Organ Donation (Deemed Consent) Bill

Matthew Offord Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Nigel Huddleston]

My hon. Friend makes a perfectly valid point that I am sure will be raised again in this debate, but we are talking about a matter of life and death. All the surveys show the large number of people willing to support organ donation in principle, so it is alarming that the number who are actually on the organ donation list is relatively low, despite the fact that it takes literally two minutes. In an ideal world, everybody would be completely educated and would voluntarily make their own choice, but that is not happening. Many such issues will be raised in Committee; I hope we will be able to find a reasonable alternative.

[Dr Matthew Offord (Hendon) (Con)]

Is my hon. Friend aware that in the past 10 years the number of organ donors has increased by 75% and the number of transplants by 56%? Is there really a need for the Bill?

[Nigel Huddleston]

There is indeed, because there is still a long way to go and people are still dying because they are not getting the donations or transplants that they need. There absolutely is a need to move forward with the Bill.

Let us look at the alternative systems around the world. The example of Spain is often mentioned. We are looking at the system there as some kind of model, although perhaps not an exact one. Spain leads the world with 43.4 deceased donors per million. It is joined at the top of the statistical league table by other opt-out systems in countries such as Croatia, Portugal, France and Italy. All these countries have better donor rates than England and all have opt-out rather than opt-in systems. Another advantage of such “soft” opt-out systems is that they do not deny or restrict the role of bereaved families, and they allow families to be consulted on the wishes of their loved ones. That is important.

One thing that surprised me about that 43.4 per million figure was how incredibly low it is. Half a million people die in the UK every year, yet just 1% of them die in circumstances or conditions that allow them even to be potential donors. It is important to note that just because someone is on the donor list, that does not mean that they will end up donating their organs, but we need to get the figure as high as possible to help as many people as we can.

We also need the supporting infrastructure to enable those who wish to donate actually to do so. We have all heard about people who have been willing to donate their organs but have, for example, passed away at the weekend in a hospital in which there is no capability to take the organs out of their bodies and transplant them. We need to look carefully at the supporting mechanisms for any changes that are introduced.

Quite a few colleagues have mentioned the need to raise overall awareness, which is linked to the need to encourage family consent. It is telling that in cases where a specialist nurse is involved, donation consent rates are 68.6%, whereas if a specialist nurse is not involved, consent rates plummet to 27.5%. That is clear statistical evidence that when people are provided with impartial but expert information about the possibility of donating, they are more likely to consent to donating their organs.

One problem is that there is still an awkwardness or queasiness about the idea of one’s body being examined and operated on post-death. We are often comfortable about that ourselves, but, in the horrible circumstances of someone passing away, particularly if the circumstances are tragic or the death unexpected, our families are particularly queasy about the idea. It is therefore vital that we continue to have these dialogues—that we all go home and have these conversations with our families, including our children, because of course children can also become donors. We must have informed conversations.

It is simply not right that 80% of people say that they would be willing to donate their organs, but only 36% actually register to do so. The number is increasing, but we need it to be much higher. In a well-publicised opt-out system, those figures could converge, and the 20% who are unwilling to donate would have a simple mechanism for making sure that they do not have to do so.

Many years ago, I was asked if I had a private Member’s Bill—I think it was during one of the selection processes—what would it be. It would be exactly this one. The hon. Member for Coventry North West should be in no doubt that I fully support this Bill, and I hope that many of, if not all, our colleagues will do so too.

--- Later in debate ---

[Dr Matthew Offord (Hendon) (Con)]

I congratulate the hon. Member for Coventry North West (Mr Robinson) on promoting the Bill, and I know that it will make progress today. As many people have said, 80% of British society support organ donation, but 20% do not. I want to speak on behalf of that 20% to ensure that they are carried along with the debate, rather than left behind.

A gentleman in my constituency, Vijay Patel, was recently unnecessarily killed, and his family took great comfort from the fact that his organs were used to help other people. For me, that is such a gift, and I commend anyone who donates, and their families, for allowing the donation to take place. Many people prepare themselves to be organ donors after they die, and their families are an integral part of that process. Within that wider framework, the crucial role of the donor’s family must be understood, because their role regarding the ownership of the body after a person dies, and their duties towards it, is a central aspect of the grieving process.

There has recently been a lot of concern about a north London coroner who refused to release bodies, which is causing a great deal of concern to my constituents. It therefore follows logically that the family must be involved in organ donation, and I believe that their consent is paramount at the crucial time. Those families need reassurance along their pathway towards consent.

It has been said that there are religious differences on donation, but that is incorrect. Both Islam and Judaism allow organ transplants from live and deceased patients in order to continue and save lives. One factor that perhaps some are not aware of, and that might influence the decision-making process of some families, is how the point of death is decided. Some people regard death as defined by cardiovascular criteria, which is when the heart ceases to function. Others use cessation of brain function—brain stem death—as their criterion. Those two distinctions sometimes make people uncomfortable with donation.

The National Institute for Health and Care Excellence recognised both definitions of death when it formulated the NICE guidelines that explain how healthcare professionals should support a bereaved family when discussing organ donation. There is one pathway for those who accept only cardiovascular death, and another for those who accept brain stem death. As a result, families are helped to understand how they might be able to combine deceased organ donation in a way that does not interfere with some religious traditions.

Enabling someone accessible to guide a family through the donation process is a humane, sensible and constructive proposal. A properly trained and resourced transplant co-ordinator should be able to do that, as it is the most important way in which families can be supported at a terrible time in their lives. In practice, however, under the system proposed, there would be less institutional incentive for health services to employ such people.

The Government are aware of the issues around transplantation, and they cannot plead ignorance in that our religious communities are being unresponsive to human need. In 2013, leading Muslim and Jewish groups wrote jointly to the Government suggesting a way forward in which an enhanced and improved opt-in system could be introduced that would alleviate their concerns. Improvements would include a Government-backed statement that Jews and Muslims could sign, which would enable them to donate organs in a manner compatible with their beliefs. If that approach were to be adopted, it would enable the two communities to be even more supportive of an opt-in system than they have been in the past. That proposal has been raised on several occasions, but I am afraid it has been ignored. The hon. Member for Coventry North West mentioned former Chief Rabbi Lord Sacks, who he said opposed such measures. As I understand it, however, the current Chief Rabbi, Rabbi Mirvis, is in favour of the proposal I have just outlined.

Life, and indeed death, has changed for many people. More people want, understandably, to spend their final months at home. If they die at home, organ donation is much less likely. Healthcare professionals who need to secure consent for donation must have a conversation with organ donors, and their loved ones, about why they are best placed to give the gift of life if they remain in hospital. That conversation is a natural feature of an opt-in service. Under an opt-out service, there will be little incentive to have that complex discussion with potential donors and their families. The result could be that patients might drift to spend their last months in hospital.

[Bob Stewart (Beckenham) (Con)]

May I ask my hon. Friend, as a doctor, how quickly the medical profession can assess whether someone who has died is the right sort of person for a donation? So few people are the right fit for a donation—1%, as I understand.

[Dr Offord]

I cannot mislead the House, because unfortunately I am not a medical doctor and I am not able to answer that question. I am certainly content to talk about socio-economic deprivation in places such as Cornwall, which was part of my PhD thesis, but I will leave the issue raised by my hon. Friend alone. He mentioned the 1%, but other potential donors and their families could be intimidated by clinical settings, have problems with language skills or be too emotionally distraught actively to engage with a system that lacked incentives to ensure professional support throughout their decision-making process. Such potential donors and families could find their rights eroded in that practice.

My hon. Friend the Member for Shipley (Philip Davies) made a point that I wish to echo. The underlying question raised by some considerations is whether public services should treat patients and their families as citizens whose active consent must be sought as a legal duty, or as subjects whose ability to choose whether to donate or not depends on the goodwill of well-meaning but overstretched professionals. Ultimately, an opt-in system that harnesses the role of both religious and civil society to increase organ donation from deceased donors is, for me, the best way forward to maximise organ donation while defending not only religious freedoms, but the rights of all potential donors and families.