Organ Transplants (Presumed Consent) (Hansard, 11 April 2000)

§ Dr. Nick Palmer (Broxtowe)

I beg to move, That leave be given to bring in a Bill to establish a national register of people who have not given their consent to transplant of their organs after death; to lay down procedures to be followed before an organ transplant takes place; and for connected purposes.

I apologise in advance for any incoherence. I have been struck by flu, and am thinking of applying for a brain transplant. However, I shall do my best.

The position is quite straightforward. At present, about 200 people die every year owing to the lack of organs suitable for transplant. Only 11 per cent. of the population have registered with the national organ donation scheme, but more than 70 per cent. have said in response to repeated surveys that they would have no objection to the transplant of their organs. In a great many cases, because people did not carry donor cards their organs go with them into the grave or, more frequently, are cremated. As a result, people who could have lived die. A number of cases have been reported in the media recently. I believe that that should concern us all, and that we should consider seriously whether it is in our power to improve the situation.

My Bill proposes that we establish a national register for those who object to the use of their organs for transplant. The existence of the register should be made known as widely as possible. One suggestion is that there should be a box on the electoral registration form. We should ensure that people know that they have such an option, which it is easy for them to take if they do object. About 3 per cent. of the population have signed up to a comparable scheme in Belgium.

The Bill would require a surgeon considering a transplant to take two steps. We would require him or her first to consult the national register of people who object to transplants, and secondly to consult the next of kin, if they are available, to find out whether they object either on behalf of the deceased—perhaps they know that the deceased did object, but had not got around to registering—or because they say that it would greatly distress them. If either condition obtained, the transplant would not take place; but if neither the deceased nor the relatives objected, it would be assumed that consent had been given, and the transplant could take place. The effect would be to cover the middle ground of people who are sympathetic to organ transplants, or have no particular view one way or the other—many people have not given it a thought—but have not obtained a donor card.

Some exemptions are necessary. First, I propose to exempt children on the ground that we cannot reasonably expect a five-year-old to take a decision of the magnitude of whether to go on to a national register. Secondly, for similar reasons, the Bill would exempt people with a long-term mental disability that makes it impossible for them to make a rational assessment of the situation. Thirdly, it would exempt non-residents. We cannot reasonably expect, say, a tourist to be aware of the register.

Beyond that, I am aware of one or two objections. In the Royal College of Nursing debate, where the proposal for informed consent was rejected by three to one, the significant factor seems to have been taking the decision out of the hands of relatives, or the effect on children. Neither would happen under the Bill.

200 A number of people feel that the Bill does not go far enough and that, if you or I, Madam Speaker, carry a donor card, our relatives should not be able to override our wishes. I believe that, in the interests of achieving a broad consensus, we should accept that relatives have the last word. The British Medical Association warmly supports the Bill in the belief that the number of relatives who will veto a transplant is very small, unless they are aware that the potential donor was opposed.

I have consulted a number of religious groups. The general tenor is that there is no religious objection on the ground that the soul is deemed to leave the body at the time of death. To quote the Board of Deputies of British Jews, it is an honour if the last act of the individual on earth is to save the life of someone else—it is not only an honour but a duty.

I ask the House to support the Bill. I am aware that it is not uncontroversial, but the purpose of ten-minute Bills is to give an opportunity to air issues that may not be entirely ripe for Government legislation. I hope that the House will allow the Bill to proceed to Second Reading, so that we can pursue the debate and prepare the ground for possible Government legislation in the next Session.

I see no reason to detain the House any longer.

§ Dr. Julian Lewis (New Forest, East)

The hon. Member for Broxtowe (Dr. Palmer) moved the Bill in a modest and moderate way. I shall try to reply very briefly in the same spirit. He has cleverly anticipated some of the main objections that might be raised to a shift from having to opt into a transplant scheme to having to opt out of one, principally those concerning children. We are all aware of the scandal involving the removal of children's organs for research purposes at places such as Alder Hey children's hospital in Liverpool, the subject of early-day motion 139 which is open for signatures and was tabled by the hon. Member for Birmingham, Sparkbrook and Small Heath (Mr. Godsiff). That case has perhaps brought to people's attention exactly what is involved when organs are taken from dead bodies.

I personally have no objection to the use of organs for transplanting. Indeed, I have held a donor card since I was old enough to do so. However, I am very concerned about the shift in emphasis from opting into a donor scheme to opting out of one.

The hon. Gentleman's argument might be stronger if we were still talking in the terms—primarily in relation to the physical carrying of a donor card—in which he almost exclusively presented his Bill. The fact is that very many people who would almost certainly have no objection to their organs being used will never get around to filling in a card or, if they do, will end up leaving it at home—as I myself have done on many occasions.

I should have more sympathy with the hon. Gentleman's view if it were the only way of securing a plentiful supply of organs for transplant, but it is not. We live in the age of the internet and of electronic communication. If it is as easy as he suggests for people to be advised of their right to opt out by ticking boxes on ballot papers, for example, why do we not first at least try to use those methods to ensure that more people opt in? There are numerous opportunities for people to be asked to opt into a scheme and to have their decision registered electronically, so that, over time, if someone really wishes 201 his or her organs to be used in that way, it could easily be arranged. They would have only to say yes once, and their consent would be placed on an internet site, electronically and permanently maintained up to date.

As I am sure that the hon. Gentleman would acknowledge—hence the concessions that he made in framing his Bill—this is not an open and shut case in which there are no arguments on one side, with all the arguments on the other. All that can be done to try to make it easy for people to register their willingness to have their organs used should be done before we fall back on the position of very last resort—that of moving to a scheme whereby consent is presumed.

Before I and many other people who have very great sympathy for what the hon. Gentleman is trying to achieve could give him our support, we would have to be convinced that ordinary people who wish their organs to be used have been contacted in a manner that makes it much easier than it is for them to register that fact. If in five years the hon. Gentleman can demonstrate that we have all been contacted and given numerous opportunities to register in a single simple action on an electronic database our willingness to have our organs used in that way, and if he can demonstrate that there has been very little uptake of that, I will listen to his proposals with more sympathy. However, to date, those modern methods have not been tried nearly hard enough. Until they are, I should feel bound to oppose his Bill.

Division No. 159]	[4.19 pm
AYES
Anderson, Donald (Swansea E)	Coaker, Vernon
Ashton, Joe	Colman, Tony
Ballard, Jackie	Connarty, Michael
Banks, Tony	Cotter, Brian
Barnes, Harry	Cummings, John
Barron, Kevin	Dalyell, Tam
Beard, Nigel	Darvill, Keith
Begg, Miss Anne	Davey, Edward (Kingston)
Best, Harold	Davidson, Ian
Borrow, David	Donohoe, Brian H
Bottomley, Peter (Worthing W)	Etherington, Bill
Brake, Tom	Flynn, Paul
Brand, Dr Peter	Follett, Barbara
Brinton, Mrs Helen	Forth, Rt Hon Eric
Bruce, Malcolm (Gordon)	Foster, Rt Hon Derek
Butler, Mrs Christine	Foster, Don (Bath)
Campbell, Ronnie (Blyth V)	Foster, Michael Jabez (Hastings)
Campbell-Savours, Dale	Fyfe, Maria
Chidgey, David	Gardiner, Barry
Clapham, Michael	George, Andrew (St Ives)
Clark, Rt Hon Dr David (S Shields)	Gerrard, Neil
Clarke, Rt Hon Kenneth (Rushcliffe)	Gibson, Dr Ian
	Gilroy, Mrs Linda
Clarke, Tony (Northampton S)	Griffiths, Jane (Reading E)
Clwyd, Ann	Harris, Dr Evan

Humble, Mrs Joan	Roy, Frank
Iddon, Dr Brian	Russell, Bob (Colchester)
Jones, Jon Owen (Cardiff C)	Savidge, Malcolm
Keeble, Ms Sally	Sheerman, Barry
Keen, Alan (Feltham & Heston)	Sheldon, Rt Hon Robert
Kennedy, Rt Hon Charles (Ross Skye & Inverness W)	Shipley, Ms Debra
	Simpson, Alan (Nottingham S)
Khabra, Piara S	Skinner, Dennis
Kidney, David	Smith, Llew (Blaenau Gwent)
King, Andy (Rugby & Kenilworth)	Soames, Nicholas
Kingham, Ms Tess	Squire, Ms Rachel
Ladyman, Dr Stephen	Steinberg, Gerry
Lloyd, Tony (Manchester C)	Stunell, Andrew
Llwyd, Elfyn	Swayne, Desmond
McAllion, John	Thomas, Simon (Ceredigion)
McDonagh, Siobhain	Tonge, Dr Jenny
McDonnell, John	Tredinnick, David
McFall, John	Turner, Dr Desmond (Kemptown)
MacKay, Rt Hon Andrew	Turner, Neil (Wigan)
Mackinlay, Andrew	Twigg, Stephen (Enfield)
MacShane, Denis	Tyler, Paul
McWalter, Tony	Vis, Dr Rudi
Mahon, Mrs Alice	White, Brian
Marsden, Gordon (Blackpool S)	Williams, Rt Hon Alan (Swansea W)
Maxton, John
Meale, Alan	Williams, Mrs Betty (Conwy)
Michie, Bill (Shef'ld Heeley)	Willis, Phil
Morgan, Ms Julie (Cardiff N)	Wood, Mike
Naysmith, Dr Doug	Woodward, Shaun
Oaten, Mark	Wright, Dr Tony (Cannock)
Pike, Peter L	Wyatt, Derek
Pollard, Kerry
Prentice, Gordon (Pendle)	Tellers for the Ayes:
Rapson, Syd	Dr. Nick Palmer and
Rendel, David	Ms Jenny Jones.

NOES
Amess, David	Öpik, Lembit
Beith, Rt Hon A J	Plaskitt, James
Bell, Martin (Tatton)	Robathan, Andrew
Bennett, Andrew F	Sanders, Adrian
Burnett, John	Smith, Sir Robert (W Ab'd'ns)
Campbell, Rt Hon Menzies (NE Fife)	Stinchcombe, Paul
	Townend, John
Crausby, David	Trend, Michael
Fallon, Michael	Waterson, Nigel
Heath, David (Somerton & Frome)	Wilshire, David
Livsey, Richard
McIntosh, Miss Anne	Tellers for the Noes:
Nicholls, Patrick	Mr. Edward Leigh and
O'Hara, Eddie	Dr. Julian Lewis.