Transplant Notification (Hansard, 3 February 1988)

§ Mr. Gwilym Jones (Cardiff, North)

I beg to move, That leave be given to bring in a Bill to require health authorities in England and Wales and health boards in Scotland to establish an effective system of identifying potential organ and tissue donors and for notifying the same to an approved organ and tissue procurement organisation; and for connected purposes. By this Bill, I seek to bring to the attention of the House a most important problem of health provision in Britain today. There are vital areas where demand is greatly increasing and where at least part of that increase is due to the very success of those areas. At the outset, it is appropriate to mention my gratitude for advice and support eagerly offered for bringing forward the Bill. As with so many parts of health provision, there are many admirable contributions from the professionals and equally from those who make considerable efforts in a voluntary capacity.

Various names readily occur—the Kidney Research Unit for Wales Foundation, the Welsh Kidney Patient Association, Professor Salaman of the university of Wales college of medicine. Mr. Ross Taylor of the Royal Victoria infirmary of Newcastle upon Tyne, and their colleagues and Miss Esther Rantzen and the "That's Life" television programme. All their contributions deserve tribute.

Few if any of us would say that we are completely satisfied with all that is being done. None the less, in being positive, it behoves us to say that tremendous advances have been made in the National Health Service. Treatments are now possible that not so long ago were but a dream for the highest levels of medical science, let alone being countenanced by the layman, particularly by the patients who would benefit. Not least has this been true of transplant surgery, and even now I doubt whether these advances are yet as widely appreciated as they deserve to be. Surgeons transplant corneas, kidneys, livers, pancreases, hearts, lungs, hearts and lungs together and heart valves, besides bone and skin tissue.

Nor is the scale of the operations readily known. Last year, there were three lung transplants, 65 heart and lung transplants, 247 heart transplants, 200 liver transplants, 1,159 cornea transplants and 1,566 kidney transplants. Imagine the change effected, the new life after a heart transplant, the change in quality of life with no more dialysis after a kidney transplant and the restoration of sight after a cornea transplant. Perhaps we cannot easily imagine these transformations until we have had that experience or closely known someone who has undergone transplant surgery, but clearly it must make a glorious difference.

The possibility of these transplants and the awareness of those possibilities inevitably provoke their own demand. Who would not wish to have the improved quality of life, in any of its different forms? Before, there were no waiting lists for treatments that were not available or did not exist. The total of more than 3,000 transplants carried out last year is, I am afraid, not sufficient. That pace will be unlikely to make a progressive reduction in the waiting lists. A continuing increase will have to be expected.

Let me refer to the situation for kidney patients. As I have said, in 1987 there were 1,566 kidney transplants. There are now 3,485 more people waiting for the same 1001 treatment, and this does not include any who have not registered, for whatever reason. Additionally, it can be assumed that new patients will be diagnosed as in need of dialysis. Estimates based on a rate of 50 per million project 2,500 more requiring dialysis each year and, in turn, 2,500 more each year for kidney transplants. Therefore, a repeat of last year's transplant operations would not reduce the waiting list by that number of 1,566. Instead, the number will grow from approximately 3,500 to approximately 4,500.

The same could well be true for the other types of transplant, particularly for heart and lung transplants, where the ratio of transplants performed to the respective waiting list is greater again than the ratio for kidney patients. Understandably, there is no one simple reason frustrating greater progress but, above all, it is frustrated by the shortage in the number of organs becoming available for transplant. This was brought out in the report of the DHSS working party. That report estimated that there are 4.000 brain deaths annually — a number sufficient to match the need for kidneys, the largest requirement, if only a higher proportion of those with brain death were to become donors.

The working party brought forward its recommendations providing a voluntary code of conduct for organ transplant identification. This reaffirms the criteria for brain stem deaths, defines when organs need to be removed and expects the senior doctor involved to seek permission for removal of the organs. These recommendations make no difference, in that the most important aspect—the identification of suitable organs—remains voluntary. The results show that the voluntary approach is not adequate, and there is no encouragement to think that it will yet succeed at the levels necessary.

I feel that the time has come to acknowledge the inadequacies of the concept of voluntary approach and to move to legislation. My Bill would put into effect the aims of the voluntary arrangements by making a requirement that the necessary questions about donations are asked —the vital questions that are not now being asked often enough. It does not interfere with any doctor's clinical freedom, but I suggest that it is the only way to achieve a significant increase in organ donation, ideally to a sufficiency to match the presently rising need.

I do not pretend that these are the easiest questions to ask, however much they need asking. They come at a time 1002 of great emotion and grief. The loss of the loved one means that this can never be easy for either relative or doctor. However, that is no different from the feelings that prevail now under the voluntary arrangements. At less emotional times, almost every one of us would agree that these gifts of life represent one of the finest gestures that can be made. Extending or improving the life of another can be a great source of comfort in bereavement: the knowledge that that greatest loss can yet result in a gift of inestimable value.

What, then, is likely to be achieved? The Bill does not take an untrodden path. Essentially similar legislation is in force in the majority of states of the United States of America. Let me take the example of one state, Arizona, where the period immediately after the legislation came into force showed a threefold to fivefold increase in the number of organs identified for transplant compared with the number for the corresponding period before the legislation came into force. In the adjoining state of Nevada, there was no increase during that period. Nevada has since intoduced a transplant notification law.

A simple projection can be made to show what a threefold increase in the organs available could do for rising waiting lists. The working party report identifies that there is the potential for that increase in organ identification. The number of transplant operations needs to increase significantly. The difference that can he made to the quality of life justifies the steps that I propose. Accordingly, I commend the Bill to the House.