Examination of Witnesses (Questions 400
- 410)
THURSDAY 20 MARCH 2008
Dr Vivienne Nathanson and Dr Tony Calland
Q400 Lord Trefgarne: We know
there is an acute shortage of organs available in this country.
You say that 900 people a year sadly die through lack of a suitable
organ. We are asked to believe that infrastructure is not the
issue in this case. Can we be sure that organs are not lost through
the lack of a surgeon to remove the organ or the lack of a theatre
in which he could do it?
Dr Calland: I do not think we can.
Q401 Lord Trefgarne: Is that
significant?
Dr Nathanson: I think the lack of infrastructure
is almost certainly a major contributing factor at the moment.
Q402 Lord Trefgarne: We have
been told that before.
Dr Nathanson: The most worrying is that we certainly
could not benefit as significantly as we should from an increased
number of donors if we do not increase the infrastructure. I am
not using the word "improve" because that would suggest
poor quality. It is not about quality; it is about numbers. It
is about resources. It is about operating theatres; intensive
care units; the numbers of transplant co-ordinators, the people
to ask the question and people then to go through all the systems—and
it is a very complex process—of making sure that this person
is right for donation, that the family is comfortable, that the
recipients are lined up, that the transport arrangements are in
place, that the operating theatre time in all the other places
is available.
Q403 Lord Trefgarne: And the
simple shortage of donors is only part of the problem.
Dr Calland: Yes.
Dr Nathanson: Absolutely. The first thing you
have to do is to make sure that your infrastructure can cope with
more donors.
Q404 Lord Trefgarne: And at
the moment it could not.
Dr Nathanson: It is pretty borderline. It could
not—certainly not a significant increase.
Q405 Lord Trefgarne: Could
it cope with another 900?
Dr Nathanson: I doubt it.
Dr Calland: Probably not.
Dr Nathanson: Most transplant co-ordinators
say that they are currently working absolutely at the edge of
the limits of the constraints that they are under.
Q406 Lord Trefgarne: With
more than enough donors but just not enough—
Dr Nathanson: No, even with 900 extra donors
we would still probably have an increasing level of donor waiting
lists. One of the things that is interesting about the donor waiting
list is that people come off it because they are treated, people
come off it because they become too ill—
Q407 Lord Trefgarne: This
is the recipient waiting list.
Dr Nathanson: This is the recipient waiting
list. People come off that because they are too ill to be treated
now or because they die or because they are treated. But there
is good evidence that people are not put on the list: when their
condition is such that the doctors feel the chance of any donor
being found or of organisationally getting them treated puts them
relatively low in the list, in the hierarchy which has to be there,
and therefore it is not worth currently putting them on the list.
Q408 Chairman: Dr Nathanson,
I am sorry to interrupt you, but we want to get to the core of
some of this. Dr Matesanz who came to see us from Spain, the person
who has really driven the co-ordination, suggested to us not to
spend a whole lot of money on donor cards, advertising and all
of that, but to concentrate the funding on the infrastructure
until that was properly in place. If you were advising the Committee
and we were looking at this European piece of advice we have had,
if you like, what would your view be of that European bit of advice?
Dr Nathanson: Number one, spend the money on
getting the infrastructure right so that you can benefit from
more donors. Once you have got your infrastructure in place then
you move to presumed consent. Let us say that the UK could pass
a law this month on presumed consent, it would take three or four
years to get that in place because we would want this long period
of getting people to understand and giving real opportunities
to opt out. I think you go ahead with the debate upon the potential
for the legislation as you get the infrastructure in place and
as you put your infrastructure in place to deal with a significant
increase in the numbers of donors and therefore of recipients.
Q409 Chairman: We needed to
have that on the record. That is what we are looking for.
Dr Calland: Perhaps I might add that I think
there is also an education issue in terms of staff working in
A&E departments or medical assessment units or whatever. Their
primary aim is to deal with the patient and get everything moving
through the system, and I think opportunities are missed in the
heat of a busy running, overheating A&E department, where
people will perhaps die and potential donors are lost because
people have not had the time or have not thought about it or whatever.
That is no criticism of them and their professionalism. It is
just one of the things, that this is another additional think
to think about.
Lord Lea of Crondall: There is one element
which will have to be addressed in our report—and you did
touch on it in a way which I found a bit surprising—which
is the need for more publicity. You mentioned the Prime Minister's
statement as being perhaps unhelpful. I do not normally rush to
support the Prime Minister, although I am a member of the Labour
Party, but I would ask you this question: Is it not the case that
what he did succeed in doing is exactly what you demanded, that
at dinner parties people started to discuss this? I do not go
to a lot of dinner parties, but I can tell you that everybody
was. Is that not a fair comment?
Chairman: I think the point is made.
We do have to change over, otherwise we will not hear from our
second set of witnesses.
Q410 Lord Lea of Crondall:
Could you just give a brief answer to that?
Dr Calland: I do not think it was the Prime
Minister's fault. I think it was the Daily Mail and radio
stations, where it just disappeared into hyperbole.
Chairman: Could I say thank you very
much indeed. I just would just like to say one more sentence to
you, the other thing our Spanish doctor said to us when we asked
him what was stopping things happening in this country. He thought
for a minute and he said, "Well, you have a very old, established
Health Service." It may be that people like you have a chance
to make change happen, but he was saying to us that there is inertia
in our system because people do not like change. I just say that
as a piece of evidence we had because I think people in your position
are helpful in trying to help those changes come abut. Thank you
very much indeed for coming. We are very grateful.
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