Organ Transplants

Kate Green Excerpts

Tuesday 8th July 2014 Westminster Hall

[Kate Green (Stretford and Urmston) (Lab)]

It is a pleasure to see you in the Chair this morning, Mrs Osborne. I thank the Backbench Business Committee for finding time for this debate during national transplant week. I also thank my hon. Friend—if I may call him that—the Member for Strangford (Jim Shannon) who went to the trouble of taking the proposal to the Committee. It has been really good to hear so many powerful speeches this morning, in particular that of my hon. Friend the Member for Bridgend (Mrs Moon), who moves me every time she talks about what is happening to her and her husband. It is incredibly brave to talk about such things publicly. For people paying attention to this debate, what she said will have brought home why they must talk to their families tonight about being an organ donor not only so that they will know their wishes, but also to inspire other family members and friends to join the register. We must remember that being on the register does not mean that just one life could be saved; up to nine lives could be saved or improved. Being an organ donor is an incredibly good, generous, human thing. If we can achieve one thing from today, I hope that more people will confidently register as donors and that families will give their consent to organs being donated at what are difficult and traumatic times.

The progress that we have made in increasing the number of registered donors is great. I was grateful for the tribute paid by the hon. Member for Montgomeryshire (Glyn Davies) to my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), who has a family interest in the matter. It is particularly powerful when hon. Members’ personal circumstances inform our debates and policy decisions. However, one under-represented group on the donor register is families from certain ethnic minority communities, which is a big issue in my ethnically diverse constituency. What steps are the Minister and NHS Blood and Transplant taking to increase donation rates among minority communities, because their need for donations is as great as any other?

I want to talk specifically today about lung transplantation, which I have discussed before not least because I was introduced to the issue by a constituent of mine, Natalie McCusker, who received a double lung transplant at Wythenshawe hospital last year. As did other hon. Members, I want to thank the Cystic Fibrosis Trust for the helpful briefing and support given for today’s debate and more generally. I also welcome the progress made since my Adjournment debate on the subject almost exactly a year ago when I talked specifically about the problems with the allocation system and how certain parts of the country, including my region of the north-west, were losing out. It is not just that in comparison with other European countries the UK performs less well; within the UK some zones do much better than others. The north-west is one zone where people have a particularly long wait for lung transplants. I welcome the allocation of super-urgent cases on a national basis and the annual review of the size of zones, which are both good steps forward.

There is, however, scope to do more. We could look at extending national allocation to all super-urgent cases and then perhaps to urgent cases. In due course, we could run the whole country on a national allocation basis. I realise that NHSBT and the Minister will want to examine carefully the possible consequences for patient outcomes, but can she assure us that the proposal remains under live and active consideration? International evidence suggests that a national allocation system could produce as good if not better outcomes. When we are so far down the European league table, it is right to consider what we might learn from other countries.

I am also pleased that NHSBT has reissued some of the guidance relating to transplantation, in particular guidance on the difficult transition from child patient to adult patient, which was exactly the situation that my constituent Natalie found herself in. She was initially being treated at Great Ormond Street hospital, but when it became likely that she would need a transplant, she was coming up to her 16th birthday and so had to transfer to the adult list and effectively lost about a year in terms of her being deemed ready to receive a transplant. I understand that improvements have been made in the guidance on handling that transition. I will be grateful for any update that the Minister can give us.

Supply of organs has been discussed by other hon. Members this morning. There have been important and welcome developments on resizing, which is especially important for children, women and CF patients, who are likely to be of smaller stature. Colleagues also pointed out, however, that only a tiny handful of doctors are able to carry out the resizing operation. What steps are being taken to extend that capacity?

Similarly, what about extending the criteria for usable lungs, which is clearly a sensitive issue? Patients’ own wishes and—I do not say the word in a pejorative sense—prejudices have to be taken into account. As the hon. Member for Strangford said, however, international research suggests considerable potential for more marginal lungs to be reusable, while differentiation between different transplant centres even within the UK is apparent. Harefield is doing particularly well, perhaps showing the way.

Will the Minister update us on what is being done to assess the evidence further on extending criteria and revising guidance? Will she also tell us what is being done about looking at the very different rejection rates in the different centres around the country? That is of particular importance when we are stuck with the zoning system, which means that people may be forced to go to a centre where rejection rates are much higher than if they were in treatment elsewhere.

Like the hon. Member for Strangford, I shall comment on some of the other techniques being developed. For example, the ECMO technique is highly specialist, as he said, and it is clearly appropriate, not in all, but in some circumstances. It will be useful to hear what work is being done to provide detailed guidance.

In particular, I wanted to raise an issue that has not yet come up this morning, which is funding for transplantation. There is no use doing what we are doing so successfully to increase the number of donors and to improve the usability of lungs and the techniques that mean more transplants can be carried out because the surgery and the science are there to enable them, if we have not in parallel put in place the funding to ensure that we can pay for an increased number of transplants. The national commissioning team understood well that the funding models had to be designed and progressed alongside and in parallel with the science, the improving clinical strategies and the successful public registration and awareness campaign.

Other interventions, however, are now competing with transplants for funding, while the specialist services budget, which funds transplants, is under pressure and might even face cuts. At the same time, commissioning is moving to local area teams, which will not have the same understanding of some of the decisions that need to be made on transplantation priorities, which risks us moving to an unco-ordinated approach and widening inequality of outcome between centres.

Transplantation risks becoming underfunded even as the numbers that can be treated are on the rise. We have already seen a significant increase in the number of transplants carried out in recent years, and that will increase further as allocation methods improve, donation rates increase and technology allows more lungs to be used. It would be an absolute crying shame if the strides forward in good practice were stymied by a lack of resource or by a commissioning model that cannot optimise the clinical progress and the public engagement being made.

I am, like others, pleased that we have had the opportunity to explore the subject this morning. I look forward to hearing the Minister’s response.