Examination of Witnesses (Questions 255
- 259)
THURSDAY 28 FEBRUARY 2008
Dr Paul Murphy
Q255 Chairman: Good morning,
Dr Murphy. We are grateful to you for coming. Obviously you bring
with you a great deal of knowledge about intensive care units.
Would you like to start by giving an opening statement?
Dr Murphy: My Lord Chairman, I am happy to go
straight to questions.
Q256 Chairman: Perhaps we
could begin by talking a bit about intensive care units across
the European Union. Could you tell us how intensive care provision
within the UK compares with other European Union countries and
if this correlates at all with performance in organ donation.
Dr Murphy: Comparative data on the provision
of critical care capacity across Europe is not that easily come
by and that which is available has to be looked at with some caution,
because what is intensive care in one Member State may not necessarily
equate to the same provision or level of care in another. The
data that is available—and it is most commonly expressed
in terms of the number of critical care beds as a percentage of
the total number of acute beds, say per 100 acute beds in a hospital—would
suggest that the United Kingdom is relatively underprovided for.
Data on the intensive care website shows that the UK has around
two-and-a-half intensive care beds per 100 acute hospital beds
and that compares with, at the other end of the scale, Denmark,
which has just over four intensive care beds per 100 acute hospital
beds. If you correlate that with donors—most commonly expressed
in terms of donors per million population per year—then
you will find no relationship. Denmark has a lower donation rate
than the UK, despite its apparently high provision for critical
care beds. Spain has 3.2 ICU beds per 100 acute hospital beds
and yet we are all well aware that it has a donation rate of three
times that of the United Kingdom. In terms of critical care capacity
or provision, my opinion is that there is little, if any, relationship.
That is not to say that there are not differences in the way in
which clinicians act in a hospital when dealing with a patient
with the most life-threatening of intracranial emergencies like
a brain haemorrhage; that is not to say there are not differences
in the way those emergencies are managed that reflect in a differential,
access or otherwise, to an intensive care unit—and if you
do not get into an intensive care unit, in all likelihood your
potential to donate should you die is lost. Perhaps I can give
the Committee an example of that. Imagine, if you will, a patient
in an accident and emergency department with a very severe brain
haemorrhage. It is judged—and there is no doubt or debate
over this, that the patient will not survive from that brain haemorrhage
but has not yet died. In some countries that patient would nevertheless
go to intensive care—and by going to intensive care the
potential to donate is preserved. In this country there is an
emerging view that to take the patient to intensive care, whether
there is a bed or not, would be futile because the patient is
not going to survive and therefore why would we wish to put the
patient through that process. There is an emerging suspicion amongst
intensivists and amongst transplantation specialities that those
patients are dying in an accident and emergency department or
in a side room on a ward and their potential to donate is thereby
lost. It is not about critical care capacity, it is about clinicians'
decision-making over who should or should not go to intensive
care.
Q257 Chairman: It is a management
issue
Dr Murphy: I think so.
Q258 Chairman: We have heard
that on a number of occasions.
Dr Murphy: It is a management issue and it is
also—and we may come back to this—an ethical issue:
Why did you take a patient to intensive care if you believed their
condition to be futile?
Q259 Lord Lea of Crondall:
If you say there is a suspicion emerging, what are the guidelines
on this?
Dr Murphy: There are no guidelines.
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