§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chapman.]
2.30 pm§ Mr. Nigel Evans (Ribble Valley)I am grateful for the opportunity to raise this most important subject in this, the last debate of 1993. I do not believe that it could have been better timed. As people look forward to sharing Christmas with their families and to what 1994 has to offer, one group will be looking to the new year with hope but also with fear and trepidation. I refer to the 5,500 people awaiting organs for transplant operations. Unfortunately, approximately 1,300 will die next year because a suitable organ will not be found.
The Government have gone some way towards trying to find more donors for people waiting for operations—with the introduction of the donor card scheme in 1971, for example. But even with that scheme, approximately 40,000 people have died waiting for an organ since 1971. We can put that into perspective by comparing it with the 3,111 people who have been killed in Northern Ireland during the same period. We are talking about a needless waste of life—a tragedy being played out. I use the word "tragedy" purposely; it need not happen.
One reason why there is such a shortfall between organs needed and organs available is that the number of road deaths in this country has declined dramatically over the years, with the use of seat belts, air bags and motor cycle helmets. We now have some of the safest roads in the world. The House will appreciate that I am not complaining about that, merely referring to the reality. The most recent figures show that the United Kingdom had 81 road accident deaths per million people; Germany, 117 per million; France, 168 per million; and Spain, 172 per million. My concern today is to ensure that those people whose lives are cut short can lengthen and improve the quality of the lives of others.
The situation was brought home to me by the BBC 2 "40 Minutes" programme entitled "Will they ring tonight?" No one who witnessed the brave struggle facing thousands of families in this country daily and hourly as they wait for the telephone to ring—to be told that an organ has become available and that their life chance has arrived —can have failed to be moved. I have nothing but admiration for the families who miraculously discover the inner strength to cope with the pressure that is put on them. Stress and uncertainty greet their every waking hour. We must also not forget the stress experienced by doctors and nurses, as they see their patients fading away.
We have an opportunity to ease those people's pain. We have at our disposal the ability to give them a better chance of life. We cannot stand by. We do not have the moral choice to turn our backs on these people: we have to act.
I pay tribute to the amazing skills of our surgeons, doctors and nurses, who help to perform these miraculous operations. In 1992, 1,614 kidney transplants, 301 heart transplants, 53 heart and lung transplants, 89 lung transplants and 501 liver transplants were performed.
John Wallwork—whose father lives in my constituency —performed the first heart and lung transplant in the country. He works at that great centre of excellence, Papworth. He and others like him are testament to the high 1470 level of service and care available in hospitals in Britain today. It is thanks to their ability and dedication that the success rate of transplants is so high.
Notwithstanding that success rate, the number of people waiting for transplants, as at 30 March 1993, is almost 4,500 for kidneys, 270 for hearts, 231 for lungs and hearts, 124 for lungs and 109 for liver transplants.
The public's goodwill towards donating organs is evidenced by the number of people who have filled out an organ donor card—approximately 18 million people—but, unlike the American Express card, unfortunately not everyone never leaves home without it. In too many cases, the card is not available when needed.
The Government's commitment to the scheme is unquestioned. I applaud the campaign that took place earlier this year, on which the Government spent more than£1.5 million, to raise the profile of the donor card scheme, but we must harness the technology currently available to bring the organ donor scheme into the 21st century.
When I first considered how a scheme that matched organs to patients could be devised, I thought of using a normal credit card on which there would be stamped a heart symbol, so that in an emergency or accident doctors would know that the card holder wished his or her organs to be donated. Then I thought about why we needed a card. We use computers to store data on virtually every subject; why not use a computer to register organ donors?
The driver and vehicle licensing centre in Swansea has a computer that registers 35.5 million car licence holders; perhaps that computer would be appropriate for the scheme. The national insurance computer has an enormous capability; perhaps that could be utilised. The technology —into which hospitals could tap to find out what organs are available and match them to waiting patients—is available.
My hon. Friend the Under-Secretary will know of the scheme that is operating in Wales called "Lifeline Wales". That scheme was launched by the Princess of Wales in 1986 and currently has 300,000 entries on its computer. The information on its computer is made available to intensive care units and neuro units in Wales. The computer can store up to 6 million entries, so even that scheme has a long way to go.
For any scheme to be a success, it must be sold well and the advantages of registeration to the nation spelled out. The donor message should be targeted towards certain groups, particularly young people. That could be achieved by advertising in magazines that are read by young people, or by advertising on television or by being featured in television programmes that are watched by them. Radio 1 recently ran a campaign to raise the profile of the problem of homeless people, which I heard on the Lynn Parsons show. It was so successful that it had to be extended so that more people could participate. The organ donor scheme could be equally successful if we target it carefully.
The two ten-minute Bills that were introduced this year promoting the opt-out scheme—under which it is assumed that people wish their organs to be used after their death unless they say otherwise—are evidence of the importance of the subject. Similar schemes are operated in Belgium, France and Austria. I oppose that measure: an assumption that inaction means consent is not good enough—we have to persuade people to come with us, not hope that the mass of people will slip into the system because they had not noticed that it was there. It would also lead to confusion for 1471 relatives—particularly if they are to be consulted about the scheme—and further pressure would then be put on doctors to negotiate with them.
Mr. Robert Johnson, a doctor working at Manchester royal infirmary, told me yesterday that he believed that doctors should be trained far more in the skills of coping with bereaved relatives when seeking their permission to use organs. He had recently attended the European donor hospital education programme in France; he said that he had learnt more in two days than in his entire previous working life. I believe that, if we can ensure that far more of our doctors are given an opportunity to take part in such schemes, we may be able to reduce the number of instances in which people are so shell shocked by the sudden death of a relative that they refuse to allow that relative's organs to be transplanted, although he had filled in the donor card.
Mr. Johnson also said that we must ensure that intensive care beds are made available and manned, giving a better chance to those who are critically ill, and also ensuring that those people's organs are in perfect condition should they die.
I cite two cases of brave young people who chose to donate the gift of life. One was a 10-year old called Paula. Last year, after being informed that she had a brain tumour, she told her mother that she wanted to donate her organs so that others could benefit. An eight-month-old baby girl received her liver; her heart went to a 57-year-old man; two teenagers received her kidneys; and her corneas went to two other people.
The other case is that of Peter Cox, who died four years ago aged 24. I pay tribute to his family, who have helped me with my campaign—his sister Christine, and his father John. Christine recently wrote this about her brother:
My brother Peter was born in Wolverhampton on 21st September 1965. He was educated at Malvern Boys College and graduated in Civil Engineering from Nottingham University. Pete was a keen Wolves supporter and enjoyed running the London Marathon in under 4 hours one year, an accomplishment I was unable to equal!Pete was 23 when he was found to have an inoperable brain tumour. It was particularly hard to understand since he had been healthy, brilliant, good and kind with a terrific sense of humour. Moreover, he was totally unselfish and always thought of others before himself.He was certainly one in a billion. Throughout his illness Pete remained brave and positive without complaining once about the difficulties and the pain he was experiencing. When the Specialist told us that the fight was lost and medication should be stopped, it was Peter who told us that he wanted to die as long as others could benefit from his organs. To our knowledge, possibly 17 people did and with his ultimate gift he saved lives and improved the quality of life for not only the recipients but their families as well.Peter died aged 24 on 12th November 1989.One of the recipients wrote to Christine Cox afterwards.
He said:
I have been in limbo for 6 years and now thanks to your nurses on the unit, I can start my life.The quantity of life is obviously important, but the quality of life makes the quantity worth while.I remind the Minister that Christmas—which is only a few days away—is a time for giving as well as receiving. Today, he has the opportunity to play Father Christmas to thousands of people by helping those who are able to give to do so, and allowing those in need to receive. I hope that he will take that opportunity. I believe that there is nothing in the world more precious than the gift of life; I plead with the Minister to give these people some good news this Christmas.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)I thank my hon. Friend the Member for Ribble Valley (Mr. Evans) for the moving way in which he presented his case. I am very pleased that for the last topic for 1993 he has chosen the subject of organ donation.
We can be justly proud of the way in which the organ transplantation programme has developed in this country. This debate is about courage and life—the courage of relatives who say yes and the life that is saved or enhanced by our willingness to sign and hold a small card.
Advances in medicine have enabled the doubling of kidney transplants in the past 15 years from 849 in 1978 to 1,640 last year. There are now in the United Kingdom more than 11,500 people with functioning grafted kidneys —more than in any other country in Europe. There were just three heart transplants in 1979; last year there were 325. The liver transplant programme did not start until 1982. In that year, there were 21 liver transplants; last year, there were 506. We owe an enormous debt of gratitude to the dedicated doctors, scientists, nurses and all others who helped to pioneer, develop and carry forward the transplantation programme. However, we should never forget that all those operations required donors—all volunteers or people who had died and whose relatives wished their organs to be used in that way. They, too, deserve to be remembered with deep gratitude.
It is perhaps ironic that advances in medicine similar to those that have enabled more transplants have contributed to the growing waiting list. In each of the past few years, there have been some 2,500 transplants of solid organs —kidneys, hearts, livers and lungs—but there are currently about 5,500 people awaiting such organs, of whom about 4,500 are awaiting kidneys.
The situation has arisen because advances in medicine have enabled many people to live who would previously have died. For example, more people than ever are receiving renal dialysis—more than 21,000 in 1991, an advance of 200 per cent. on 1978. However, the majority of dialysis patients would, I am sure, prefer to have a transplant. Many of them find dialysis unpleasant as well as inconvenient. If they were able to receive transplants, most of them would be able to lead fuller and much more independent lives. Anyone who attended the British Transplant Games in Newcastle this summer would have been tremendously impressed by the participants' ability not only to perform strenuous sports but to achieve such high standards.
For people awaiting hearts, livers and lungs, of course, there is at present no alternative. Without new organs, they will surely die. The remedy is to increase the supply of donor organs and the Government would dearly like that to happen. There is no shortage of funds or expertise for transplants; there is a shortage of donor organs. As my hon. Friend said, that shortage is in part due to the fact that the potential pool of suitable organs is limited. Generally speaking, organs are suitable only if they have come from people who have suffered sudden brain damage from a stroke, road accident or something similar. Organs must also be free of disease or other damage to be suitable for transplantation. That means that the maximum potential yield of suitable organs is only a few thousand a year.
Another problem is that the pool is shrinking. About a quarter of current donors are the victims of road accidents. 1473 As my hon. Friend said, deaths from road accidents in the United Kingdom have, happily, been falling for many years; they have gone down from 5,554 in 1989 to 4,379 in 1992—a reduction of more than 20 per cent. That is welcome news, but it presents problems for organ transplantation. Deaths from other conditions that can result in organ donation are also going down—brain haemorrhages, for example. We are, therefore, faced with the prospect of fewer transplants unless the number of people prepared to be donors can be increased.
An important principle of organ donation, to which the Government have always subscribed, is that donation should be a matter of choice by the individual or his immediate family and that it should be a positive, altruistic gift. That was also recognised by the working group set up by the Government under the chairmanship of Sir Raymond Hoffenberg, a past president of the Royal College of Physicians, to consider ways of increasing the supply of donor organs. In its 1987 report, the working party made a number of recommendations. They included regional health authorities having plans and written guidance on organ donation and the identification of donors, education and publicity initiatives, education for medical and nursing professionals, a reimbursement scheme for donor hospitals, multi-organ retrieval teams and a donor declaration on driving licences. I am pleased to say that all those recommendations have now been implemented.
As I have said, one of the Hoffenberg recommendations was about publicity. Last year, we were able to increase the Department of Health's budget for organ donation publicity to £350,000. That has been used for a variety of purposes, including providing publicity material to charities, funding the Freefone advice line, research, exhibitions and displays, and publicity for ethnic minorities. In addition, the Department of Health funded the prime time television campaign last March. Given that the pool of potential donors is shrinking, it is vital to maintain publicity and, if possible, to increase the numbers.
At this point, I pay tribute to the many voluntary organisations that do so much valuable work to publicise organ donation. The Government must and will play their part, but not nearly so much could be achieved without the help of the voluntary organisations.
One of the main ways in which people can indicate their wish to be donors is by means of the donor card. People sometimes claim that the donor card scheme is not effective, or there would be more transplants. I disagree. Research has shown that the card is well known and popular. It is excellent publicity and good value for money and there can be no doubt that it has made a major contribution to the cause of transplants over the years. However, research has also shown that although about 70 per cent. of adults claim to favour the scheme, only about 25 per cent. claim to carry the card at all times. That underlines the point that my hon. Friend made. I suspect that the true figure is probably somewhat less.
That can cause hospitals considerable problems. It is, of course, possible to find out whether a person wished to be a donor even without a donor card, but the presence of a card makes life a lot easier for hospitals. That is why the department's publicity states:
carry your card at all times1474 —but unfortunately, many still do not.In that connection, as my hon. Friend has pointed out, a computerised register of organ donors would be a help. That would enable hospitals to ascertain quickly whether a person is a donor. We are considering carefully options for such a register and we will consider the ideas that my hon. Friend has put forward today. We hope to make a decision early in 1994. I am not sure whether Father Christmas is allowed to arrive after Christmas as well as on the eve, but if my hon. Friend will allow him that latitude I am sure that he will see what he can do.
Whether or not a patient has a donor card, doctors invariably establish with his or her next of kin that they are content for the organs to be donated and will not proceed if the relatives object. That is common practice even in countries that operate opt-out schemes, where the presumption is that one is willing to donate one's organs unless one specifically expresses a wish not to. The reason for that practice, which in the United Kingdom and many other countries is not a legal requirement, is that certain people have strong religious or other beliefs in the integrity of the human body after death and we respect those views. Doctors also fear that families could be profoundly shocked if they discovered that their loved one's organs had been removed without their consent. The whole organ donation programme could be damaged if such a thing were to happen.
I am informed that refusal is virtually unknown if the relatives know that the deceased wished to donate. The problem is that relatives often do not know and it is hardly surprising that in their state of grief some of them refuse. In fact, refusal by relatives who do not know is the biggest single reason why suitable organs are lost to the transplant programme. About 30 per cent. of families who are asked refuse in that way. That is a loss we can ill afford. My Department is therefore funding a study into the reasons why relatives refuse. The study is expected to be completed by July of next year.
A number of people have called for a presumed consent or "opting out" system under which anyone's organs could be taken unless they had registered their objection. However, there is no consensus support in the medical profession or in the public generally for a system which would make retrieval of organs a presumed right on the part of the state. The evidence from countries where it is used seems to be that, after an initial increase, supply drops off as a result of people opting out—perhaps as a result of the publicity surrounding the introduction of such a scheme. It is also probable that even if such a scheme were introduced, doctors would still continue to consult relatives.
Another suggestion has been the "required request" which has been introduced in some states of the United States of America. That legislation requires doctors to ask relatives in every case if they may remove organs. Results so far are not encouraging and enforcement has been a problem. Doctors may judge that in some cases it would be inadvisable to approach relatives and we must respect that judgment.
In response to a point made by my hon. Friend, may I say that my Department is funding a pilot project in teaching doctors and nurses about techniques of approaching relatives. I hope that that will play a big part in enabling doctors to reassure relatives and to encourage the 30 per cent., to whom I referred, to be more willing to give their consent.
1475 The standard of British transplantation services is second to none in the world, not least because those services have developed cautiously and responsibly. Survival following transplant is now 10 years in 85 per cent. of cases and the improvement in quality of life is enormous. Great progress has been made in the short period since transplantation began. I am sure that the House will want to join me in paying tribute to the dedication and skill of all those who have played a part in this story of success and to thank all those who, by their extraordinary generosity, have donated their organs to help others.
Madam Speaker, as I wish you, my hon. Friends, all hon. Members, Officers and staff of the House the very 1476 warmest of good wishes for Christmas and the coming year, there is one present that I hope everyone in the House and beyond it will consider: please give blood for Christmas. We need 10,000 donations every day. In every sense, such a donation, with the carrying of a donor card, really would be a present for life.
§ Madam SpeakerMay I reciprocate by placing on record my good wishes for a merry Christmas to all hon. Members, Officers and staff of this House and I wish them a very happy and, if I may say so, peaceful new year.
§ Question put and agreed to.
§ Adjourned accordingly at three minutes to Three o'clock.