Examination of Witnesses (Questions 211
- 219)
THURSDAY 21 FEBRUARY 2008
Dr Anthony Warrens and Mr Keith Rigg
Q211 Chairman:
Welcome. We are very grateful to you both for coming. We are looking
very much to hearing your evidence and will, of course, have read
any submissions you have made. I have to do some rather boring
housekeeping points, and I have to do them out loud for the record.
The nice thing is to say that we do have Professor Farsides, our
adviser, helping us here today. I have to remind you that the
session is open to the public. As you can see, we have got masses
of public here this morning, but it is recorded for possible broadcast,
so you will have to remember that we are very much on record.
A verbatim transcript will be taken of your evidence and this
will be put on the public record in the printed form and on the
Parliamentary website; so we are very transparent in the open
this morning. After the session you will get a copy of the transcript
to check for accuracy. Can you advise us on corrections as quickly
as possible? Things here move very rapidly from one bit to the
next and we would like you to have the opportunity of corrections
if you have any. If you feel at the end we have not got through
everything, you can send us supplementary evidence—we are
always grateful for anything that will help us with what we are
doing—amplifying points or telling us things that we have
not had a chance to get through. These rooms are not easy. You
may think that we have got a PA system; in fact they are not wonderful.
Unless you address us, as I am trying to, as rather semi-public,
we will not hear you and we do want to hear what you have to say
to us. If you could keep your voices and your heads up as much
as possible, we will try and do the same and we will then be able
to hear what you have to say. When you begin, although we have
got your names here, we have to ask you to state your name and
background for the public record, then I will ask if you want
to make a short opening statement and then we will move into the
questions. Although you have been advised of the questions, you
know that members can ask others if they so wish. They may not
ask all the things you might expect, partly because we have had
a lot of witnesses, but I think you will find we will cover a
lot of ground. Would you begin by stating your names for the public
record and then letting me know whether or not you want to make
an opening statement?
Dr Warrens: My Lord Chairman, I am Anthony Warrens;
I am a consultant renal physician at the Hammersmith Hospital
where I have a specialist interest in the management of the transplant
recipient; I am also an academic at Imperial College, where I
am a Reader in renal medicine and immunology. I am also a trustee
and Treasurer of the British Transplantation Society and I prepared
the submission, obviously, after consultation with my colleagues,
the other trustees and the Council of the British Transplantation
Society so that the information you had represented the feelings
of the senior member of the Society. Finally, I am a member of
the Advisory Committee on Safety in Blood, Tissues and Organs.
After Mr Rigg has introduced himself, I am happy to make a short
opening comment.
Mr Rigg: Good morning. My name is Keith Rigg;
I am Vice-President of the British Transplantation Society and
I am a consultant transplant surgeon at Nottingham University
Hospital. I am also a member of the Human Tissue Authority.
Q212 Chairman: Thank you very
much indeed. Dr Warrens, would you like to make your brief opening
statement, remembering that we have had your documentation?
Dr Warrens: I think all I wanted to do is just
focus the conversation at the beginning on the fact that we are
talking about a situation of real human suffering for a large
number of people who do not have the opportunity to have organ
transplants. One of the great attractions of my area of medicine
is that I see people on a regular basis whose lives are transformed.
Their quality of life on dialysis is often very poor and even
days after their transplant operation, they come into my clinic
and say, "I have been given my life back." The sad thing
is that there are so many people out there that do not have that
opportunity because we have got an insufficient supply of organs,
and so I think it is very gratifying to those who are involved
in this field to see the Government, Parliament and the European
Commission taking an interest in what we believe is very important.
My message is simple: for every new donor that we find, we can
give our recipients approximately 56 extra years of life.
Q213 Chairman: We are all
aware of the UK Transplant Report, but we are very much focused
on the European Union issues and how that whole scenario can help.
We have to get a baseline of what happens in the UK to understand
it, but we really want to focus on how the European Union can
help. As you know, they have had the Directive, which concentrates
on the quality and safety of organ donation, and then the formulation
of the action plan to strengthen co-operation on organ donation
between Member States, and you have said somewhat about that,
Dr Warrens, in your evidence. What we would like to know is what
are you views on the benefits that action at EU level on organ
donation could have for citizens across the EU and, more specifically,
for UK citizens, and what disadvantages do you think there might
be, as our job is to scrutinise Europe on behalf of UK citizens?
Dr Warrens: My Lord Chairman, I think there
are tremendous opportunities with the interest that has been taken
at a European level to help the patients both throughout Europe
but also in the UK by the pooling of expertise. As I am sure you
are very aware, our donation rate in the UK is significantly lower
than many other countries in Europe and, therefore, there is a
lot we can learn from how they have managed to increase their
donation rate. It is interesting, if you look at the change in
donation rates, we were on a par with countries like Spain and
Belgium perhaps five years ago, but now they have raced ahead
of us; so there are things that we can do to find out and improve
our services locally. We can learn about how they have organised
their services, how they have communicated to the citizens of
their country the importance of organ donation. I think that is
something that we need to give some focus to in this country,
as has been highlighted very nicely in the excellent document
that was published by the Organ Donation Taskforce in January
of this year. We believe there is also a general requirement to
increase public awareness in the UK. These are the positive sides:
co-operation, information exchange, improvement of systems based
on what other countries have done. I am less convinced that there
is a role for organ sharing or having a supranational organisation
as a general way of distributing organs to recipients throughout
Europe, because I think that is something that currently we do
well in this country. I think UK Transplant is a first-class organisation
that has got very high level buy-in from professionals who are
active in the transplant world, and so I feel that is an area
that perhaps we would be able to help some of our sister countries
in Europe with, information exchange. I know you have already
heard from Mr Chris Rudge, who is the Managing Director of UK
Transplant, and his organisation makes a very major contribution.
I think that would be my feeling: it is information exchange rather
than supranational organisation that will move us forward.
Q214 Chairman: Certainly we
have heard from some of the witnesses about their anxieties regarding
the possible bureaucratisation of the work, and the medical profession
really feel that the EU could add a dimension of gold-plating
that would make it more difficult for some services to be developed.
Do you have a view about that and any experience from which to
form a judgment?
Dr Warrens: I would generally agree with that
view. Services, where possible, are better developed locally,
and I think it would be hard to find a model that would be easily
applied to all the different Member States of the European Union.
I think we should cherry pick the things that we can do well by
sharing information and by sharing best practice, but I think
if there is the potential for, as you have already said, excessive
bureaucratisation if we were to impose a system where we actually
have something that works very well in the UK.
Q215 Chairman: Before I move
on to Lord Lea, I am involved in children's services in relation
to Hypoplastic Left Heart Syndrome children. We therefore know
about other children through the Heart Federation. Recently a
child received a heart from Spain which actually saved her life,
not a child with Hypoplastic Syndrome but another child. How do
you see that kind of co-operation if you do not see a register?
Dr Warrens: That already happens, as you have
already said. There are situations where we do share organs. We
were relatively recently offered a kidney from Spain. I think
you have highlighted the important area where we can effectively
co-operate, and that is in the area of difficult transplants,
patients who are difficult to find a match. That may be because
of the disease they have got or the nature of their immunological
status, for example. Somebody who may have high levels of antibodies
is one example, to a molecule that is very common in the UK population
but may be less common, let us say, in sister countries in Eastern
Europe. So there is the potential for helping those people, and,
I think, if we develop services focused on the people with particular
problems in the UK then we may help them, but overall, the system,
I think, has a number of pitfalls that you have already implied.
Q216 Lord Lea of Crondall:
I think that last reply was very helpful to me because I was beginning
to wonder whether we were, talking at cross purposes about the
European structure which will just run the thing. I do not think
anyone was suggesting that. I think you used the expression you
are less convinced about organ sharing or a European structure
for organ transplants. You will perhaps tell me where I have written
that down wrongly, but the essential question follows on from
what you have just said. You have given us in your evidence a
very interesting example from the group who are difficult to transplant,
for example, Human Leucocyte Antigen sensitisation, is that right—
Dr Warrens: That is right.
Q217 Lord Lea of Crondall:
---and the increased pool of potential participants that this
would generate could help the practice of paired donation, which
has been found difficult within the UK alone. Then, paradoxically,
in some ways, you say, "We are not convinced there is yet
a role for a Europe-wide unified single organ sharing scheme."
Is that not comparing apples with oranges? Within the spectrum
of one to ten you want information sharing, which is number one,
but for some purposes you want numbers three, four, five six and
seven and yet you have got to have some rules about reciprocal
arrangements around all of that; so it is not just something that
is number one in some across the board way, is it?
Dr Warrens: No. I think you are absolutely right.
There are situations, and they happen now, as you have said, where
we do share organs and, therefore, to have a background framework
in which we can be sure that the level of safety of organ transfer
is high enough to meet our standards is important. What I am talking
about is where all organ transplants went through a supranational
sharing scheme is a situation that I think many of us in the profession
would be worried about; it is a situation where we might end up
losing time, losing organs because of the excessive bureaucratisation
of it, but at a specific, particular difficult transplant level,
it may very well be an attractive option to try and develop. Does
that clarify?
Q218 Lord Lea of Crondall:
It is a big step forward, but it is not totally clear me, therefore,
which bits of the EU paper do you agree with and which bits do
you not agree with: because you are knocking down a bit of an
Aunt Sally insofar as what you are not agreeing with is not what
is their paper, is it?
Dr Warrens: I felt it was implied by the paper.
Q219 Lord Lea of Crondall:
Which bit of it is that then?
Dr Warrens: I do not know that I am going to
be able to give you chapter and verse. Mr Rigg was going to talk
about pooling. Perhaps if he wanted to address that answer I will
see if I can find it.
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