Organ Donation (Presumed Consent and Safeguards) (Hansard, 3 February 2004)

§ Siobhain McDonagh (Mitcham and Morden) (Lab)

I beg to move, That leave be given to bring in a Bill to provide for the removal of organs for transplantation purposes, after death has been confirmed in a person aged 16 or over, except where a potential donor previously registered an objection or where a close relative objects.

On average, one person dies every day in this country while waiting for an organ transplant. I come to the House this afternoon because of that stark sad fact. What is more, in the past 10 years, the number of people waiting for a transplant has increased by more than one third. During the same period, the number of organ transplant operations has decreased by 12 per cent.

Medical advances in our modern NHS have enabled very sick people to live longer while they are waiting for transplants. They have also ensured that more people who might in the past have died in accidents or from strokes now survive. Their organs are therefore no longer available for transplant. Therefore, there is a widening gap between the number of people waiting for transplants and the number of organs that become available.

I want us to reflect seriously today on how we can begin to narrow that gap and save hundreds of lives every year. First, I thank the BMA, the National Kidney Federation and doctors and patients at my local hospital, St. Helier, which has one of the south-east's leading renal units. They have persuaded me to take up this issue now. I also praise the efforts of other Members on both sides of the House who have led previous campaigns to extend organ donation, especially my hon. Friends the Members for Linlithgow (Mr. Dalyell), for Broxtowe (Dr. Palmer) and for West Bromwich, East (Mr. Watson), the right hon. and learned Member for Rushcliffe (Mr. Clarke) and the hon. Member for Oxford, West and Abingdon (Dr. Harris). I also thank those listeners to the Radio 4 "Today" programme who voted for presumed consent as the measure that they most wanted us to pass.

Surveys repeatedly show that between 70 and 90 per cent. of the population want to help someone else to live by donating their organs for transplant after their death. However, fewer than 20 per cent. formally join the NHS organ donor register or carry an organ donor card, and most families do not discuss their wishes about donation.

Unfortunately, the upshot is that at a time of bereavement, half of all relatives opt for the default position, which is not to donate, although studies show that many families later regret that decision. I do not criticise the families of deceased, who are undergoing a terrible ordeal. I hope that changing to a system of presumed consent will make the decision a little easier for them.

The decisions made have terrible consequences for the very ill patients in hospitals such as St. Helier who are desperate for a transplant. Without a transplant, they may have to spend years getting treatment such as dialysis at great cost to the NHS, and are often unable to carry out normal everyday activities or have a good 645 quality of life. It is estimated that for the average patient, compared with dialysis, a kidney transplant saves £191,000 over nine years, which is the median graft survival time. A patient who has had a transplant is far more likely to be able to contribute fully to society: to have a full life, to work, and, indeed, to pay taxes.

My constituency is in the London borough of Merton. Recently, Merton's head of special needs education, Trevor Cook, had to leave work because he was too ill to continue. The people of Merton have lost a highly experienced and respected man who has contributed enormously to local public services, simply because he cannot get a transplant. Obviously, there are many other Trevor Cooks throughout the country.

As long ago as 1994, the King's Fund carried out a major survey of potential solutions to the transplant shortfall. It concluded that an initiative which increases the supply of organs will, ipso facto, have one very important ethical argument in its favour: the potential to avoid death and relieve suffering. The Bill aims to defend the wishes of the deceased and deal with the gap between people's wishes and donation rates. It will reflect the fact that a majority support transplants, and allow doctors to presume that the deceased have consented for their organs to be used for transplants. Since consenting is more likely than not consenting, that should become the default position.

As things stand, we presume that the deceased have not given consent, even though the chances are that that is against their wishes. However, the Bill includes several safeguards. It will be easy for people to opt out. It would be fair to say that anyone who had not opted out had made an informed decision not to do so. The Bill applies only to transplants, not to organ retention, and the families of the deceased can opt out. The proposals will not apply to children.

Presumed consent is neither a new idea nor simply a theory. It already operates elsewhere in the world. In Belgium, some interesting research has compared Antwerp with Leuven, two areas that are otherwise similar. Antwerp did not introduce the new presumed consent system, and its donation rates remained the same. However, Leuven adopted the new law and in three years its rates rose from 15 to 40 donors a year.

Let us consider the slightly more complicated story of Spain, which currently has the highest rate of organ donation in the world. Although it has a presumed consent law, the Spanish transplant organisation always seeks the consent of those closest to the donor. I propose that practice. Spain has the mindset that consent is presumed but that the relatives can overrule. That is more likely to get a positive and accurate outcome than is currently obtained in the UK.

Some, like Dr. Rafael Matesanz, believe that Spain's law on presumed consent is not the cause of increasing donation rates. However, since the change in the law, the number of families who withdraw consent has fallen to about one in five, compared with approximately half in the United Kingdom. I believe that a soft form of presumed consent has helped to change the mindset in Spain and improved attitudes to organ donation. The best comparative evidence from abroad clearly shows that presumed consent works.

646 Gimble et al have conducted the most thorough analysis of organ, donation. They considered all the factors that contribute to increased donation rates, including religion, culture, education and other social pressures. Their conclusions were that presumed consent laws had a significant effect on the number of cadaveric donors per million population. As the gap between supply and demand for transplant organs continues to widen, professionals and policymakers should consider revisiting the implications of this legislation, or some hybrid of alternatives, as an effort to expand the 'gift of life' to those in need. That is the crux of the matter: to expand the gift of life to those in need.

I hope that I will be allowed to take this brief opportunity to urge all hon. Members, and anyone following the debate—in the Galleries, in Hansard or in the media—to sign up to the NHS organ donor register. It is possible to do that by visiting website www.uktransplant.org.uk or by calling 0845 60 60 400. Until presumed consent is in place, that remains the best way in which to help someone else to live after one's death.

In the long term. I believe that the best means of increasing the number of lives saved by organ donation, respecting the wishes of the deceased and being kinder to grieving relatives is to presume consent unless someone has opted out. I hope that the Bill will persuade more people to consider organ transplants seriously and to discuss it with their families. For the sake of thousands of people who are awaiting transplants in my constituency of Mitcham and Morden and throughout the country, I commend the Bill to the House.

§ Mr. David Wilshire (Spelthorne)(Con)

I oppose the Bill, not because I am against its objectives but because I disagree with its methods. Before I explain the reasons, I stress that I am not speaking as an official spokesman. We are considering an intensely personal, free-vote issue for all of us.

My views were formed following the death of my 12-year-old daughter 22 years ago. I explained the painful details in the debate on Second Reading of the Human Tissue Bill on 15 January, so I hope that hon. Members will forgive me if I do not repeat them today. However, I cannot avoid referring to them because the Bill would draw a distinction between a child and an adult. I do not believe that that distinction is valid. Surely a 17-year-old or a 25-year-old child is as precious to its parents as a 12-year-old. Many people of 30-something are just as precious to their spouses or children. I do not understand the distinction.

I have no objection in principle to the removal of parts of a dead body. I have carried an organ donor card all my adult life. However, I have serious anxieties about presumed consent. I readily accept that there are some powerful arguments for presumed consent, principally the shortage of donor organs and the many opportunities to help even more people who need a transplant. They are worthy objectives, which I hope that we all support.

However, I doubt whether presumed consent would solve the problems that its supporters claim it would. There are other, better ways in which to achieve the 647 Bill's objectives. In addition, there are understandable fears about abuse and the potentially distressing impact of presumed consent on bereaved relatives. In the circumstances I found myself in 22 years ago, had presumed consent been in operation, a doctor would have got on and done what he judged was needed, or would have had to check that I had no objections. Had I discovered later that although I was in the hospital, no one had taken the trouble to consult me, I would have been outraged. Had I been invited to object, rather than asked to agree, I would probably haw, been made to feel guilty for the rest of my life had I decided to refuse. When struggling to cope with the death of a loved one, of whatever age, the last thing a person needs is avoidable additional grief. In my mind, something that has the capacity to cause outrage and guilt, and add those to the hell that that person is going through, simply has to be wrong.

That said, I well understand that doctors are busy people, and one might ask why I want to put obstacles in their way. Asking permission from a bereaved family will never be easy, so why make clinicians do something difficult and unpleasant? My answer is this: if ever there is a situation in which the needs and wishes of patients and their families must come first, this is it. On such occasions, clinical convenience is a very secondary issue. Even so, presumed consent would not spare doctors the dreadfully difficult task of raising the issue of organ donation with bereaved families. Asking, "Do you wish to object?" is no easier than asking "Please may I do this?" but the latter is far kinder and gentler.

As I said at the outset, I believe that there are better ways of achieving the highly desirable outcome for which the hon. Member for Mitcham and Morden (Siobhain McDonagh) has spoken. My preferred way would be required request, and I shall give the House a few examples of what I have in mind. We could train, then require, general practitioners to raise the issue with 648 their patients, especially when registering new patients, and record all agreement on a central database. We could help, then require, hospital managers to add some sort of question to hospital admission forms. We could train, then require, hospital doctors, especially those who specialise in accident and emergency, to raise the subject gently with the bereaved.

I am as keen on the objectives underpinning the Bill as its sponsors are. In opposing them, I mean no criticism of either the objectives or the sponsors. The last thing I want is to be divisive. Happily, all these issues, and more, are currently being fully considered by the Standing Committee handling the Human Tissue Bill. I understand that there will also be a very full debate during that Bill's Report stage. That is the time for all those who want to speak on and wrestle with these intensely personal issues to do so. That is the time to have a full and free vote on the best way of achieving the objectives. That is why I have no wish to divide the House this afternoon.