§ Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Sutcliffe.]
§ 10 am
§ Mr. Geoffrey Clifton-Brown (Cotswold)
I am grateful for this opportunity to participate in a debate on the removal, donation and transplantation of human organs.
The debate follows in the wake of the tragic Alder Hey case in Bristol, in which children's organs were removed, allegedly without their relatives' consent. I should make it perfectly clear at the outset that I do not believe that anybody could condone such behaviour. Whatever the status of the law—whether it remains as it is or is changed—I do not believe that anybody would wish to remove organs from any deceased person if the relatives concerned did not wish that to happen.
§ Mr. Clifton-Brown
I should like to make a little progress and at least introduce the subject before I give way to the hon. Gentleman.
The debate follows a previous debate in the House so excellently opened by the hon. Member for Oxford, West and Abingdon (Dr. Harris). I am delighted to see him in his place today, because few hon. Members know more about the subject than he does. Indeed, before the debate in the House, he proposed a debate at the British Medical Association conference, as a result of which the BMA adopted, for the first time, a policy of calling on the Government to change the general presumption in favour of opting into a system of organ donation.
§ Mr. Dalyell
Before telling us that we should not condone something, can the hon. Gentleman tell us whether he has talked to the doctors at Alder Hey so as to hear their side of the story?
§ Mr. Clifton-Brown
I have had correspondence with them, but I have not discussed the matter with them personally. However, it must be a general presumption that, where the relatives do not wish organs to be donated, those wishes should be respected at what is a time of great sadness and grieving.
The debate is set against a worldwide background of a shortage of cadaveric organ donors, and waiting lists are lengthening all over the world. They currently stand at some 60,000 in the United States, 13,000 in Europe and 6,000 in the United Kingdom. More tragically still, there are more than 4,000 kidney dialysis patients, 1,000 of whom are under 30, whose quality of life—indeed, life expectancy—could be transformed by a transplant operation. I have to say that most will remain disappointed.
2WH The challenge is to ensure that everyone in society is given the opportunity to think constructively and sensitively about whether they would like to donate their organs in the event of their untimely death, while ensuring that their relatives and dependents are fully aware of their views. Given the enormous benefit that recipients gain, it is surprising that only 26 per cent. of adults in this country have obtained a donor card, and that only 18 per cent admit to carrying one. Yet surveys have shown that, when people are asked about organ donations, 70 per cent. of the population would be willing to donate. Death is something that many of us find hard to contemplate. The removal of our organs after death, at a time when our relatives are grieving, is even more difficult to contemplate.
It is worth recapitulating how the present system operates and the legal framework under which it does so. The Human Tissue Act 1961 stipulates the two circumstances in which organs may be removed—where there has been a specific request to that effect by the deceased person or, in the absence of such a request, if there is no reason to believe that the deceased expressed an objection and the relatives also do not object. That was the point that I was making in my opening remarks when the hon. Member for Linlithgow (Mr. Dalyell) intervened. In other words, the deceased, or his or her relatives, must positively state that they wish to have the organs removed.
There is a legal argument, which will need to be tested in the courts at some stage, as to who is legally in possession of the body. It is usually presumed to be the hospital until the body is claimed by those with a greater claim—namely, the relatives. The problem then arises as to which relatives take precedence in that respect. Irrespective of the law, it would be unacceptable to remove organs unless the relatives were all agreed on that.
In some European countries the presumption is reversed, so that those who positively object will not be considered eligible for organ donation. The Government—including the Minister of State, who is here today—have ruled out that change in presumption on the basis that countries that have it, such as Italy, do not have a higher donation rate. However, I suspect that in the case of Italy that is for other reasons—for example, poor procedure and lack of public awareness. On this occasion, I agree—unusually—with the Deputy Prime Minister, who recently, during Prime Minister's questions, said:Ministers have continually said that we shall consider all suggestions for improving transplant rates, but any proposed measures in that sensitive area will have to command public confidence and support."—[Official Report, 30 June 1999; Vol. 334, c. 343.]That is something around which all hon. Members could unite.
On a positive note, what could be done to improve the present system under the current legislation? The donor card system was introduced in 1971. It is purely voluntary, and my hon. Friend the Member for Woodspring (Dr. Fox), who will speak in the debate, has some excellent proposals for publicising that. To put it rather brutally, the butchers' offal approach of the tick as to which organs one wishes to donate—eyes, heart, lungs, pancreas and so on— tends to put many people off signing a donor card. I hope that the Minister will, if 3WH nothing else, consider whether the donor card wording can be altered so that one merely ticks the box if one wishes to donate any organs. I can see no reason why there should be a distinction between different organs. As a start, all Members of Parliament and all those connected with the medical profession should volunteer to carry one. I hope that all Members of Parliament will pledge to do that as soon as possible.
The voluntary consent part of the driving licence is almost unknown to most people. When I first passed my test, far too many years ago to remember, I signed the organ donation part of the licence and put a little note in with it. However, that was a long time ago, and few people now realise that the driving licence contains such a provision. I am sure that the Government could do much more to publicise that avenue to allow people to inform those concerned that they wish to have their organs donated.
The national organ register should be properly updated and overhauled. It should be computerised and made available on the internet, and the Government should be much more proactive in making the contents of the register known. Robert Sells, the professor of transplant surgery at the Royal Liverpool University hospital, recently stated in a British Kidney Patient Association silver lining appeal brochure of December 1999, that in Spain, in 1986, the number of organ donations was drastically improved by introducing into hospital intensive care units a co-ordinator who was directly responsible to the chief executive of each hospital for counselling those who might be prepared to donate their organs. That dramatically increased the number of organ donations from six people per million in the population in 1985 to 31 per million in 1988. As a result, Spain's transplant waiting lists have fallen. Waiting times for liver and heart transplants are considerably shorter, and Spain now exports organs to other European countries. That is a very positive development, which the Minister may wish to consider. Robert Sells said:It seems clear beyond doubt to practically every transplant surgeon world wide that the adoption of such a system would produce an immediate increase in organ donation. I believe the effects would be particularly beneficial in this country where there are too few co-ordinators, who generally work within inadequate job descriptions and with inappropriate salaries."
It is arduous work, of course, and, in Spain, co-ordinators work within the system for only three to four years, after which they move on to other specialties in the medical profession. The introduction of properly trained co-ordinators who could counsel relatives at a time of grief and distress and advise on organ donation would be a positive step forward. I call on the Minister to establish a task force with a cross-departmental remit, which could consider organ donations in the light of the cost to the NHS of, for example, daily dialysis. It could also consider whether the law should be changed. At the moment, the general presumption is that those who wish to donate organs should opt in to the system. That general presumption should be reviewed. As I said, the British Medical Association has, for the first time, changed its policy on 4WH the matter. I know that the Minister and his colleagues have said in the House that there would be no advantage in changing the general presumption. I am not sufficiently qualified to judge, but experts should consider the matter in depth.
The third job for the task force would be to consider the issue of public awareness and education. It would have a remit to employ public relations consultants to consider whether a general advertising and publicity splurge would be of benefit. Such a campaign took place in 1995 and 1998 with only limited success, although it was perhaps not planned and conceived as well as it should have been. A campaign to increase awareness of the voluntary systems of donor cards, licence forms and the national organ donation register could have considerable benefit. It would enable people to consider the issue well in advance of an untimely death. The problem with the present system is that, when someone dies, people naturally suffer much distress and grief, and they often make decisions that they later regret. Therefore, if the public were educated well in advance of such events, it would be a great benefit to all concerned.
Life is short. No one knows when a life-threatening emergency condition is likely to occur. Such a condition could occur to any of us tomorrow. I hope that the Minister has listened to my speech, and that a few notches of progress will follow. I pledge to apply for a donor card today. I hope that all Members of Parliament, and everyone connected with the medical profession, will, as a matter of course, carry donor cards, and make it known to their relatives that they have done so.
§ Mr. Tam Dalyell (Linlithgow)
The House is in the debt of the hon. Member for Cotswold (Mr. Clifton-Brown), for his choice of subject and for his constructive speech.
I should like to begin by putting a question to my hon. Friend the Minister of State. What are the Department of Health's latest figures on the shortage of organs? In this Room last night, Professor Robert Winston was asked about organ shortage, and replied that the American figure was much more accurate than the British one. He put the American figure at 600,000. If we were to divide that according to population, our figure would be 140,000 to 150,000. Would the Department of Health accept such an estimate?
I have a history of interest in this matter. On several occasions in the 1970s I tabled a Bill to allow hospitals to take the organs of anyone other than those who had contracted out through the centre at Bristol. As often happens with Members of Parliament, my interest arose from a case in my constituency—an especially poignant case when I was a new Member of Parliament. It concerned a 23-year-old teacher called Grant Allen, whose parents begged for an organ to save his life. We did not succeed—there was no matching tissue to be had—but I undertook to those people that, as long as I remained a Member of Parliament, I would take an interest in the subject. It is tragic that so many useful organs go into the incinerator.
I believe passionately that decisions on these matters—as the hon. Member for Cotswold mentioned—should not be made at the point of maximum grief. In 1969, I was 5WH parliamentary private secretary in the Department of Health to Richard Crossman when Sir Hector Maclennan, the distinguished doctor and father of the hon. Member for Caithness, Sutherland and Easter Ross (Mr. Maclennan), chaired a report on organ donation. The recommendations of the Maclennan committee were somewhat ambiguous, but opting out was left as an option. With the encouragement of the then chief medical officer, Sir George Godber, and his deputy, Dr. Henry Yellowless, I conducted a survey—which took 42 days—of 1,000 people in my constituency. A Member of Parliament can talk confidentially as a pollster cannot, and I remember the results of the survey very well. Of those 1,000 people, 372 would have agreed to the opting-out scheme, while 316 preferred the voluntary system. A further 108 were passionately against it, on various different grounds. Of those, three state registered nurses separately told me to do something about the common hernia first, but that was 30 years ago. Expectations have risen since then, and people think that they have the right to sophisticated and, as my hon. Friend the Minister knows, extremely expensive operations. Will my hon. Friend consider whether the opting-out scheme should at least be tried? Hospitals would be able to take the organs of anyone other than those who had opted out during their lifetime, after clinical death has been established by two separate doctors, neither of whom is the renal surgeon.
My friend Roy Calne briefed me on the proposals that I put forward 30 years ago. The hon. Member for Cotswold referred to Robert Sells; he had great reservations about my proposal on the ground that it might lessen the number of available organs. I will not hide the fact that there was a considerable difference of opinion among distinguished renal surgeons, and I do not pretend that all the argument is one way. Given a desperate shortage of organs, different expectations, and the greater chance of success, however, the Department of Health should consider the introduction of an opting-out scheme.
Ironically, the flow of organs was lessened by a new piece of legislation—the seatbelt legislation. Thankfully, that has reduced markedly the number of deaths from motor accidents. Therefore, organs, especially those of young people, are not as available as they were before.
§ Mr. Clifton-Brown
Is the hon. Gentleman aware that, in 1997, the French changed the law in favour of an opt-out system?
§ Mr. Dalyell
Yes, I am. Other countries have done so, and the hon. Gentleman's description of the Spanish scheme deserves a long and detailed answer. The French have succeeded, as has Israel, and with considerable effect. It is ironic that opposition comes from strange places. When I introduced a ten-minute Bill on the matter for a second time, the right hon Member for Old Bexley and Sidcup (Sir Edward Heath), the then Prime Minister, stayed to hear the debate, which was most unusual. Afterwards, he said that, although he personally sympathised with my view, I would never persuade Keith Joseph, the then Secretary of State for Social Services. I was a bit vexed, therefore, to discover 6WH that the former chief rabbi, the late Sir Immanuel Rehobovits, who passionately opposed the idea, managed to persuade Keith Joseph against it, even though Israel had introduced a successful system. There are a variety of views, but the hon. Gentleman has made an important point.
§ Mr. Clifton-Brown
I am sure that the hon. Gentleman is aware that it was Sir Keith Joseph who introduced the voluntary donor card system.
§ Mr. Dalyell
Yes, he introduced that system, but it has proved far less successful than he anticipated because none of us wants to contemplate our own demise. People forget to carry donor cards because they take the view that, if they are to step under the proverbial bus, at least it will not happen this afternoon.
The issue is complicated. A number of those who, in the heat of the moment, refused to donate the organs of loved ones have subsequently said, "If we had thought about the issue, we should of course have liked to help someone else." Many such people take the rather curious view that the organs of a deceased loved one are still alive. The subject provokes strong emotions. On conducting my survey, I discovered great differences in attitudes towards, for example, the kidney and the heart. I vividly recall one woman who told me, "They can take what they like from my husband, but not his heart. The heart is something different—that belongs to me." One might say that that is irrational, and that the heart is only a pump, but such feelings nevertheless remain.
Last night, a fascinating meeting about the question of therapeutic cloning took place in this Hall. Perhaps the hon. Member for Oxford, West and Abingdon (Dr. Harris), who was present, intends to discuss it. Professor Lord Winston, who was in attendance, argued that we must consider generating organs for the future. He explained the advantages of transplanting cardiac cells, for example, that could assist bladder transplants, and therapeutic cloning. He called for facilitating directed cell culture and emphasised that, potentially, embryonic cells could be used directly for specific purposes, particularly the improvement of chromosomal disorders. He cited the transplant of neurals, which would help in the treatment of Alzheimer's. Those of us who saw Mohammad Ali on television the other evening will recognise the possibilities of such developments.
The growth and use of tissues and embryonic cells to cope with illnesses such as mitochondrial disorders are complicated issues. Has the Department of Health considered the possible legislative consequences of the remarkable developments at Hammersmith hospital, Imperial college and a number of other centres throughout Britain, not least in Edinburgh and Glasgow, with which I am particularly familiar? In view of the limited time, I close with that question.
§ Mr. Desmond Swayne (New Forest, West)
I have one point to which I want briefly to draw the Chamber's attention. To a large extent, I share the views expressed by the hon. Member for Linlithgow (Mr. Dalyell), and would countenance an opt-out scheme rather than an 7WH opt-in scheme. However, having spoken to a number of surgeons, it would appear that relatives refuse organ donations only rarely. As the hon. Gentleman noted, to some extent the supply of potential donors has declined because of improvements in the treatment of road traffic accident victims, a decline in the severity of such injuries, and a reduced number of intracranial vascular ruptures.
However, the use of elective ventilation has helped partially to restore that supply. On behalf of Mr. Curry, who is a constituent of mine, I recently wrote to the Minister on the matter. In 1993, when elective ventilation was in its infancy, pioneering work was undertaken at the Royal Devon and Exeter hospital. With relatives' consent, patients who were close to death were placed on ventilators, enabling their organs to be made available for transplant. Had they been allowed to die, it would not have been possible to recover those organs. Elective ventilation increased the availability of organs at that pioneering centre by 50 per cent. in 1993.
However, elective ventilation was reluctantly abandoned by the Department on the basis of legal opinion. I do not know whether that opinion related to the Human Tissues Act or the presumption in common law that medical treatment must benefit the patient. Irrespective of the consent of relatives, a person who is close to death cannot be placed on a ventilator for someone else's benefit. That is an anomalous situation. We allow minors—children under the age of proper, rational consent—to donate bone marrow for the benefit of others. They are subjected to a medical process that is not exclusively for their own benefit. In other words, the underlying principle is exactly the same as for elective ventilation. If we would not dream of doing without bone marrow transplants, why has the law been used to put an end to elective ventilation?
I urge the Minister to amend the law, so that we can overcome the presumption in common law against elective ventilation and restore what was a promising supply of potential organs for donation.
§ Dr. Evan Harris (Oxford, West and Abingdon)
I, too, pay tribute to the hon. Member for Cotswold (Mr. Clifton-Brown) for introducing the debate, and also to the hon. Member for Linlithgow (Mr. Dalyell) for his contributions over many years, and for the help and advice that he has given me. I also want to comment on a provocative and thoughtful—I will not say uncharacteristic—contribution from the hon. Member for New Forest, West (Mr. Swayne).
It is important to make it clear that different issues relating to this matter are discussed in the media. First, there are the decisions about the use of tissues that have to be taken at a coroner's post mortem. Under current law, when cause of death needs to be established, there is no opportunity for relatives to say that there should not be a coroner's post mortem and that such tissues that are needed to make a diagnosis should not be removed. I do not think that there is a general call for relatives to be able to veto the actions of a coroner and a pathologist in establishing the cause of death.
There is also the matter, both ethically and in practice, of the retention of organs for research purposes. We deprecate the fact that in at least one hospital it has been 8WH common practice after post mortems—whether coroners' post mortems or others—to retain organs for research purposes, or any other purposes, without consent being sought from the surviving relatives of adults, or from the parents of dead children. It is accepted as good medical practice—the only ethical medical practice—to seek that consent. Those research projects should seek ethical consent through a local research ethics committee, which would insist that adequate, informed consent procedures exist for such relatives, as did the committee on which I sat for some years.
As the hon. Member for Cotswold recognised, those situations are different from the issue of organ donation for transplant purposes, which has occupied most of our time in this debate so far. The Human Tissue Act 1961 must at least be considered for significant repair because of the lack of clarity in its wording, and the problems that that causes for people awaiting transplants. I can give the hon. Member for Linlithgow the figures he seeks, as, I am sure, can the Minister. In 1998, 7 per cent. fewer organ transplants were carried out in the United Kingdom than in 1997, and in the same period the waiting list for those requiring organ transplants to save or transform their lives increased by 3 per cent.
The increasing gap between supply and demand appears to be a continuing trend, and figures more recent than those that I quoted show a continuing decline in the number of organ transplants carried out, and an increase in the number of people on the transplant waiting list. The number of people on the waiting list is the tip of the iceberg, compared with the number who would benefit from organ transplantation. Because so few people are likely to have a transplant, relatively few are given the false promise of being placed on a transplant waiting list.
As I said when I introduced a ten-minute Bill on the matter to an empty Government Front Bench—the Minister has assiduously attended discussions on this issue since then—a silent tragedy is taking place. Thousands of people are dying for want of an organ that could save or transform their lives, while many organs are being buried or cremated with their hosts. Many of those hosts, had they thought about the issue and had an opportunity to register their view, would not have objected to their organs being used in the event of their death to save the lives of others. The tragedy of such preventable deaths is a stark one, not only for those of us who have worked in medicine on both sides of the donation and transplantation field, but for those on transplant waiting lists.
One partial solution to the problem would be a shift, after a suitable period of education to obtain broad public consent, to a system of presumed consent. That would give people several opportunities to register the fact that they did not wish to have their organs used, whether through driving licences, tax returns, electoral registration or at post offices. Their views would be respected; they would be registered on a database which would be checked. That would strongly encourage, if not force, people to consider the issue of death before they might wish to do so, especially young people who are often tragically in a position to donate following traumatic injury. They think that they are immortal and do not like to think about death.
9WH Public opinion polls ask whether people prefer the current system, in which they do not have to think about the issue unless choosing to seek a donation card, to one in which they would have to discuss the matter with relatives and register their views. The result of those polls, as the Government will suggest, may well be that people prefer the status quo. Of course people will say that, but we must recognise that there are other interests at stake—those of patients awaiting an organ transplant and their relatives.
The evidence suggests that, if that system were introduced properly and carefully, the supply of organs could be increased. That would be one benefit. A second benefit would be that the wishes of the donor would be paramount, and the tragic situations that arise at the moment would no longer do so. At present, in a large number of cases, no one knows the view of the potential donor; and relatives, at the height of their grief, have to second—guess that view. I can tell the hon. Member for New Forest, West that as a result of surveys—I do not think that this is contentious we know that, in about a third of such cases, relatives refuse consent when asked. I do not necessarily blame them for that, although we know from Spanish surveys that at least 30 per cent. of them regret that refusal a year later. That is not surprising: I would not trust myself to make those decisions at the start of a grieving period. Therefore, the presumed consent system would not only increase the supply of organs, which would save lives, but give primacy to the views of the donor, which is critical.
§ Mr. Dalyell
The hon. Gentleman is a doctor, and I am not. Is it not asking rather a lot of doctors, when they have been struggling to save someone, to summon the energy to ask such terrible questions? Those questions would have to be asked within half an hour, otherwise deterioration would set in. I would not blame doctors for not putting those questions to relatives at such a time.
§ Dr. Harris
The people who have to seek consent—doctors, nurses and transplant co-ordinators—do a valuable job, and it is part of their role. Learning how to achieve consent should be, and in most places is, part of their training. As a doctor, I find it much easier to approach relatives when the views of the deceased are known. In my forecast scenario, one could explain to the relative that their loved one had not opted out of the scheme and might well have discussed the matter with them. In the light of that, one could ask the relative whether they had any subsequent knowledge that the deceased did not want his or her organs to be donated. The deceased person's views would be of primary concern. Only in the event of a fundamental objection from a relative should the presumed consent opt-out system be overruled.
§ Mr. Clifton-Brown
On the issue of presumed consent, what does the hon. Gentleman think of the idea that solicitors should be encouraged to ask clients of sound mind drawing up a will to include a positive clause stating that they wished to have their organs donated in the event of their death?
§ Dr. Harris
I support any way of making people think about the matter, but access to a will at such a time is not 10WH reasonable, except in a small minority of circumstances. However, if that promotes discussion of people's wishes with their relatives—the filling in of donor cards by the minority of people who carry them often does so—that can only be desirable.
§ Dr. Liam Fox (Woodspring)
On this interesting part of the hon. Gentleman's speech, does he have any data to share with the House on the experience of countries with an opt-out system and the relative shortage or otherwise of organs? If he does not have the information, I am sure that the Minister can provide it. One fact to be considered when examining an opt-out system is whether it has worked in other countries.
§ Dr. Harris
The hon. Gentleman makes a critical point. The BMA has adopted that policy. I would not want the scheme to be introduced if there was not clear evidence that it would increase the supply of organs if introduced in the most effective way, following best practice in Europe, where practice is variable. There should be a Government-sponsored programme of education and research because the worst that could happen would be to have this controversial debate—my postbag shows that it is controversial—with no evidence available. I have examined the Belgium system and there was a clear increase in the number of available organs. Useful controls were Holland, which has a similar culture, and some hospitals in Belgium, which did not change the system, but were subject to the same education process and publicity about the change in the law. Neither experienced the increase in organ donation that the Belgian hospitals which did switch experienced.
In a consensus statement on meeting the organ shortage, the Council of Europe stated:Presumed consent laws, when fully accepted, seem to benefit donation".It went on to refer to a Belgian paper by Dr. Roels, which set out the evidence. Professor Gells, who was cited earlier, was a member of the European transplantation forum, headed by Professor Kennedy. In a paper in The Lancet a few years ago it stated why it believed that a presumed consent system could work.
I turn to the existing possibilities for improving the current system which the Government should consider. The donor register is a useful idea, but is unwieldy. People on the register are never taken off, even after they have died. There is no automatic link between certification of death and removal from the register. That cannot be sensible. People may change their names when they marry and for other reasons, but there is no link between the marriage certification system and the donor register.
The Minister's colleagues at the Home Office and the Treasury have been apprised of the situation by the campaign group, Donor 2001, which proposed the use of electoral registration forms for registration on the donor register. In Taunton Deane borough, that produced remarkable results, with an increase in the number of people registering as donors—10,000 new registrations from a total of 44,000 people. That shows that presumed consent is not the only idea in my locker. I pay tribute to Councillor John Meikle, who promoted the scheme. People in Taunton Deane, as well as Donor 2001, are frustrated that the Home Secretary is not as 11WH enthusiastic about extending the scheme as the Government have been about extending all sorts of schemes with less strong data for the success of the pilot schemes.
Elective ventilation is an interesting idea. As the hon. Member for New Forest, West suggested, under common law treatment should only be given for the benefit of the patient. Another practical problem is the chronic shortage of intensive care beds. Someone might have opted for future elective ventilation, but ventilators or intensive care beds might not be available. Despite my support for presumed consent, I believe that the Government could increase the supply of organ donors at a stroke simply by increasing the resources for, and the number of beds on, intensive care units. There is medical consensus for that. The legal barrier to elective ventilation could be circumvented if the law were changed to allow the existing donor card to offer an opt-in to future elective ventilation. Consent would then be given for that intervention, albeit not for the benefit of the person concerned.
The increasing use of non-beating heart donations for kidney donation needs to be considered. The Government should promulgate a debate on the ethics and practicalities of xenotransplantation before irrational opposition on health grounds and spurious ethical grounds takes over the argument as it took over the argument on genetically modified organisms.
Therapeutic cloning should also be considered. It was disappointing to many scientists and clinicians when the Government rejected the advice of their advisory groups—the Human Fertilisation and Embryology Authority and the Advisory Committee on Genetic— Modification—and set up yet another working party to consider whether research would be useful. The usual way of finding out whether research would be useful is to do that research. A huge amount of work remains to be done on transplantation and donation. The Royal College of Surgeons produced a report, the author of which was my constituent, Professor Sir Peter Morris, on organ transplantation. It suggested that, in addition to donor issues, a series of issues needs to be considered, including the organisation of transplantation services, an increased supply of junior doctors to become transplant surgeons and a national transplant service and strategy to deliver increased efficiency using available organs. I hope that the Minister will respond to that working party and adopt many, if not all, of its recommendations.
I thank the hon. Member for Cotswold once again for introducing the debate.
§ Mr. Nick Harvey (North Devon)
I, too, congratulate the hon. Member for Cotswold (Mr. Clifton-Brown) on introducing the debate. I saw the title of his intended debate last week and thought that it would provide the opportunity to bring together several different issues, but when I listened to the hon. Gentleman this morning, he suggested a closer connection between the issues than actually exists.
Hon. Members may know that, for several years, I have been involved with the Bristol heart action group, which brings together the relatives of those whose babies 12WH died in the tragedy at Bristol royal infirmary. In that connection, I have recently taken an interest in events at Alder Hey hospital, and there is now a connection between the two groups of parents.
The hon. Member for Cotswold said that no one was accusing doctors of deliberately removing organs without the consent of relatives—
§ Mr. Clifton-Brown
I did not say that. I said that it was not acceptable for any organs to be removed when the consent of the relatives had not been properly given.
§ Mr. Harvey
I am sorry. I misrepresented the hon. Gentleman and I am grateful to him for correcting me.
It would be too benign an interpretation of what happened at Bristol, Alder Hey and, I suspect, many other places, if not generally, to say that doctors have not removed organs without the consent of relatives. That seems to have happened on an extraordinarily wide scale and has, understandably, caused great alarm. I have not seen any suggestion that the purpose of that removal of organs was in any way to assist with the supply of organs for transplantation. In a macabre way, that would almost have been more acceptable.
The organs were retained principally for research. The Royal College of Pathologists is conducting a review of its guidelines and issued a document on which it is consulting. That document makes it clear that there are a number of sound medical reasons for retaining organs. It describes the ideal practice for pathologists when explaining to relatives the possible reasons for retaining organs and the advantages that might accrue from that. It also stated that, when that is done sensitively but determinedly, it is unusual for relatives not to give permission for organs to be retained. The considerable advantages that that involves include medical research benefits and the fact that a fuller understanding is later available about why the death took place when it did. The document also suggests—
§ Mr. Clifton-Brown
The hon. Gentleman and my hon. Friend the Member for New Forest, West (Mr. Swayne) make the same case. In the article that I referred to earlier, Professor Robert Sells states:Although there has been a significant rise in living organ donation during the last two years, 30 per cent. of relatives still object to organs being removed from a bereaved loved one.That conflicts with the hon. Gentleman's argument.
§ Mr. Harvey
In fairness, we are discussing two slightly different matters. I was discussing retention of organs after a post mortem when there has been a suggestion that doing so may teach us about the medical circumstances of the death. I was not discussing those who died in, for example, accidents.
The royal college has made suggestions about what should be best practice in terms of explaining to and communicating with bereaved relatives. If such an approach were adopted in general, there would not be such a scandal about the retention of organs. However, that approach is not common practice. No one really knows what the scale of organ retention is—it has a chequered pattern throughout the country. Some hospitals that have retained organs on a widespread basis do not know why they are doing it, and in the most bizarre 13WH cases hospitals have lost documentation about the organs that they have. They might find some years later that they have all sorts of organs about which they had forgotten because they did not have the proper records.
The situation throughout the country is a grim and grizzly picture. The previous Secretary of State rightly instructed the chief medical officer to conduct a national survey to establish, as best he can, a national picture. The Secretary of State helped me to speak to the chief medical officer about that matter; I believe that he has the right approach and that if he can obtain honest, candid and accurate responses from hospital authorities we could form a better idea about what to do next.
This subject involves various strange developments. Parents at Bristol have had to go through three separate phases of grief. They suffered the initial grief of losing a baby unexpectedly. Years after they had got over that, they discovered that the circumstances of their baby's death was part of a wider picture involving the incompetence of medical professionals, which reopened their wounds. Having come to terms with that, they suffered a third grief—they discovered that organs that they believed had been buried or cremated with their child had been retained without their knowledge or permission.
Parents who cremated their babies are in strange legal territory because it is not legally permissible to cremate organs on their own. I am grateful to the Home Office for its response in this regard. When it learned about the parents' distress it adopted—or it encouraged a funeral director to adopt—a pragmatic interpretation of the law in this regard. That enabled people in the south-west and south Wales to go to that funeral director, whose approach disregarded the problem. The Home Office is aware that the subject needs to be revisited in a legal review.
Several hon. Members have already discussed the shortage of organs that are available for transplantation. My hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) and the hon. Member for Linlithgow (Mr. Dalyell) appeared to support an opt-out system. The key point, which has been made by the BMA and by my hon. Friend, is that our approach should be considered only after extensive public education, advertising and debate. The decision to go down that road should be made only when the process of education and advertising has advanced considerably. Evidence from other countries suggests that that approach can produce a better supply of organs, which has tangible benefits. There are various reasons why other countries have a better supply, and we need to be aware of them all when we consider the matter.
I was struck by the evidence that the hon. Member for Cotswold quoted about the impact of counselling on the number of people who are prepared to sign up. My hon. Friend the Member for Oxford, West and Abingdon and the hon. Member for Linlithgow mentioned breakthroughs in scientific advances, which will increase the need and demand for organs. I hope that the Minister of State will discuss that.
The hon. Member for New Forest, West (Mr. Swayne) rightly discussed ventilation, which has been stopped on legal grounds. I echo his call on the Minister to consider whether changes in the law might enable us to get around that problem.
14WH My key point is that I do not believe that there is any connection between this macabre, horrible and widespread practice of organ retention—when the chief medical officer has completed his survey, I suspect that it may be found to have occurred on a larger scale than some press reports have speculated—and transplantation, both of which are serious issues. As many hon. Members said this morning, it is vital to obtain a better supply of organs for transplantation.
Finally, I echo the words of those hon. Members who congratulated the hon. Member for Cotswold on securing a debate on these two interesting issues.
§ Dr. Liam Fox (Woodspring)
I, too, congratulate my hon. Friend the Member for Cotswold (Mr. Clifton-Brown) on securing this debate and on raising several important issues. I also echo the views of the hon. Member for North Devon (Mr. Harvey), who said that we are discussing distinct issues that should not be regarded as being exactly the same.
My constituency shares borders with the relevant Bristol constituencies, and I entirely understand the despair of the parents who are involved. They discovered that their consent had not been sought at the time and later they were not given information about decisions. It is the latter fact that caused them so much grief so late in the day. As the hon. Member for Oxford, West and Abingdon (Dr. Harris) said, all hon. Members must accept that the removal of organs for research without proper ethical consent is totally unacceptable. I am sure that there is no difference of opinion in that regard between the political parties.
Our debate today is inevitably tinged with sadness. We are carrying the burden of the hopes of the chronically sick, who want something that we all take for granted—the chance to have a normal life span. We must balance that against the sadness of the untimely death of an otherwise healthy person and the inevitable grief of his or her relatives, who find it difficult to make rational decisions at that time.
A third sadness is also involved—it concerns the small number of people who carry donor cards or who are donor registered. While my hon. Friend the Member for Cotswold was speaking, I checked to see whether my donor card was in my wallet, but I discovered that it was not there. I wonder how often that happens. Those of us who believe that we are willing to give any of our organs for transplantation may walk outside and be hit by the proverbial bus, but we may find it difficult to have our wishes carried out. Of course, in that situation we would also be suffering the difficulty of having been hit by a bus.
What reforms should be introduced? The purpose of debates in this Chamber is to raise issues and to give pointers about what should be done. We want the 4,000 patients who are awaiting kidney transplantation and who are on dialysis, and those who suffer from cardiomyopathies and who are awaiting a heart transplant, to be given the chance to have a healthy life style. As several hon. Members have said, we must avoid the heartbreaking situation that involves patients having to watch their chance of life being buried or cremated—they are denied the healthy existence that we all take for granted.
15WH As the hon. Member for Linlithgow (Mr. Dalyell) said, we are in some ways the victims of our own success. Our success in reducing death from road traffic accidents, not least through our seat belt legislation, has put us into a more difficult position in that we now have fewer organs available for transplantation from otherwise healthy adults. We created that problem through legislation and we have a duty to try to address it.
I would like the Minister to reply to two or three specific points. At the moment, we are all consumed by millennium hysteria and all sorts of frivolous projects for our entertainment are being proposed. I hope that Parliament can give a lead by setting up some projects that will give a chance, not for entertainment, but for survival. We as a population have many contacts with health professionals and next year, as part of the millennium celebrations, I would like the Minister to dedicate a month in which everyone who has contact with a health professional—a GP, a hospital doctor, a pharmacist, or a dentist, for example—is given a form to register as a donor, and in which every health professional tells everyone that he or she comes into contact with what can be achieved, as part of a wider programme of health education. It will not cost anything and will take only a few moments of a health professional's time, but could make a huge difference in terms of public education and understanding.
Will the Minister consult his colleagues to see whether it is possible to include a form with the annual communication that we all receive—those of us who fail to fill in the form on time receive several of them—on electoral registration? It would go to every household, at almost no cost to Government, and increase public awareness of what can be done simply by filling in a form. Those are cost-free measures that cut across Governments and across Departments and are easily achievable, giving vast benefit to all our society, not least to those who need a transplant. As the hon. Member for Oxford, West and Abingdon said, we need an updated donor register, using the available information technology, to ensure that the information is always available at our fingertips at the correct time. It is all very well to spend an hour and a half debating the issues—an hour and a half immediately after death is a long time. The decisions have to be made very quickly.
In presenting this debate, my hon. Friend the Member for Cotswold talked about the difficult position of relatives at a time of great grief and reduced ability to make rational decisions. We all understand that, but it gives all the greater urgency to the proposal for an education project. My hon. Friend referred to the Spanish survey showing the number of people who make a decision that they regret later. I am sure that everyone present sympathises with that plight. It seems to add an unnecessary grief to those who have already undergone the pain of bereavement.
We need to have the political debate on opting out. I understand why Ministers would find that difficult. I have no doubt that the civil servants advising the Minister will be saying, "But Minister, can you imagine the story in the tabloids when for the first time a mother says that her daughter just did not get round to opting out, but always wanted to, and that her organs have 16WH been taken against her will?" Ministers will face that unpalatable situation and we can all imagine the tabloid treatment that such a case would attract. However, we balance that against the real, on-going tragedy, not of those in elected office, but of those who are being denied the chance of a healthy life because of the shortage of organs for transplantation. We need to put the interests of those people higher up the agenda.
§ Dr. Harris
I accept the necessity for the balance to which the hon. Gentleman referred, but it must be stressed that the system of presumed consent proposed by the BMA could involve a check with relatives—not necessarily to ask their views, but to ask whether they knew of any undisclosed wish on the part of the deceased to opt out. That would underline a respect for the donor's wishes. There will be people who never got round to opting out but who discussed doing so, and that must be recognised since I do not doubt that there might be controversial media coverage of occasional cases with any system.
§ Dr. Fox
I am sure that that is correct. My point was simply that there will always be political resistance to a Minister, of whatever party, being pilloried in the tabloid press and being made a scapegoat in what may be rather unpleasant coverage.
I would like the Minister to tell us about the evidence from other countries on opting out and what difference it has made to the number of organs available. I note that one of his colleagues said:More importantly, there is no evidence from European countries that have an opt-out that it would increase the number of organs available."—[Official Report, 19 October 1999; Vol. 336, c. 245.]I would like to know the basis for that information and whether it can be published by Ministers so that we can have a better-informed debate.
My hon. Friend the Member for New Forest, West (Mr. Swayne) mentioned elective ventilation. Again, I would like the Minister to comment on what consideration is being given to that. The hon. Member for Oxford, West and Abingdon mentioned the shortage of intensive care beds; that will be a major practical problem, but perhaps the Minister could deal with the theoretical rather than the practical aspect of that and let us know the Government's thinking on it.
Finally, I hope that our actions and our words today remove a great source of sadness, despair and unnecessary death. We have a chance to give life and there can be no duty on us, as Members of Parliament, greater than that. I hope that we do not fail in that duty.
§ 11.7 am
§ The Minister of State, Department of Health (Mr. John Hutton)
I warmly congratulate the hon. Member for Cotswold (Mr. Clifton-Brown) on raising these important matters and on giving us the opportunity to discuss what has turned out to be a wide range of matters relating to organ donation and transplantation—matters which, as all hon. Members have said, touch on complex ethical, moral and legal considerations. I shall try to respond to all the points that have been made.
17WH The hon. Member for Cotswold expressed his concerns about the developments at Alder Hey hospital in Liverpool and about the issue of the removal of organs. The hon. Member for North Devon (Mr. Harvey) also spent considerable time on that point. Both hon. Members made good speeches, with thoughtful and substantial content. It may be helpful if I set some of the issues at Alder Hey into context and offer some thoughts about the legal background to them.
Evidence given to the Bristol Royal infirmary inquiry in September indicated that organs removed following post mortems were being stored at hospitals elsewhere in the country, including at Alder Hey hospital in Liverpool. Local investigations at Alder Hey revealed an additional issue, relating to organs allegedly retained in breach of protocols by a pathologist undertaking research into sudden infant death syndrome. Consequently, this debate is set against a background of increasing sensitivities and serious concerns around the protocols governing the retention of tissues and organs at post-mortem examination.
The events at Alder Hey children's hospital are obviously enormously distressing for the families concerned and present major questions about children's organ retention in the NHS. I, as I am sure do all hon. Members, extend my sympathies to all the families concerned in this tragedy. An internal inquiry, which the local trust set up when the issue first came to light, is due to report early in the new year. It is essential that we now seek to restore public confidence in health services at Alder Hey children's hospital, a hospital with a fine reputation for high-quality care for children.
On 3 December, we announced that we would set up an independent inquiry into the events at Alder Hey children's hospital, which will report to my right hon. Friend the Secretary of State by the end of March next year. That report will be made public. A team comprising a patient's representative, a leading pathologist and someone with an appropriate legal qualification will conduct the inquiry, which will be entirely independent of the hospital. The inquiry will specifically consider what happened at Alder Hey to identify lessons to be learned, and to recommend to the Secretary of State further actions that might be necessary to reform organ retention practices at the hospital and to better support the families affected.
Before the Bristol Royal infirmary and Alder Hey cases became the subject of media attention, my Department and the Royal College of Pathologists had begun work on new guidelines in recognition of the sensitivities around the issue and the need for greater openness. The new guidelines for the retention of tissues at post-mortem examination are being developed in the light of the need for greater openness and better public information, married to best clinical practice. Wide consultation has ensured that the views of patient representatives have been taken on board.
The guidelines represent a dramatic shift in approach, with an emphasis on transparency and sensitive management of the bereaved, which are concerns that we have all referred to today. They also include a new model consent form for bereaved relatives to sign. We hope that the guidelines will be ready for dissemination in the new year, and the Department will clearly need to scrutinise them closely.
18WH Several hon. Members referred to the present legislation regulating organ removal during post mortems, so it might help if I spoke about those provisions. It will not surprise hon. Members to discover that the legal situation is complex. I do not think that I have ever been asked to make a speech in which I have not been given that to say. The legal situation is always complex—a legacy from lawyers.
As I understand it, the Coroners Act 1988 permits the removal of tissues and organs during the course of a post mortem called for by a coroner even without the agreement or consent of relatives. Rule 9 of the 1984 coroners rules permits the preservation of materials which, in a pathologist's opinion, bear on the cause of death. In relation to coroners' post mortems, organs can be retained only to establish the cause of death and for such time as agreed by a coroner. In Britain, 90 per cent. of post mortems are called for by coroners and are therefore conducted under the 1988 Act.
Hospital post mortems are quite different. The Human Tissue Act 1961 refers to the relative not objecting to the removal of organs. However, the Act does not specifically require the relative's consent before the removal of tissues or organs. The Act therefore makes no provision to determine the purpose for which any retained organs can be used. Previous practice in relation to hospital post mortems may not seem compatible with the modern concept of informed consent.
§ Mr. Dalyell
I would not try to amend the 1961 Act. Dr. Gavin Thurston, then an inner London coroner, wrote an interesting paper on the problems that face coroners. It was written a long time ago but may have current relevance. Will my hon. Friend ask his officials whether it is somewhere in the departmental archives?
§ Mr. Hutton
I am grateful to my hon. Friend, who has a legendary memory. I shall certainly make that inquiry and see what we can dig up.
I want to refer to the chief medical officer's inquiry, as several hon. Members have already done so. We asked him in October to investigate the scale of organ retention in the national health service generally, including in children's hospitals, and how NHS pathologists undertake that important work. The report will ensure that clinical practice on the subject throughout the NHS respects the rights and wishes of patients, while enabling the study of illness to benefit patients. We should always bear it in mind that the pathological and clinical examination of tissues and organs is a proper and important function of medical diagnosis and of furthering the understanding of medical science. Of course, as many hon. Members have made clear, those benefits must be balanced against the need for public acceptance and informed individual consent.
The chief medical officer, Professor Liam Donaldson, will ensure that lessons from the events at Alder Hey children's hospital can be learned throughout the NHS. As part of his investigation, he is conducting a census of organ retention and practice on consent in all NHS hospitals in England. I am especially grateful to the hon. Member for North Devon for his support of that work. The chief medical officer's inquiry will consider the 19WH practice of removing and retaining organs as well as the legal framework in which that takes place. Ministers have asked him to provide a comprehensive report on how such matters can be dealt with in future.
Much of our debate has focused on organ transplantation. Patients who might become donors are typically people in intensive care units who have had a sudden brain injury, such as a stroke, or as a result of a road accident. Of course, doctors' principal duty is to make every effort to save a patient's life. If a patient dies despite their efforts and is certified brain stem dead, organ donation can be considered. First, two doctors must be called in who have no connection to the transplantation unit. Each will independently carry out a series of tests to confirm that a patient is brain stem dead. When that has been confirmed, the local transplant co-ordinator is contacted. He will check to see if the potential donor has a card or is registered on the NHS organ donor register. I shall respond to the point made by the hon. Member for Oxford, West and Abingdon (Dr. Harris) about the register in a moment.
If the deceased has made his or her wishes clear, the transplant co-ordinator can approach the family to discuss donation with confidence. Objection is almost unknown if families are aware that their loved ones wanted to donate. The hon. Member for Woodspring (Dr. Fox) drew attention to the fact that he did not have his organ transplant card with him. We always point out how important it is that people who are willing to donate their organs communicate that to their families, so that even the physical absence of an organ donation card will not stand in the way of organ removal and transplantation.
§ Mr. Clifton-Brown
There is a practical problem. A lot of people do not have their donor cards with them for one reason or another—their wallets might have been stolen, or they might have lost them. Will the Minister consider establishing a better link between those who carry organ donor cards and the placing of names on the national organ donor register? That way, it would be possible in a matter of seconds, even if people did not have their cards with them, to establish that they were willing to donate their organs.
§ Mr. Hutton
I hope that that would be the case in most circumstances, but I shall certainly consider that point. However, if organ donors have made no record of their wishes and their families have not discussed the issue, the transplant co-ordinator's task is much harder. Overall, three of every four families generously and courageously agree to donation.
Whether there is a formal record of the wishes or not, the transplant co-ordinator will talk to families and ensure that they have no objection. There is no question of a transplant taking place against the wishes of the family. The history of the donor will also be checked to confirm that there are no medical or social contraindications to donation.
If permission is obtained, the transplant co-ordinator will contact the United Kingdom Transplant Support Service Authority. It maintains the national transplant database, which contains details of all potential organ 20WH transplants and recipients in the UK and the Republic of Ireland. A search of the database is made to find the most suitable patients. Once the patients and their locations are identified, the doctors at those transplant units are alerted and asked to confirm acceptance of the organ. As they do so, the preparation of their patients for the transplant operation begins.
A team of specialist surgeons is called to the donor's hospital to carry out the surgery to remove and preserve the organs for transport to the transplant unit. If necessary, special transport arrangements will be made to ensure that no time is lost. The process of recovery and new life can then begin for the patient. Meanwhile, once the first immediate pain of bereavement has passed, many donor families find profound comfort in the thought that their relatives' organs have enabled others to live.
Several hon. Members referred to the shortage of organs suitable for transplant. So far this year, 2,517 people have received life-saving operations. My figures are accurate up to 10 December, which was Friday of last week. Organs from 900 donors give a new lease of life to more than 3,000 people every year in the United Kingdom, and a further 3,000 people have their sight restored. Transplants are now so successful that many more patients can be considered for such treatment, as my hon. Friend the Member for Linlithgow (Mr. Dalyell) said. More people are being added to the waiting list each week, faster than organs become available.
Currently, 6,730 people are on the waiting list for transplantation in the United Kingdom. The vast majority of them are waiting for kidney transplants, and will have a much-reduced quality of life on dialysis while they are waiting. For those waiting for hearts or livers, there is of course no alternative to transplantation. As several hon. Members have rightly said, the success of other policies has exacerbated the problem of availability of organs for donation. The main source of organs suitable for donation is people who have died from sudden brain injury, such as that which can be caused by a stroke or a road traffic accident. Partly as a result of the legislation to which the hon. Member for Woodspring referred, the United Kingdom now has one of the lowest rates of road traffic deaths in the world. Together with advances in neurosciences, that has resulted in a reduction by about two thirds in deaths from intracranial haemorrhage since 1970. Those developments are significant and are warmly welcomed, but, as hon. Members have recognised, they have implications for the subject of the debate.
It is obviously urgent for many more of us to agree that when we die our organs should be used for transplantation. Some people have argued?we have heard such arguments today?that the shortage of organs means that we should change the basis of organ donation in Britain to an opt-out system, as the hon. Member for Oxford, West and Abingdon strongly believes. Such an approach would mean that, unless people have registered their unwillingness to be donors, their organs could be taken and used. Some people believe that that approach would lead to a vast increase in the number of organs available for transplantation, but the Government do not believe that that is the case.
21WH The hon. Member for Woodspring referred to a parliamentary answer. We do not think that there is any clear evidence that, where an opt-out approach has been introduced and rates have risen, it is the sole factor in higher donation rates. Other important factors include different cultural attitudes to the disposal of bodies, greater numbers of intensive care beds, more aggressive procurement policies and road death rates.
§ Mr. Hutton
We shall certainly share with the hon. Gentleman as much information as we can. As I understand it, his argument is that such information relates simply to the difference between an opt-out and an opt-in system, which can be quantified and measured in the availability of organs. I am trying to tell him and other hon. Members who have advanced similar arguments that the matter is not that simple.
§ Dr. Harris
First, I have never said that an opt-out system would "vastly increase", to use the Minister's words, the number of available organs. I do not believe that supporters of such an approach have suggested that, and such a suggestion should not be put up just to be shot down. Secondly, supporters of a shift to presumed consent do not offer their support solely on the basis of the organ shortage. I have already referred to the paramountcy of the donor's views and to the need for relatives not to have to second-guess those. Thirdly, the European transplantation forum considered the evidence, and suggested that an opt-out system, such as that used in Belgium, could well be a factor in increased availability of organs. That change involved a control group of hospitals that did not shift to the new system and shared everything else in common with those in the rest of the country, but did not benefit from an increase in the supply of organs.
§ Mr. Hutton
I am well aware of the hon. Gentleman's views on the subject. He will know, however, that only the BMA—which is not an unimportant source of opinion—has supported his suggestion of an opt-out scheme. As I understand it, the professional opinion of most other relevant bodies is either divided or hostile to the notion. For example, I am advised that the United Kingdom Transplant Co-ordinators Association would not accept any version of the opt-out approach that did not include a requirement to gain family agreement. During the debate and, I think, in the summer, it has appeared that the hon. Gentleman does not support that suggestion. As I understand it, he would support the removal of an organ notwithstanding whether the family involved wished to withdraw consent.
§ Dr. Harris
I am grateful to the Minister for giving me the chance to clarify my views. As I said at the BMA conference, when relatives strongly object to organ removal, despite a donor having indicated that he or she wished to donate by not opting out when the 22WH opportunity arose, the relatives' wishes should be respected. I believe that the majority of people operating within the BMA and promulgating its policy recognise that practical point. It is fair to say that professional opinion is split. However, the trend among bodies such as the National Kidney Federation, which has adopted a policy of considering presumed consent after an education period, is towards considering the option.
§ Mr. Hutton
I am grateful to the hon. Gentleman for clarifying that point, and I am sorry if I misrepresented his argument. I have listened closely to his remarks, however, and I understood him to be suggesting that an organ may be removed and made available for transplantation notwithstanding the strong views of family or relatives. The hon. Gentleman referred to Austria and Belgium, which are often cited as examples of countries with opt-out systems and higher donation rates than our own. However, those countries have double the road accident rates that we have. Organs are suitable for transplant only if the donor patient died as a result of sudden brain injury and was receiving mechanical ventilation in an intensive care unit when death occurred. Many such deaths occur as a result of road accidents.
The concerns expressed today are evidence that public confidence in the system in place is crucial. We know that there is public support for the current system of donation, in which potential donors opt in, rather than for an opt-out or presumed consent approach. For example, a Department of Health survey commissioned in July found that 50 per cent. of people were in favour of the current system and that only 28 per cent. were in favour of an opt-out system. The hon. Gentleman will be familiar with the terms of the survey, as we have already discussed these matters. It established that there is a strong preference for the current system.
The sensitivity of the organ donor programme to adverse publicity, to which the hon. Member for Woodspring rightly referred, has been illustrated by events in France, which has opt-out legislation. There was a strong public reaction when a couple discovered that their son's eyes had been removed against their wishes. That is exactly the scenario to which the hon. Gentleman referred. The incident received widespread coverage in the French media, and led to a 20 per cent. drop in organ donation and to a 30 per cent. drop in corneal donation. It took three to four years for the donation rate to recover. Such considerations are important, and we must keep them under review. To reassure the public, French law was amended to require relatives to be approached when the donor's wishes are not clear.
Although opt-out implies that organs should be taken unless the dead person is known to have objected to donation, doctors do not in practice assert their right to take organs against the wishes of the grieving family. Apart from sensitivity to families' distress, there are also practical difficulties, such as the need to consult the family in case there was something in a potential donor's health or life style that would make him or her unsuitable for donation.
§ Mr. Dalyell
Will my hon. Friend at least see Lord Winston, who last night presented a powerful case on therapeutic cloning? Many hon. Members are interested in these matters.
§ Mr. Hutton
I shall certainly do so. The best person to see Lord Winston may be my noble Friend Lord Hunt, the Under-Secretary of State with specific responsibilities in the Department for such matters.
I am not sure whether I shall be able to respond in the limited time remaining to all of the points made. I shall try to do so as quickly as possible. The hon. Member for Woodspring referred to a number of proposals that he had in mind for improving the system. We shall of course consider any of his proposals. We keep an open mind about these matters, and we are keen to find any way of improving the existing system.
My hon. Friend the Member for Linlithgow asked what consideration we are giving to the use of therapeutic cloning. As he said, the issues are complex and involve morality, ethics and law. The Department keeps them under vigorous consideration through various advisory groups, including the gene therapy advisory committee and the Human Fertilisation and Embryology Authority.
The hon. Members for New Forest, West (Mr. Swayne) and for Oxford, West and Abingdon mentioned elective ventilation.