HL Deb 29 October 1992 vol 539 cc1204-6

3.5 p.m.

Lord Jenkin of Roding asked Her Majesty's Government:

Whether they will introduce legislation to improve the organ donor scheme by making it possible to use the organs of those who have died unless they have specifically opted out.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

No, my Lords. At this time the Government believe that organ donation should be based on a positive choice made by individuals or their surviving relatives rather than on a presumed right.

Lord Jenkin of Roding

My Lords, is my noble friend aware that the organ donor scheme, which was introduced by my noble friend Lord Joseph over 20 years ago, still entails fewer than 14 per cent. of people carrying cards? Is she further aware that, notwithstanding that, surveys over a number of years have shown that more than three-quarters of the population would be prepared to donate their organs after death to allow someone else to live? Does she feel that it is now time to begin to look at rather more adventurous ways of trying to increase the supply of donated organs so that more people can be treated more quickly and not have to wait—as some have to do for months—until a suitable organ becomes available?

Baroness Cumberlege

My Lords, the only problem is with kidney donors. At the moment there are 4,000 people waiting for kidney transplants but no one waiting for heart or liver transplants. The organ donor scheme has been very successful. There were twice as many kidney transplants in 1990 as there were in 1980. But the Government have an open mind in as much as if we were convinced that an opt-out policy would increase the number of organs available, and if we had the majority of the public and the medical profession behind us, we would certainly then consider a change.

Lord Ennals

My Lords, I am grateful to the Minister for saying that the Government have an open mind on this matter. I support the noble Lord, Lord Jenkin of Roding, in putting forward this proposal. With regard to kidney transplants, does the Minister agree that there are many hundreds of people waiting who cannot have an operation because an organ donor is not available at the right time? Secondly, does she recognise that recent surveys have shown that there is increasingly a movement toward public acceptance of the idea that if people have not opted out, it should be assumed that they agree? Does she agree that would avoid some very embarrassing and difficult presentations by the medical profession to patients or patients' families at a very difficult time for them?

Baroness Cumberlege

My Lords, one of the reasons why we are not able to meet all the demands for spare organs is because of the very successful impact that recent legislation has had on reducing accidents, including the seat belt, crash helmet and drink-driving laws. Were the general public to feel very strongly that they would rather have an opt-out scheme and if the medical profession supported that, then the Government would reconsider the matter. That is not the position at the moment.

Lord Skelmersdale

My Lords, is my noble friend aware that in Northern Ireland a donor consent form is an integral part of the driving licence? Does she feel that it is time that such a system were introduced on this side of the water?

Baroness Cumberlege

My Lords, I entirely agree with my noble friend. In fact we are discussing with the DVLC the possibility of including the donor card in the driving licence.

Viscount Tonypandy

My Lords, does the Minister agree that it would be better for there to be a greater campaign to encourage people to agree to donate organs? She said that the Government have an open mind. Is she considering taking organs, whether or not the family agree?

Baroness Cumberlege

My Lords, the medical profession is implacably opposed to that. It is felt that would jeopardise the trust which the public place in the profession. Even where people at present carry the donor card, the medical profession still consults with the family to check that the family is willing.

Lord Carter

My Lords, is the noble Baroness aware that some people involved in the transplant field believe that a system of presumed consent would result in a reduction in the supply of organs because more people would take the positive step of carrying a refusal card? I am sure that the Minister has heard that view expressed.

Baroness Cumberlege

My Lords, I believe that there is a great deal of support for that view.

Lord Mackay of Ardbrecknish

My Lords, in her last answer but one, my noble friend indicated that in the case of someone who already carries a donor card the medical profession asks permission of the families of accident victims, let us say, before removing donor organs. Is she aware that that often makes for great difficulties and that in many cases the medical staff are not prepared to make that request in those difficult circumstances? Will she not agree that against that background even encouraging more people to carry donor cards is unlikely greatly to increase the supply of organs, and that we ought to consider the proposal put forward by my noble friend Lord Jenkin?

Baroness Cumberlege

My Lords, the medical profession is in a very difficult position on this issue. We are anxious to help the profession as much as possible. Indeed, we have increased publicity. We are improving education and procedures for hospital staff; we are currently funding a survey into the reasons why so many relatives refuse permission to use organs; and we are introducing a computerised register of organ donors. I hope that that will go some way towards meeting the need.

Lord Stoddart of Swindon

My Lords, is the noble Baroness aware that her last two answers give me serious cause for concern? Does it not mean that if a person who has been in an accident or who dies suddenly has not opted out, his body could be cannibalised even before his relatives were aware that he was dead?

Baroness Cumberlege

My Lords, I cannot believe that members of the medical profession, who are so compassionate and sensitive, would allow that to happen.

Lord Renton

My Lords, is there a central register of those who have signed donor cards or in other ways expressed their willingness to donate their organs? If not, would that not be a solution to some of the problems that have been raised?

Baroness Cumberlege

My Lords, my noble friend is right. We are introducing a computerised register of organ donors.

Lord McColl of Dulwich

My Lords, does my noble friend not agree that every year there are probably only 250 potential donors whose relatives refuse donation? As transplantation surgeons will continue sensitively always to consult relatives and are never likely to ignore their wishes, does she agree that there will not be an increase in donors if such legislation were introduced?

Baroness Cumberlege

My Lords, my noble friend is right. When we looked at the position in other countries—principally Austria and France—where such legislation has been introduced, we found that although initially it proved to be successful, there was a considerable backlash later.

Lord Campbell of Alloway

My Lords, would not presumed consent present enormous difficulties for the medical profession?

Baroness Cumberlege

My Lords, yes. I agree with my noble friend.