Organ Donation

Andrew Gwynne Excerpts

Wednesday 30th November 2011 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

Thank you, Mr. Crausby. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this debate. I also pay tribute to the hon. Member for Chippenham (Duncan Hames) for his sterling effort in squeezing a whole speech into a minute and a half—he did very well.

The system of opt-in for organ donation has been the subject for debate for many years because of the serious shortage of organ donors and consequent waiting lists for transplant operations which has led to suggestions from a number of stakeholders that a review of the current approach to organ donation is long overdue. In the United Kingdom, the number of people awaiting transplant operations greatly exceeds the number of organs available. This shortage of organ donors means that some 400 patients, mainly those waiting for life-saving heart, liver or lung transplants, die each year before a suitable donor can be found. As we have heard during the course of this debate, the BMA, many transplant surgeons, patient groups and many hon. Members in both Houses would like the UK to adopt a system of presumed consent where it is assumed that an individual wishes to be a donor unless they have opted out by registering their objection to donation after death. I recognise that there are strong feelings on both sides of the debate, as we have heard today—not least those put so eloquently by the hon. Member for Montgomeryshire.

Hon. Members who have served in this House for some time will be aware that the former Health Secretary, my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), asked the organ donation taskforce to assess the possible impact of a change to presumed consent and the acceptability of such a change for the United Kingdom. By doing this, the previous Government recognised the complexity of the issues and widely differing viewpoints surrounding systems of consent to organ donation.

We know that the taskforce examined the complex moral and medical issues around presumed consent, including giving the family of the deceased a final say on the donation of any organs. It also looked at the views of the public, health organisations and other clinical, ethical, legal and social issues raised by a wide range of stakeholders, while at the same time establishing a series of expert working groups to help gather the relevant evidence. The Minister will be aware that the resulting report, entitled “The Potential Impact of an Opt Out System for Organ Donation in the UK” was published in November 2008, recommending that the current system of opt-in be retained and the recommendations of the taskforce’s earlier report on organs for transplant, produced in January 2008, be implemented. However, in July 2007, the chief medical officer supported the idea of an opt-out system with proper safeguards and good public information. My right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) also called for a public debate on the issue of presumed consent when he was Prime Minister and did not rule out changing the law to an opt-out system.

So what would actually happen under a system of opting out? It proposes that every person living in the country in which it is introduced is deemed to have given their consent to organ donation unless they have specifically opted out by recording in writing their unwillingness to give organs. Supporters of the introduction of such a system in the United Kingdom believe that establishing an automatic right to take organs when the donor has not expressed wishes to the contrary would lead to a significant increase in the number of potential donors. They also conclude that the relatives of, or those close to, a person who has not expressed a wish to donate would be relieved of the burden of making that decision at such a traumatic time.

However, one fear with presumed consent is that people will not get round to registering an objection and the subsequent expectation that organ donation should take place could lead to unnecessary distress for relatives and widespread adverse publicity. Many transplant recipients add that a donated organ is more easily accepted because they know that it has been positively given by the deceased whereas presuming consent would turn donation into an action by default.

Other concerns surround the potential medical risks involved in removing organs without full discussion with relatives. Families are a valuable source of information about their loved one’s previous health and relatives are questioned as part of the screening process. If an individual does not register an objection, it is possible that their silence may indicate a lack of understanding rather than agreement with the policy. It is because of these concerns that, in the majority of countries operating an opt-out system, health care professionals still consult the family to establish consent.

While always looking closely at both the pros and cons of the system of presumed consent, there is recognition across the health care profession and more widely that there is a crisis which leads to tragic loss of life—in the UK, at least one patient a day dies waiting for a transplant.

The former chief medical officer, Sir Liam Donaldson, was an enthusiastic supporter of presumed consent. He told The Guardian in 2007:

“We have something of a crisis in this country. Every day at least one patient dies while on the transplant waiting list. There are something like 7,000 people on the waiting list at any one time. There is a shortage of organs in this country and the situation is getting worse.”

A team at the centre for reviews and dissemination at the university of York focused on 13 studies and found strong links between presumed consent and increased donation rates. One of the studies found that donation rates were 25% to 30% with presumed consent. However, researchers also said that it was unlikely that presumed consent alone accounted for all of the effect as one study found that the number of transplant centres had a greater effect than an opt-out system. Other factors that had an effect on donation rates were death from road traffic accidents, health spending, public awareness and religion.

Support for presumed consent in the UK, as we have already heard, has grown steadily since 2000 and, in a survey carried out in 2007, 64% of respondents were in favour of moving to presumed consent. The BMA’s own figures are even more favourable, showing that around 70% to 90% of the population would be willing to donate their organs after death.

As I said earlier, when my party was in government, the then Health Secretary asked the organ donation taskforce to make specific recommendations to improve the infrastructure within which donation takes place and, since those were made, improvements have been achieved, with a 28% increase in donation rates over three years. The changes proposed by the taskforce include a wide range of measures designed to make the offer of donation a standard part of the care provided to dying patients—in the words of the taskforce, to make donation a

“usual and not an unusual event”.

As we have heard today, the Minister will be aware that this issue is being pursued in Wales with the National Assembly for Wales and the Welsh Assembly Government recently publishing a White Paper on an organ donation Bill for Wales which suggests an opt-out system with safeguards. As we have heard today, the moral and ethical arguments continue. It is right that we have this debate and have it in the United Kingdom Parliament as well as in the Assembly and that we raise awareness of this issue and help to educate people.

I share the concerns expressed today about the insufficient organs donated in the United Kingdom. There is no doubt that we need more people to realise that organ donation saves lives. We know that, in future, organ shortages—particularly for kidneys—are likely to increase. I congratulate the hon. Member for Montgomeryshire on securing this important debate, thank all hon. Members for their contribution and look forward to hearing from the Minister how the Government propose to resolve the crisis, what their position is on a presumed consent system and what action the Department of Health is taking to carry forward the work done by the previous Government on this issue.