RESTRICTION ON TRANSPLANTS BETWEEN PERSONS NOT GENETICALLY RELATED (Hansard, 6 July 1989)

§ Mr. Freeman
I beg to move amendment No. 3, in page 2, line 30, after 'children', insert 'of his brothers and sisters of the whole or half blood or'.

§ Madam Deputy Speaker
With this it will be convenient to discuss the following amendments: No. 1, in page 2, line 31, at end insert `and (e) his nephews and nieces of the whole or half blood.' No. 2, in page 2, line 44, at end insert— `(c) the person into whom the organ is to be transplanted is

(i) the spouse of, or

(ii) related by marriage within the degrees laid down by subsection (2) above to the person from whom the organ is removed.'.

§ Mr. Freeman
We accepted the principle of amendment No. 1 in Committee. It was not our intention to exclude nephews and nieces from the definition of genetic relations for the purposes of the Bill, and, as promised in Committee, we have tabled amendment No. 3, which will have the effect of including them in the definition.
Amendment No. 2 was also tabled in Committee but was withdrawn by the hon. Member for Peckham (Ms. Harman). I was given to understand that the hon. Lady accepted my argument on why the statutory exclusions from the prohibitions of clause 2 should not be extended. However, as the amendment has been tabled again, I shall repeat my reasons for urging hon. Members to resist it.
Amendment No. 2 seeks to extend exemptions to prohibitions under clause 2 far beyond what is intended. The Bill already excludes genetically related people from scrutiny by the authority. A reason for that is that the existence of a close genetic relationship can be verified with a high degree of accuracy by laboratory testing. In this country, the vast majority of live transplants would be covered by that exemption, as close family members are both more likely to come forward to offer themselves as donors and to prove compatible, in the medical sense.
Under the Bill, the existence of a genetic relationship would be verified in each case in an objective way by such testing. Appropriate tests may have already been carried out in the process of trying to establish the compatibility of the donor and would-be recipient. In the case of relatives "in law" or people not related at all to the would-be recipient, the existence of some kind of relationship or personal tie is more difficult to establish. Unfortunately, we cannot rule out the possibility of non-genetic "relationships" being formed solely for the purpose of the operation or of pressure—economic or otherwise—being brought to bear upon a donor to submit to a transplant operation.
For those reasons, it is intended that the authority will consider the available evidence in each case where no genetic relationship has been established, before giving an independent decision on whether an offer of donation is altruistic. However, the fact that the authority will 572 scrutinise all cases of live donation between non-related persons does not imply that unnecessary obstacles will be placed in the way of transplants between spouses or "in law" relations. I suggest that amendment No. 2 is contrary to the whole intention of clause 2. 1 urge the hon. Lady to reflect further and not to press it to a Division.

§ Ms. Harman
Long ago in the distant past, before I became a Member of Parliament, I wanted to be a parliamentary draftsman. Government amendment No. 3 has been introduced at this late stage because the Government become so confused by all the gobbledegook that they omit to say what they really mean. In this case, they omitted nephews and nieces from the definition because they were so busy referring to brothers and sisters of the whole or half blood. Helpfully, with my otherwise under-used parliamentary drafting skills—and certainly for free—I drafted amendment No. 1. But the Government prefer their gobbledegook, which is more complicated and will therefore provide more work for the lawyers. None the less, the definition has been restored, so I am grateful to the Minister for at least incorporating what would otherwise have been a significant omission.
The Minister reminds me that in Committee the intellectual brilliance of his arguments swayed me against my own amendment to include married people and people related by marriage. However, when it came to drafting my amendments, the force of his arguments escaped me. Now that he has made them again, I am happy to accept them, and I shall not press amendments Nos. 1 and 2.

§ Sir Michael McNair-Wilson
My hon. Friend the Minister referred to the authority in clause 2. He said that it is the body that will give consent to these various operations. Again, I am puzzled. Is he saying that the transplants that will take place have been notified to the authority referred to in new clause 6 and that they will be notified also to the authority referred in clause 2. so that two authorities work together? Are both authorities to keep a record of all these transplants? If not, one authority will be aware of all the transplants taking place within families and one will not. I cannot see how that is possible. Unless both authorities know what is going on, the authority that is meant to police the Bill cannot function. I should be grateful if my hon. Friend would clarify that point.
Mr. C. J. Rudge, consultant transplant surgeon, has said: I have considerable reservations about this second clause in the Bill. There are a number of situations in which the emotional relationship between a potential donor and recipient can be overwhelmingly in favour of allowing transplantation to proceed. I am thinking in particular of transplantation between husband and wife (or vice versa), between step-parents and their children"— they are not referred to anywhere in the Bill— and even between individuals related by marriage. I can see nothing morally or ethically wrong for transplants in any of these categories to be carried out, and I have considerable anxieties that they are all made illegal by this Bill. There is no doubt that the number of cadaver kidneys becoming available in this country does not meet, and is never likely to meet, the requirements for the number of patients awaiting transplantation. Within my NHS practice I am currently carrying out a number of emotionally related transplants—until now exclusively between husband and wife. I am very concerned that if these transplants are to be stopped then this would have a significantly detrimental effect on the dialysis and transplant programme within the NHS. 573 Mr. Rudge referred to step-parents, about which no hon. Member has spoken yet. Can my hon. Friend the Minister say anything about step-parents being included in the legislation?

§ Mr. Freeman
Under clause 2, an authority will be established under regulations. It will comprise perhaps 12 members, perhaps under a medical chairman. Its purpose is to permit, or not permit, transplants between those who are not genetically related. It is a screening mechanism prior to the transplant. It relates only to live transplants. I can give my hon. Friend the assurance that we are not making ethical pronouncements about what is or is not acceptable. In Committee, I said that I could well understand that proposed transplants between spouses, who were not therefore genetically related—or, to use my hon. Friend's example, stepchildren—would be perfectly in order. It is important that we do not send a message that, if the proposed transplants were altruistic and the tissues matched, the House or the authority would frown on them. I hope that that answers my hon. Friend's question.
New clause 6 deals with the reporting mechanism ex post facto of all live and cadaver organ transplants. It is a separate issue. The reporting mechanism provides information and permits monitoring or "policing", as my hon. Friend said, of the intent and purposes of the Bill. The two are totally separate. The authority under clause 2 is a group of individuals, perhaps under a medical chairman. Under new clause 6, we are talking about authorities as being regional and district health authorities that gather and collect the information on transplants that have taken place.