considers how we obtain donor material and whether we should have an opting-in or an opting-out system.
I have been involved in the campaign run on behalf of kidney patients for a long time. It is extremely distressing that medical science has produced a remedy for a disease which, 20 years ago, was nearly always fatal but that young children and elderly people still die from kidney failure because there is a shortage of donors. The Esther Rantzen television programme recently tore at our heartstrings by showing pictures of agonised parents and doctors who, if kidneys had been available, would have been able to save children's lives.
1159 10 am
The shortage of donor material, not a shortage of donors, has prompted the Bill. The amendment is prompted by a desire to increase the amount of tissue available. One of my first campaigns in the 1970s was for attendance allowance to be paid to kidney patients on dialysis. We achieved that. We then got more money for kidney units. The Government responded to that challenge with substantial increases in resources, backed up as usual by voluntary contributions and voluntary organisations. We now have a large new kidney unit in Exeter.
The Government then launched the donor card programme. Most of us carry kidney donor cards. I hope that all those present do, although I shall not challenge them. The result of that campaign has been a substantial increase in the number of transplant operations, but there have not been enough. I am afraid that the voluntary donor system is not good enough. We shall have to bite this difficult bullet and change to an opting-out system in which it will be assumed that organs are available unless people carry a card or their relatives say that the removal of organs is not desirable.
Such a change could free us from the haunting spectre of people dying, not because we cannot save them or because people are unwilling to donate vital organs, but because the system fails to produce the organs at the crucial time. The amendment takes us a little way in that direction, but I am not sure that progress should be piecemeal. I doubt whether we should change the Bill when other organs or tissues are not covered in the same way, although I shall listen carefully to my hon. Friend the Minister's advice.
I should like to thank my hon. Friend the Member for Richmond and Barnes (Mr. Hanley) for giving us an opportunity to discuss an important aspect of transplantation policy.
§ Mr. Whitney
I, too, am grateful to my hon. Friend the Member for Richmond and Barnes (Mr. Hanley) for tabling the amendment. It draws attention to an important source of corneal tissue which is all too often neglected.
I should like to draw a distinction between a coroner's autopsy and an autopsy that is undertaken on the initiative of a health authority. Whenever a coroner is worried about the facts surrounding a death, he has the power to order that an autopsy be performed, and neither the health authority nor the deceased person's relatives have the right to stand in the way. The amendment is not concerned with coroner's autopsies.
Autopsies may also be performed on the initiative of a health authority if, for example, doctors want to discover fuller information about the course of a patient's disease so that their understanding of it will be increased. Such autopsies can fulfil a useful function, but they can be performed only if the deceased person's relatives give their permission. As health authorities are already required to approach relatives in such circumstances, it would seem sensible for them at the same time to ask relatives whether they have any objection to the removal of corneas for transplantation.
§ Mr. Frank Cook (Stockton, North)
The amendment proposes that permission should be sought for the removal of corneal tissue andfor the purposes of medical education or research.Will the Minister give an assurance that, when considering that request, relatives will be made aware of the more 1160 macabre and unfair aspect of the regulations relating to such activity—that those who donate their bodies to medical investigation forfeit entitlement to death grant as they no longer have a responsibility to dispose of the remains?
§ Mr. Deputy Speaker (Sir Paul Dean)
Order. That is going a little wide of the amendment. I am sure that the Minister will keep his reply within the terms of the amendment.
§ Mr. Whitney
I am happy to follow your direction Mr. Deputy Speaker. I note the hon. Gentleman's point and do not doubt that my colleagues with responsibilities in the matter will have done so as well.
I hope that health authorities will ask relatives whether they object to the removal of corneas when asking for permission for autopsies. It provides a straightforward way in which the supply of corneal tissue can be increased. I hope that, in the event of the Bill becoming law, health authorities will profit, if that is the most practical way in which tissue can be procured.
I would not want health authorities to be required to do that, as my hon. Friend's amendment suggests. With some autopsies, the delay between death and the permission of relatives being obtained makes corneas unsuitable for transplantation. My hon. Friend the Member for Richmond and Barnes referred to the 14-hour maximum. I would not want relatives to be asked about corneal transplantation when there was no possibility of its being carried out.
Moreover, the deceased person's eyes might have been damaged enough to make that unsuitable, and asking about transplantation could only aggravate relatives' distress. The circumstances surrounding death might render such an inquiry more harmful than advantageous. I urge health authorities to ask relatives for permission to remove corneas when they ask permission to perform an autopsy, provided that the circumstances are propitious.
A balance must be struck. Moving in the direction which the amendment suggests—a legal obligation—is going too far. The Government share my hon. Friend's view about the need to increase the availability of all organs. We are doing everything that we can to promote the organ donor campaign and are considering the possibility of other initiatives. However, to lay down a legal duty on health authorities would be misguided and unnecessary, and I hope that my hon. Friend will feel able to withdraw the amendment.
§ Mr. Hanley
I plead guilty to trying to introduce an opting-out system by the back door, but I believe that such a system is desirable and will dramatically increase the number of organs available for transplantation. The fact that there are only 2,000 transplants in Britain each year, of which about 90 per cent. are successful, and that there are more than 500,000 deaths in Britain each year is a poor record. I am certain that many more than 2,000 people would be willing for their corneas to be used. I fully appreciate what my hon. Friend has said about the difficulty for a doctor at the time of autopsy.
I understand, as perhaps I did not appreciate fully before, what my hon. Friend said, that it could make the position worse if there were a statutory obligation to ask permission to take tissue at a difficult time for the next of kin. I would do nothing that would make their suffering at that stage even greater. On balance, I believe that it is 1161 better to leave the matter to the skill, care and consideration always shown by doctors in these circumstances, and I beg to ask leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ Order for Third Reading read.10.12 am
§ Mr. Hannam
I beg to move. That the Bill be now read the Third time.
Recent weeks have been extremely exciting for me and all others involved in disablement matters. Last Friday, the House completed deliberations on the Disabled Persons (Services, Consultation and Representation) Bill, a major piece of legislation by any standards, especially as it was a private Member's Bill involving probably £100 million of new resources. As a sponsor of that Bill, I congratulate the Government on the major support they gave. Having been involved throughout consideration of that Bill, I can assure the House that the Government assisted with its drafting and. in the end, the financing of the measure. That Bill was top of the ballot.
My Bill today drew number 19 in the ballot, but as a lucky coincidence of being in the right place at the right time for once when it came up for Second Reading and slipping into the airstream, as it were, of the rather larger disabled persons measure of the hon. Member for Monklands, West (Mr. Clarke), this Bill received a vital Second reading on 17 January and moved up the snakes and ladders hoard into second place; we are now today putting it through Parliament. I should like to thank all hon. Members who helped make that possible.
The basic aim of the Bill is to remove a major obstacle to successful eye transplants in this country. The obstacle is not in the actual transplant area, but in the collection of suitable eye tissue needed for the operation. The amendments we have been discussing are designed to assist in that regard. We all know that this material is desperately needed to prevent loss of sight and blindness.
The cornea is the circular and transparent lens on the front of the eye, approximately 11 mm by 13 mm in size. When disease, degeneration or injury causes a loss of the normal tranparency of the cornea, light fails to get through to the retina and blindness occurs. So in corneal transplants we are talking about a graft of a 7 mm to 8 mm button of donor tissue being transplanted into a recipient hole in the eye.
It is a simple graft operation performed routinely in teaching hospitals and district general hospitals with special units. Some 1,500 to 2,000 grafts are carried out in the United Kingdom each year, with a 90 per cent. success rate. However, the supply of eye tissue donor material is not great enough to satisfy the waiting list for transplants, and some hundreds of people are anxiously waiting for the time they can have an operation to save their sight. The hold-up is not due, as it is in the case of kidney transplants, to a shortage of donors. It is due to a shortage of opthalmic surgeons, the specialists required under the existing law to perform the routine cornea removals from the bodies of the donors.
The Human Tissue Act of 1961, which we seek to amend, requires that the removal of organs from bodies for medical purposes can be carried out only by fully registered practitioners. That has undoubtedly been a perfectly proper requirement and certainly needs to continue for organs other than eyes or parts of eyes where 1162 a comparatively simple operation can now be carried out, as in other countries, by eye technicians properly trained and supervised.
Our hospital ophthalmic doctors, who are under great stress these days, cannot be available day and night to interview relatives and then remove eye tissue. In the United States and other countries considerable developments have occurred and eye banks are now a standard part of ophthalmic units, under the direction of a medical board and run by eye bank technicians. In the United States, in 1984, 24,000 corneal removals were carried out, 98 per cent. of them by such technicians. In Holland and other European countries, similar eye banks are now operating, and I have received letters from the United States and Holland supporting this Bill.
There is absolutely no opposition from medical organisations; indeed, they support the Bill and welcome a relaxation of the 1961 law so that an improved supply of corneal material can be available for transplantation. The national United Kingdom organisation promoting this change is the Iris Fund for Prevention of Blindness, ably led by its director, Susanna Burr, whom I thank most deeply for her inspired help for the Bill. The iris fund established the United Kingdom Corneal Transplant Service in 1983 with Department of Health and Social Services support and has financed it since then, although it hopes that the scheme will be taken over next year by the DHSS.
The service is based in Bristol, in the constituency of my hon. Friend the Member for Kingswood (Mr. Hayward). In a letter dated 3 December 1985, the director, Ben Bradley, states:The demand for donor material is always increasing, and despite having recorded more than 900 cornea grafts since we started in October 1983, there are still 316 people on our cornea waiting list.Your help in bringing the plight of these patients to the attention of the House will, I am sure, result in an increase in the number of corneas made available for transplantation.Over the whole country, 4,000 eye grafts have taken place during the past two years in hospitals from Bristol to Edinburgh. As many as 1,500 extra transplants a year could take place if this Bill were enacted. The life of the eye tissue is very short—14 hours from removal to transplant, so the need for an efficient system is obvious. Until very recently, these short-lived eye materials have been kept alive for a maximum of four days by a conventional liquid preservation technique using the MacCarey-Kaufman solution, but most transplant operations are still carried out using fresh material—removed from the donor—within that short period.
However, a revolutionary advance has just been made by the Bristol eye hospital and the United Kingdom transplant service research team at Bristol university. Within the past week or two, a new technique for storing corneas for up to 30 days in an eye bank has resulted in the first two corneal transplants being carried out by Professor David Easty in Bristol using corneas stored in a special nutrient fluid. These organ cultured tissues can be re-checked over a period to make sure that they are suitable and in good condition, and also that their tissue material can be better matched with the patient's needs.
In those two operations, David Easty used one cornea which had been stored for two weeks in the United Kingdom transplant bank and one from Denmark which had been stored for a month. That represents a tremendous 1163 advance and helps, with the Bill, to produce a solution to this long-standing problem. Both patients have been discharged and are doing well.
Because such transplant tissue can be stored for up to a month, both the patient and the surgeon can plan when the operation will take place. That relieves the pressure on operating theatres and the patient's anxiety. Following the successful operations, Professor Easty said:This means that our eye banks can now provide an instant supply of material for emergencies.Material will be readily available to save sight if major accidents occur. Eventually, by having a store of this tissue, there will be an end to waiting lists for corneal transplants and we shall be able to deal promptly and efficiently with major disasters. Through this legislation, we can increase and speed up the supply of corneal tissue provided by the eye banks. That tissue can be used to restore the sight of all those facing loss of vision and blindness. My hon. Friend the Member for Kingswood must be proud of the Bristol team's achievements. I hope that he will pass on our congratulations to all those involved.
I thank all those who have helped to pilot the Bill through Committee and Report. Some of those hon. Members who were active in the early stages were not able to be present today. They include my hon. Friend the Member for Weston-super-Mare (Mr. Wiggin), who, following an accident, was given a corneal transplant—as was my hon. Friend the Member for Richmond and Barnes (Mr. Hanley)—and my hon. Friend the Member for Walden (Sir G. Johnson Smith), who has suffered from an eye illness. I especially thank my hon. Friend the Under-Secretary and his officials for their assistance in drafting the Bill. I hope that the House will now send the Bill to the other place so that it can quickly become law and end the waiting lists for eye transplants.
§ Dr. M. S. Miller (East Kilbride)
I welcome the Bill. There have been amazing developments in modern science and technology which will ensure that, when the Bill is enacted, cornea transplants will take their place among the other grafts and transplants which have become an acceptable part of the fight against illness and disease and the battle to make the afflicted healthy. I congratulated the hon. Members responsible for the legislation.
The faith of hon. Members and the Minister in the medical profession is touching. The Bill states:No such removal of an eye or part of an eye shall be effected except by—(a) a registered medical practitioner".I cannot imagine the eye or part of the eye being removed by anyone other than a registered medical practitioner, although the hon. Member for Exeter (Mr. Hannam) mentioned other people who could be involved.
The Bill states that the registered medical practitionermust have satisfied himself by personal examination of the body that life is extinct".Sometimes, it is not as easy as one imagines to ascertain that life is extinct. I am sure that the Under-Secretary of State is well aware of that. The absence of a fully detectable pulse or heartbeat does not necessarily mean that a person is dead. I assure the public that tissues are not taken from people who have not been certified as dead. People have expressed that concern.
1164 We know the scaremongering about this issue. People should be encouraged to state clearly that they are willing to donate parts of their bodies. Eye tissue should be added to organs listed on the card carried by people who wish to donate.
I warmly welcome the Bill. I hope that, before long, these transplants will take their place with the others.
§ Mr. Rob Hayward (Kingswood)
I support the Bill. As my hon. Friend the Member for Exeter (Mr. Hannam) has said, I have a personal interest in it. I believe that all hon. Members would willingly support the Bill if they were aware of its contents.
The legislation arises primarily from the advance of modern technology. The Human Tissues Act 1961 recognised the limits of technology at that time. Ophthalmic surgeons had to perform the operations to ensure that transplants were suitable for recipients, but that is no longer the case. Twenty-four years have passed and there have been substantial changes in medical technology. People with lesser skills—I do not want to denigrate them—can now perform these operations.
I pay tribute to the efforts of my hon. Friend the Member for Exeter not only in introducing the Bill but in working for the disabled. Last week, he was given an honorary degree by the Open university. That is a substantial recognition of his efforts on behalf of many people.
My hon. Friend the Member for Exeter said that the service is based in Bristol. The United Kingdom transplant bank is organised from Bristol. Research is undertaken by Ben Bradley and his team and by the staff at the Bristol eye hospital to benefit people suffering such tragedies. For those reasons, I take great pride as a Member from Bristol in supporting the Bill.
I have a direct interest in this issue because, when I was 17—regrettably, that was too long ago—I developed partial blindness, which recurred intermittently for the next four years, sometimes with total blindness. Fortunately, at no stage did that blindness continue for a substantial period. Obviously, it was disconcerting. I saw eye specialist after eye specialist, none of whom could tell me precisely what was wrong. Fortunately, when I was 22, the problem seemed to disappear and, for the next eight or nine years, I suffered no problems with my sight.
When I was 30, the problem recurred on a few occasions to a limited extent. Again, I suffered from either partial or total blindness, but, mercifully, it was for a fairly short period. Less than two years ago the eyesight in my left lower quartile deteriorated substantially. That had the dramatic effect of stopping me from being a rugby referee because it confirmed what all players believe about rugby referees—that they are blind. The problem continued and I visited a series of specialists at a number of hospitals, both in London and Bristol, for assessment of my eyesight difficulty. At the time I was also suffering from a nervous difficulty in my hand.
After undergoing a series of tests I was referred to the Burden institute at Frenchay hospital where I had a brain scan. I am in the unique position of being able to say that I am the only Member who can prove that he has a brain. The brain scan provided no further information about the cause of my problems. Ultimately, it was diagnosed that I had multiple sclerosis, a disease for which there is no cure. I was not over-frightened by that diagnosis. People 1165 live with far worse diagnoses than that. At this stage there is no known treatment or cure for multiple sclerosis. The virus was identified a few years ago. Work is being done at the moment, and people who suffer from it are given advice about the forms of diet and exercise that they might take.
Where an illness is not treatable or curable, one learns to live with it and accept it. Surely it is far worse to know that one will go blind, and needs an operation, that the technology is available and many people can carry it out by performing a transplant, but that legislation does not allow it. That is the point of the Bill. The technology is available. Just imagine if one were a surgeon or doctor, and had to say to a patient or his relatives, "We know what you are suffering from. We could cure it, but the legislation does not allow us to do so because it is too restrictive."
It is for that reason that I am such an enthusiastic supporter of the legislation. It broadens the opportunity for many more people to have an operation, for which the facilities and the expertise have been available for so long. For those reasons, I encourage the whole House to support this excellent and long-overdue measure.
§ Mr. Colin Moynihan (Lewisham, East)
It is difficult not to rise with a substantial degree of humility, having heard the expertise of those hon. Members on both sides, either through professional or personal experience, who have introduced the Bill. I hope that the Bill will pass expeditiously through the other place and on to the statute book.
I wish briefly to concentrate on the substantial technical developments which have occurred and make the Bill all the more important. We have come a long way since the early days of this century when the first transplant was performed by a doctor on his pet gazelle in Africa. In due course it was rejected.
Now we seek tissue types for corneal grafting. Often complex grafting is required, which makes the special identification of the right type of tissue through clinical work most important. The Bill will allow the more widespread collection of the right tissue types, relieving the pressure on those in advanced clinical work, resulting in providing the right tissue in the right place and supporting the technological developments in the eye banks.
It is important to recognise that at present ophthalmic surgeons must spend a geat deal of time collecting corneal tissues. Their clinical work has developed substantially, and the most important aspect of their work is probably the delicate issue of receiving consent. With today's legislation we can combine all three, and what is effectively the simple operation of collecting corneal tissue can now be handled by a larger number of people. For that reason, the legislation seems appropriate at this stage, especially with regard to the technical development of corneal tissue collecting.
When I studied the Bill and spoke to some eminent surgeons at St. Thomas's, I was sufficiently convinced that the process was not so highly technical that it would require the present legislation to remain unamended. It is a simple procedure. It has the advantage of taking place in an immuno-privileged site. That means that one can remove the eye and the relevant tissue and transplant it, without facing the problem of rejection, as is the problem 1166 with many other transplants. It also means that much more tissue typing can be undertaken after we have received more tissue. That is important for the development of the procedure. For those reasons, I warmly welcome the developments in the Bill.
One can describe the procedure simply to a layman as a nip in the covering of the eye, after which one hooks on to the muscles surrounding the eye, severs the nerve at the back and removes the eye. As the eye is such a sensitive part, that process may naturally worry people, especially compared with the removal of a finger nail or an operation on some less sensitive part of the body.
Nevertheless, I recognise that the importance of good supervision is essential. The Bill ensures that only those who are properly qualified, and under proper supervision, can remove the tissue. I am pleased that my hon. Friend the Member for Exeter (Mr. Hannam) gave due recognition to that when he drafted the Bill. It would have been easy to think that such a simple procedure could be extended more widely than he suggests.
I echo the congratulations offered to my hon. Friend the Member for Exeter. He was right to say that this has been an important week for health and social service issues. I was privileged to serve in Committee on the Disabled Persons (Services, Consultation and Representation) Bill introduced by the hon. Member for Monklands, West (Mr. Clarke), and passed in the House last week. I congratulate both the hon. Gentleman and my hon. Friend on following up that legislation so readily, as my hon. Friend lucidly explained to the House. I hope that my hon. Friend's Bill will succeed. It will undoubtedly receive the support of the medical profession. I hope that hon. Members on both sides will also support it.
§ Dr. John G. Blackburn (Dudley, West)
I support the Third Reading of this important legislation, and, in so doing, I must immediately pay triple tribute to my hon. Friend the Member for Exeter (Mr. Hannam). First, I congratulate him on his success in the ballot. It is perhaps even more remarkable that, having been drawn 19th, he now finds his Bill before the House. That is against all parliamentary odds.
Secondly, I congratulate my hon. Friend, as many others will, on his warmth, dedication and skill in selecting the subject of the Bill before us.
Thirdly, I congratulate my hon. Friend on the fact that, with the help of hon. Members on both sides of the House, he has skilfully steered the Bill through its Committee and Report stages. It reflects the greatest credit upon him and the constituency that he serves. He has a long, well-documented testimony of care for the disabled, with which I am glad to be associated.
This morning sees the House at its best. When one considers the events of the past week, it is a tribute to the House that, on Friday morning, we are discussing a Bill which is so important to those who suffer from blindness.
I was deeply humbled by the moving speech of my hon. Friend the Member for Kingswood (Mr. Hayward). The House will long remember his account of his illness. We wish him good health and godspeed in his service in the House.
Medical science has advanced greatly since the original Act, especially in the transplant of organs and tissues. There is a renal transplant unit in my constituency, and I am thrilled to be the patron of the friends of that unit.
1167 My introduction to blindness, no doubt like that of many hon. Members, was as a little boy sitting in Bible class and discovering, through the scriptures, how the Lord came down and made the blind see again. Close to where I worked in Liverpool, the first blind workshops in the world were established. From conversations with people in the medical profession, I know that there is a keen awareness of the benefits and blessings that can come from the transplant of tissues, especially from the eyes.
I welcome the Bill and give it my complete support. My concern for such matters was awakened remarkably some years ago when I heard the sad news of the death of Lady Churchill, the widow of Sir Winston Churchill, and was astonished to discover that within hours of her death her wish that her eye tissues be taken and used again was fulfilled. That brought home to me in a simple but dramatic way the blessings that can come from the transfer of tissue to those who suffer from ophthalmic diseases.
I am especially attracted to the need for speed in such transplants, and I wish to make a simple plea. This morning, I took the precaution of checking that my kidney donor card was with my credit cards and other effects. I commend for consideration the suggestion that such a card should include eye tissues—
§ Mr. Hanley
The new card issued by the DHSS contains the words:I request that after my death
I am grateful to my hon. Friend for giving me the opportunity to point out that multi-donor cards are now available. This might be the right time to apply for a new card or pick up a new card at one's library or citizens advice bureau.
- (a) my kidneys, eyes, heart, liver, pancreas be used for transplation; or
- (b) any part of my body be used for the treatment of others. (delete if not applicable)."
§ Dr. Blackburn
I am never too proud to accept a rebuke. Perhaps it is a reflection of my age that my card does not contain those words. However, I assure my hon. Friend that my card is not written on parchment.
This has been a wonderful debate and a momentous occasion. In conclusion, I pray that many people will look back on this day and say, "As a result of the House of Commons and the hon. Member for Exeter introducing this Bill, I can now see." I commend the Bill to the House and wish it godspeed.
§ Mr. Hanley
I have already spoken on the Bill this morning, but I hope that the House will allow me a further statement before it goes to the other place. I have been moved by the contributions of hon. Members, and it is important that we consider in the calm atmosphere of a Friday morning matters that will benefit people. That is what I have always believed to be the objective of Parliament, but I regret that often the reverse seems to be true.
This is a remarkable Bill which has been steered through Parliament by a remarkable Member. During the past three years, I have followed faithfully the legislation introduced and supported by my hon. Friend the Member 1168 for Exeter (Mr. Hannam), just as faithfully as he has followed me in the alphabetical list of Members, and almost as closely. Our objectives are similarly inseparable.
The Bill does not introduce a new concept. It merely takes us back to the position that obtained before 1961. In 1961, the Human Tissue Act tightened the restrictions on those who could remove organ tissue. It was vital for the trust that the public should have in those who removed organs and tissues that it was done by those who were properly qualified and that no one could deny the right to a medical practitioner.
Before 1961, the techniques were such that few organs could be removed and used for transplant. Indeed, corneal transplants were the only ones to achieve any notable success. But techniques developed later in the middle of the century and the possibility of kidney, liver and heart transplants meant that the legislation had to be tightened. The fact that corneas lost out because of that tightening of the legislation was wholly justifiable at the time. It is now clear that corneas should be exempted from the general rules that are still desirable for the removal of other organs, although kidneys may soon follow suit.
The object of the Bill is an increase in donation, which could be achieved by more publicity, the issue of donor cards and educational leaflets to schools, associations and colleges, by direct publicity in newspapers and by the public reading the stories of those whose lives have been enriched and recovered through receiving organs from donors. It could also be publicised through the experiences of the next of kin of those who have donated their organs, who can explain the enrichment that results from the realisation that a part of their deceased loved one is giving life or removing pain.
I dislike and have serious qualms about the personality cult which has recently followed some organ transplantations. If the personality cult can increase the flow of organs, so much the better, but I wonder whether it is right to subject the lives of the next of kin of those who have donated and received organs to the glare of often ghoulish publicity. I therefore ask that the sensitivity of the next of kin be remembered above all. We need publicity for the success of the transplantation programme, but ghoulish interest must be resisted at all costs. I hope that newspapers and television programmes, which have done so much good in encouraging transplantation, will remember the sensitivity that the area deserves.
I pay a further tribute to my hon. Friend the Member for Exeter. He was fortunate in his place in the ballot, but the subject that he has chosen has promoted him above the normal expectations of Parliament. That shows not only the wisdom of his choice but just how the House receives the things that my hon. Friend says and the causes he espouses. Because of his character and what he has stood for during his years in the House, the House immediately expects that his Bill will be for people's benefit and will receive general agreement. That feeling has accelerated the passage of the Bill through Parliament.
The Bill deserves a speedy passage. I am a sponsor of no fewer than three Bills that are to be debated today. I know that the promoters of the other Bills will understand me if I say that this is the most important of them all.
I therefore thank my hon. Friend, and I thank the Minister and his officials for their co-operation. This is a marvellous Bill; Parliament should be proud of itself and of my hon. Friend.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I will be brief, in order to facilitate the passage of the next Bill. I congratulate the hon. Member for Exeter (Mr. Hannam), and his sponsors on both sides of the House, on this measure, which is most welcome and appears to command support in every part of the House.
§ Mr. Whitney
I congratulate my hon. Friend the Member for Exeter (Mr. Hannam) on his success in the Ballot for Private Members' Bills, on choosing a Bill that will be of a great benefit to people who have lost or are in danger of losing their sight, and on piloting the Bill so successfully through the House in its early stages. I would like also to assure the House that the Bill in its present form has full Government support.
The Human Tissue Act 1961, which governs the removal of organs for transplant purposes, requires that organs be removed from cadavers only by registered medical practitioners. In the case of kidneys, hearts, livers and pancreases, that is a sensible and indeed a necessary precaution. But corneal tissue is different from other transplantable organs in two important respects. The first is that the removal of corneal tissue is a much simpler procedure and does not require the skills of an experienced surgeon, and the second is that corneal tissue does not deteriorate so quickly and can safely be removed from a body up to several hours after death.
The requirement that corneal tissue be removed only by registered medical practitioners is a serious constraint on the supply of suitable material that is urgently needed for corneal grafting. The requirement makes heavy demands on the valuable and limited time of ophthalmic surgeons, and in practical terms it means that it is very difficult for them to remove corneal tissue except from donors who happen to die inside hospitals that have ophthalmic surgery departments.
This constraint on the supply of tissue means that in most departments of ophthalmic surgery, corneal grafting is still an emergency procedure undertaken only as and when the right sort of tissue becomes available for a particular patient on the waiting list. This in turn often results in a wasteful use of hosptial beds and theatre time and makes yet further demands on surgeons and theatre nurses, and creates uncertainty for patients. If more corneal tissue were to become available, corneal grafting could become a scheduled procedure and much would be gained, and the purpose of the Corneal Tissue Bill is indeed to ease the constraints so that the increase in supply which we all seek can be achieved.
The number of people who die in circumstances where corneal donation is a practical possibility is far in excess of the number of people who die in circumstances which permit the donation of other organs such as kidneys, hearts, and livers. Corneal tissue suitable for grafting can be taken from people in older age groups whose other organs would not be suitable for transplantation, and the longer permissible period between death and tissue removal means that tissue can be taken from patients who die in hospital wards and even at home; the only patients who are suitable donors of other organs are those who die on respirators and whose functions are artificially maintained after brain death has been diagnosed. The hon. Member for East Kilbride (Dr. Miller), with his medical 1170 expertise, has made that point. The simplicity of the procedure of corneal removal also means that health service staff who are not qualified doctors can undertake it provided that they are properly trained. This Bill will permit them to do so.
Yet the removal of corneas from bodies is a procedure which must be undertaken properly and sensitively, so a number of safeguards are required. The safeguards need to be flexible enough to ensure that the procurement of corneal tissue is not unnecessarily constrained, and yet rigid enough to ensure that the procedure is competently performed with due regard to the safety of patients and the sensitivities of relatives. The Corneal Tissue Bill provides four safeguards which we beleive achieve exactly this.
The first safeguard is that the staff who perform the procedure will have to be acting under the instruction of a registered medical practitioner. This will allow a doctor to instruct them to go to a distant hospital or to a patient's home without his having to make the journey himself, but will not allow them to act on their own account. The doctor will be professionally accountable for the instructions that he gives, and he will know that he will have to answer for any instructions that are unprofessional or irresponsible.
The second safeguard is that the doctor will be required to satisfy himself that the people that he instructs are sufficiently qualified and trained to perform the procedure competently. For obvious reasons, there are at the moment no recognised qualifications or training courses for technicians or nurses in this field, and we think that the most appropriate safeguard for ensuring their competence is that responsibility should be laid upon the doctor. The medical profession is prepared to accept this. There will, of course, be opportunity for my Department's chief medical officer to issue guidance on the matter at some later date should he consider it to be necessary and appropriate. I should perhaps add that I was pleased to learn that the United Kingdom Corneal Transplant Service in Bristol is preparing a training course on the procurement of corneal tissue which could be run in the event of the Bill becoming law. I have every confidence in the UKCTS and its training course could make an important contribution in getting any new arrangements off the ground.
The third safeguard is that the people who will be permitted to remove corneal tissue must be employees of a health authority. In supporting this provision which was discussed earlier, the Government are attempting to achieve the same balance between ensuring that the procedures are properly controlled and allowing flexibility to ensure that there are no necessary constraints. As employees of health authorities, staff will be subject to whatever procedures health authorities consider necessary, and I am confident that health authorities will exercise those responsibilities wisely.
Private hospitals will not be prohibited by this provision from performing corneal grafts, and I would expect that in most instances they would enter into arrangements with health authorities or with the UKCTS for the supply of corneal tissue. If they wanted to make their own arrangements for the procurement of corneal tissue, the tissue would either have to be removed by registered medical practitioners as now, or they would need to enter into some agreement with a health authority over the use of health authority staff. I do not see this provision as presenting an unreasonable constraint on private hospitals, 1171 and it will of course ensure that the procurement of corneal tissue does not become an entrepreneurial activity undertaken outside health authority control.
The fourth and final safeguard is that certification of death will remain a prerogative of the medical profession. It would to totally wrong for corneal tissue to be removed before death had been certified by a doctor, but the doctor who certifies death will not under this provision necessarily have to be the same doctor as the one who gives the instructions for the tissue to be removed.
So I commend the Corneal Tissue Bill to the House. Corneal grafting is a procedure that can safeguard or restore peoples' sight, but it is a procedure that can only be carried out if there is an adequate supply of corneal tissue. I am told that new techniques are being developed—we have heard about some of them today—which will enable corneal tissue to be successfully stored for considerable periods of time. It is not too fanciful to imagine that before long an ophthalmic surgeon will select the right sort of tissue for each patient from the shelves of a well-stocked eye bank. But this will not be able to happen unless the eye bank is well stocked, and this will require an increase in the supply of corneal tissue, which in turn will require that the present constraints be eased. So patients will benefit greatly from the Bill. The National Health Service as a whole will benefit as demands on staff time are reduced and resources are allocated more efficiently. As I have said, the safeguards that are included in the Bill are sufficient to enable these new procedures to be introduced safely and sensitively.
After a traumatic week, the Bill reveals the House of Commons at its best and is an example of the best use of our procedures. For that we must thank my hon. Friend the Member for Exeter. I congratulate my hon. Friend and assure the House that the Bill has the Government's unqualified support.
§ Question put and agreed to.
§ Bill accordingly read the Third time, and passed.