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2.49 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on raising the subject of the debate this afternoon, and on the general tenor of his remarks. He raised a number of issues of general policy on organ donation, and I shall come to those in a moment, but he referred at the beginning of his remarks to two particular cases. It may be helpful if I start by dealing with those.
The hon. Gentleman mentioned the case of a young girl who recently underwent a heart transplant operation against her declared wishes. It is not usually appropriate for a Minister to comment on particular cases in detail, as I am sure the hon. Gentleman understands, but under the existing law, the refusal of treatment by a young person may be overridden by parental consent or by the courts. The court will always give considerable weight to the child's views, but the paramount consideration must be the best interest of the child. I am sure that the hon. Gentleman would accept that in the case that he mentioned, the issue was not so much the donated organ as the child's ability to consent or not. That issue was resolved by the court in its decision.
The hon. Gentleman also referred to the recent case involving a kidney donated at Northern general hospital, Sheffield, which was highlighted in the press. The relatives of the deceased stipulated that they did not want the organ to go to anyone who was not white. The Government's view is that organs should not be accepted with conditions attached. As far as the Government are concerned, donated organs and tissues are a national resource available to anyone who needs them, regardless of race, religion, age or other circumstances.
We would expect that policy to be explained to potential donors or their relatives. Organs and tissue should not be accepted unless they are freely donated without any conditions attached. The NHS organ donor register, as the hon. Gentleman no doubt knows, specifically excludes any donor who wishes to attach conditions to his donation in terms of potential recipients. The only restriction allowed is on the organs or tissue that can be retrieved.
The hon. Gentleman mentioned his concerns about racism. The NHS is not exempt from the provisions ofthe Race Relations Act 1976. Racism and racial
discrimination have no part in a modern and dependable NHS or in modern social services. Ever since the Government took office, we have made clear our determination to tackle racism and racial discrimination whenever it occurs. That means investigating and acknowledging problems where they occur, and taking tough action to remedy matters.
As the hon. Gentleman knows, an investigation has been set up to discover what went wrong in that incident, and to recommend any further action that may be necessary to ensure that such an incident never happens again. My right hon. Friend the Secretary of State has made it clear that if legislation is needed to keep racism out of organ donations, the Government will introduce it.
In his wide-ranging remarks, the hon. Gentleman covered substantial policy issues relating to organ donation. From his own experience, he is aware that transplantation is usually the best and most cost-effective treatment for organ failure. We know that each year in the UK, about 2,500 organs are transplanted, but there are more than 5,000 people on the transplant waiting list. However, there is a world shortage of organs, so the problem is not unique to the UK.
Paradoxically, the success of other policies has exacerbated the problem. The main source of organs is from people who have died from sudden brain injury, such as a stroke or as a result of a road accident. The UK now has one of the lowest rates of road traffic deaths in Europe and that, together with advances in neurosciences, has resulted in a reduction in deaths from intra-cranial haemorrhage by about two thirds since 1970.
In answering the hon. Gentleman's points, I shall explain first how the current organ donation system works, in terms of the legislation and in practice. The legal position is quite clear. Under the Human Tissue Act 1961, if a person has recorded his wish to donate his organs, those organs may be taken when that person dies. If an individual's wishes are known, the hospital can authorise removal of the organs. The 1961 Act does not require the relatives or any other person to be consulted in those circumstances.
If the person did not record his wishes, the organs may still be taken if it has been established that the deceased, or his surviving relatives, do not object to that. There are a number of ways in which people can make their wishes known. They can carry a donor card, put their name on a computerised register or, most importantly, make sure that their relatives know their wishes. Ideally, each individual should make his or her wishes known in one or more of those ways.
In the United Kingdom, doctors will ask relatives if they may use the organs whether or not the individual had a donor card or was on the register. There are sound practical reasons for that. It is important to ask the family detailed questions about any aspects of the donor's health or life style that would make him or her an unsuitable donor. Those might include questions about sexual behaviour and any history of drug taking. Transplant co-ordinators say that, having put such difficult questions to extremely distressed relatives, it is often very difficult to ignore their wishes if they object to the donation.
Ignoring people's wishes provokes strong responses in families and, in turn, can damage short and long-term donation rates. For example, in France, which has opt-out legislation, a public outcry was followed by an alarming
drop in donations when a couple discovered that their son's eyes had been removed against their express wishes. That incident, which received widespread coverage in the media, was followed by a 20 per cent. drop in organ donation and a 30 per cent. drop in corneal donation. It took three or four years for the donation rate to recover. To reassure the public, the law in France was amended to require that relatives be approached when the wishes of the donor are not clear.
The hon. Gentleman argued that the current system allows the family to overrule the wishes of the donor and implied that many organs that could be donated are lost because of that. That is not the case and refusal is almost unknown when relatives know that their loved one wished to donate. I understand that there are refusals in less than 1 per cent. of cases.
Dr. Harris:
I should put it on record that I made it clear that overruling is extremely rare when express pre-mortal consent has been given, and I certainly accept the Minister's figure of 1 per cent. or less.
Mr. Hutton:
I am sorry if I have caricatured the hon. Gentleman's argument. I did not intend to do so, but I thought that he was implying that requiring relatives to state their position on the donation somehow places an unnecessary burden on the present system. My point to him is that it is not a burden and refusal rates are less than 1 per cent. in those cases in which the deceased person has made his or her wishes known.
Potential donations are much more likely to be lost when families do not know the wishes of the deceased relative. For the reasons I have outlined, families must be consulted. Potential donors are usually those who have died unexpected, traumatic and sometimes untimely deaths. Some families find solace in the thought that their relative's organs will give life to others. I must emphasise that the majority of families--three out of four--agree to donation. If a minority find the idea abhorrent, do we really feel that the hospital should add to their distress by insisting on removing the organs? I am sure that the hon. Gentleman would not want to go that far.
Additionally, opt-out as it is run in many European countries does not exclude consulting families. In most countries, whether they have an opt-in or an opt-out system, hospitals will not take organs if the family of the deceased person objects. The consulting of relatives is, therefore, not a distinction between opt-out and opt-in systems of organ donation. I have to say to the hon. Gentleman that I am not convinced that introducing an opt-out system would solve the organ shortage in this country. Far from it; the most important factor in any donation system is public confidence, to which he referred repeatedly. All organ donor schemes depend on public support, whether they operate within an opt-in or an opt-out system. As he rightly said, there is no consensus on that issue among the public or the professions.
A survey undertaken in May on behalf of my Department asked which of those two systems people would prefer to have in the United Kingdom. It found that 50 per cent. were in favour of the current system, but only 28 per cent. were in favour of an opt-out system. There is a 22 per cent. net preference for the current system.
The rest of the sample--22 per cent.--expressed no preference at all. That is clear evidence that currently there simply is not public support for an opt-out system.
Dr. Harris:
I recognise those figures, and I have seen the poll. Given that bald question, that is the public's position at the moment, but if it were shown that such a change in the system could increase the number of organs donated--that is the key question--and therefore save lives, and if the question were restated in those terms, supported by a professional consensus, the figures might change. Had transplantation not been allowed 30 or 40 years ago only on the basis of a public opinion poll, a million or so lives might not have been saved worldwide through transplantations. Those figures should therefore be treated as a basis, not as an end.
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