§ Baroness Macleod of Borve
asked Her Majesty's Government:
When the revised Code of Practice on Organ Transplantation will be made available.
§ Lord Trefgarne
We are today issuing a revised Code of Practice for doctors for organ transplantation including guidance on diagnosis of brain death. The code revises the original code published in 1979 and was prepared by a working party chaired by Lord Smith, of Marlow. It is for use by medical, nursing and420WA administrative staff concerned with organ transplantation. We hope the new version will resolve any doubts about procedures and the requirements of the law. Our main object, of course, is to ensure that we can treat as many patients as possible who need transplants of kidneys, corneas or other organs and that no unnecessary confusion or hesitation reduces the supply of donor organs.
The present position of kidney transplants is particularly serious. Last year there were over 1,000 transplant operations but the supply of kidneys for transplantation is only about half that necessary. The waiting list has now reached 2,263. Many more members of the public are carrying organ donor cards and we are doing everything possible to encourage the carrying of cards. But one of the reasons for the continuing shortage of organs for transplants is hesitancy on the part of hospital staff to identify potential donors among their dying patients and uncertainty about the procedures that must be followed to lead to transplantation. We believe the code is clear, helpful and sensitive and should increase the supply of organs for transplantation, particularly kidneys.
The revised code emphasises the care with which relatives of a deceased person should be interviewed to establish their views. The need to maintain confidentiality is brought out more strongly. It suggests that the person who makes the approach should be senior and have experience of personal interviews of a sensitive nature. Any approaches should be made with proper sensitivity and a feeling for the relative's distress.
Approaches to the parents of a dead child need a particuarly high standard of sensitivity and tact. The law does not demand parental consent but it should always be obtained in the case of a child.
We hope that the section which deals with diagnosis of death and brain death in particular will put an end to controversy on this difficult subject. A television programme nearly two years ago led to widespread public alarm on the subject and set back the kidney transplant programme substantially. The diagnosis of brain death is based on the up-to-date and considered view of the Conference of Medical Royal Colleges and their Faculties in the United Kingdom, who confirm their previous criteria for diagnosis which is backed by every leading professional in the field. The diagnosis is to be carried out by a combination of experienced doctors who are not to be members of the transplant team and who will carry out a series of tests and repeat them after a suitable interval. As the conference recommended, a new check list is being introduced to facilitate the proper recording of the test results in the case notes. There is not the slightest chance, when the code is followed, that organs will be removed for transplantation from someone who is not dead in every sensible meaning of the term. It is a tragedy that fears of that kind have cost us hundreds of operations that might have returned patients to happy and full lives.
We hope the code will, therefore, accelerate the steady growth of the transplant programme. One thousand patients in one year is a new record and a significant landmark to have passed. We need to do 421WA much better than that, however, and we need the full support of the public and the professions to help us go much further.