Organ Donation

Anne Milton Excerpts

Wednesday 30th November 2011 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

Thank you Mr. Crausby. It is a pleasure to serve under you today. I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this debate on presumed consent. I also thank him for his thoughtful contribution. Like him, I am fixed only on the evidence. I do not have an ethical position on this—I will act on the medical evidence in front of me. Sometimes, with an issue like this, there is a huge danger that the plight of those waiting to have a transplant clouds the ability for some to consider the evidence clearly. What matters is what actually works. The hon. Member for Denton and Reddish (Andrew Gwynne), the shadow health spokesman, outlined some of the complex issues around presumed consent and what faces the public.

This is not a party political issue. It is an issue decided on by politicians, but I would be saddened if it became a party political issue. It is also not an opportunity to exchange insults. Rather, it is an opportunity to make a difference. So, if nothing else, I would urge hon. Members to leave the Chamber today, and call their local press to see whether. together, they can start a campaign to raise awareness and to begin a conversation in their constituencies. Politicians generally have considerable access to the press. On the whole, we are not averse to having the odd photo of ourselves. I am sure that we have opportunities to raise awareness of this important subject.

There are now about 10,000 people requiring a transplant. Three of them die every day waiting for a transplant or after they are taken off the list because, tragically, they are too ill. Research shows that the majority of people in the UK support transplantation. Extensive reference has been made to Wales, and we shall study those proposals carefully before we respond. But I want to make it clear that the Government do not believe that the introduction of presumed consent, by itself, will necessarily lead to an increase in donor rates. It is important that any Government keep the evidence under review.

As many hon. Members have said, the organ donation taskforce considered the issue of presumed consent in great detail. As my hon. Friend the Member for Cardiff North (Jonathan Evans) said, many of those involved in the taskforce changed their minds, and that is an important point to make. In its second report, published in 2008, the taskforce did not recommend introducing an opt-out system. It felt that an opt-out system would have the potential to deliver benefits but, as my hon. Friend said, it would also present significant challenges that would need to be overcome. Instead, the taskforce believed then, and believes now, that a significant increase in donor rates can be achieved by acting on the recommendations in the first report.

The UK needs to maximise its potential for donation and make organ donation a usual part of health care. We still believe that the implementation of those recommendations will result in an increase in organ donation rates at least 50% by 2013, and that is still on track. Through NHS Blood and Transplant, the number of specialist nurses, clinical leads, donation committees and donation chairs in acute trusts have all increased, and that has borne considerable fruit—since 2008, an increase of 31%, up from 28% —those are the most recent figures.

Some studies suggest a link between presumed consent and higher donor rates, but closer examination shows the picture to be very much more complex—my hon. Friend the Member for Kettering (Mr Hollobone) was so right. Spain has been quoted at length. It has a donor rate of 32 per million of population, compared to the UK’s 16 per million. They have presumed consent, but the architect of the “Spanish model” has repeatedly stated that the legal basis of consent is irrelevant to organ donation. What is critical is the organ donation and retrieval system in place, with highly trained staff and a well-designed donation framework, supported by high public awareness of the issues and benefits. We need awareness and a conversation with our families. In practice, I doubt whether there is a surgeon anywhere who would take an organ from somebody without the consent of their family.

I am pleased to report that organ donor rates have increased by around 31% since 2008 and we are on track to meet the 50% improvement. On top of that, over 18 million people, some 29% of the United Kingdom population, have added their name to the organ donor register. In 2010-11, there was a record number of deceased organ donors—1,010 donors compared with 745 in 2001-02. That year also saw a record number of transplants from deceased and living owners—3,740 transplants were carried out in the UK, compared with 2,600-odd in 2001-02. However, despite the progress, there is still a shortage of organs and I am surprised that more has not been made of the inequalities that surround this issue.

The situation is very serious for people from African-Caribbean and Asian backgrounds, who are three to five times more likely to need a kidney transplant. Almost a quarter, 23%, of patients waiting for a kidney are from black or minority ethnic groups but they make up only 8% of the UK population. Three quarters of people from a BME background refuse organ donation when asked, compared with an average figure of 40%. There is particular and specific issue, which we need to address, but it is not insurmountable. We need more people from BME communities to register to donate their organs and, more widely, there needs to be a greater understanding in BME communities of the problems that they face—a greater need for kidney transplants, longer waits and less well-matched organs being donated for their communities.

We cannot be complacent and must carry on the work of the previous Government through schemes such as the give and let live initiative; requiring people to answer a question on organ donation when applying for a driving licence on-line; signing on the organ donor register when applying for a European health insurance card or a Boots advantage card; and specific initiatives within the black and minority ethnic populations, like working with faith organisations, radio stations, charities and community groups. What we really need is for people to sign up to having a conversation with their families. That is what really matters.

Work continues at every level on referring and procuring organ donors. We are also trying to make organ donation a usual part of end-of-life care. I hope hon. Members will think on that for a moment. When we think about making organ donation a part of end-of-life care, one realises what a complex, emotional and sensitive issue this. The hon. Member for Llanelli (Nia Griffith) mentioned families talking about this matter. That is so critical, so that when tragedy comes, the transition to donation is simple.

We have set up a transitional steering group, and it will focus on six key areas: increasing consent rates; brain stem death testing in all appropriate cases; donation after circulatory death to be considered in all circumstances; increasing donation from emergency medicine; referral of potential donors; and improving donor management.

I thank hon. Members for their thoughtful contributions. I know that this is an emotive issue that raises strong feelings. We need an evidence-based approach. I thank all those in this country who have donated the organs of family members in the midst of the turmoil of death. That death has and does give life to others—not just one person, but often two, three or four people. Nothing can ever relieve the burden of grief or loss, but nothing can replace the gift of life that organ donation represents. We have to use every tool at our disposal to increase those donation rates. We have to remind people, at every opportunity, that this is about a gift of life and in particular focus on those communities that are more disadvantaged than others.