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Charities Bill [HL]
Lord Grocott: My Lord, I beg to move the Motion standing in the name of my noble friend Lady Scotland of Asthal on the Order Paper.
Moved, That the amendments for the Report stage be marshalled and considered in the following order:
Clauses 1 to 6, Schedules 1 and 2, Clauses 7 and 8, Schedules 3 and 4,
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Clauses 9 to 12, Schedule 5, Clauses 13 to 29, Schedule 6, Clauses 30 to 33, Schedule 7, Clauses 34 to 73, Schedules 8 to 10, Clauses 74 to 77.—(Lord Grocott.)
On Question, Motion agreed to.
Civil Partnership Act 2004 (Overseas Relationships and Consequential, etc. Amendments) Order 2005
Code of Practice: Access and Unfair Practices during Recognition and Derecognition Ballots
Code of Practice: Industrial Action Ballots and Notice to Employers
Lord McKenzie of Luton: My Lords, I beg to move the three Motions standing in the name of my noble friend Lord Sainsbury of Turville on the Order Paper.
Moved, That the draft order and codes of practice laid before the House on 5 July be approved [2nd Report from the Joint Committee].—(Lord McKenzie of Luton.)
On Question, Motion agreed to.
Fire (Scotland) Act 2005 (Consequential Provisions and Modifications) Order 2005
Further and Higher Education (Scotland) Act 2005 (Consequential Modifications) Order 2005
Mental Health (Care and Treatment) (Scotland) Act 2003 (Consequential Provisions) Order 2005
Lord Evans of Temple Guiting: My Lords, I beg to move the three Motions standing in my name on the Order Paper.
Moved, That the draft orders laid before the House on 7 June be approved [First Report from the Joint Committee]—(Lord Evans of Temple Guiting.)
On Question, Motion agreed to.
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Railways (Convention on International Carriage by Rail) Regulations 2005
Railways Act 1993 (Determination of Turnover) Order 2005
Lord Davies of Oldham: My Lords, I beg to move the two Motions standing in my name on the Order Paper.
Moved, That the draft regulations laid before the House on 13 June and the draft order laid before the House on 14 June be approved [First Report from the Joint Committee.]—(Lord Davies of Oldham.)
On Question, Motion agreed to.
Organ Transplants
11.30 am
Lord Hughes of Woodside rose to call attention to the benefits of organ transplants, and the case for increasing the number of organ donations; and to move for Papers.
The noble Lord said: My Lords, I am grateful for the opportunity to raise such an important issue as organ transplantation. I shall speak today with particular reference to kidney transplantation. I declare an interest in this area as the honorary president of the National Kidney Research Fund in Scotland. However, I enter the caveat that the views I express are my own, and not necessarily those of the NKRF.
Transplantation is truly one of the miracles of modern medical science. It quite simply offers patients with end-stage renal failure, who would otherwise die or have to endure daily lifelong dialysis treatment, the opportunity to live a normal life.
Much has been achieved over the past 10 years since the establishment of the Organ Donor Register to raise awareness of the importance of organ donation and to encourage people to register as doners. As a result, there are now 12 million people on the register. However, in applauding the Government's efforts to boost organ donation, we must not lose sight of the fact that there remains an acute shortage of available organs for transplants.
Some 6,204 patients are currently on the waiting list—696 of those are in Scotland—for a life-saving transplant. The average waiting time for a kidney transplant is 792 days for an adult and 168 days for a child, but I am aware of cases where the wait has been several years. Those figures are based on adult patient registrations in the UK during the period 1998–2000 and paediatric registrations in the UK during the period 2001–03. I am grateful to the NKRF for supplying me with them.
The UK's record falls well short of transplantation rates in other European countries and shows marked regional variations. The situation is set to become even worse as kidney failures are forecast to increase significantly over the next 15 years.
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It appears that there is an increasing move towards live donor transplants. I understand this helps with the problem of compatibility, increases the likelihood of a successful "take" and obviously reduces the problems of organ rejection. I can see its attractions, especially given the shortage of organs, but in my view that is no panacea as it leaves a donor vulnerable with only one kidney, and there can be problems of family pressure to provide an organ. However, with proper counselling and the removal of family pressure, there can be no doubt about the benefits to a patient. Live donors have their place, but in my view they are certainly not the sole solution to the problems we now face. We will have to rely on cadaver organs for the foreseeable future to meet the need.
While 90 per cent of the general public support organ donation, only 20 per cent have registered their intention to donate. That means that a considerable number of organs that could be made available for transplantation may be being missed.
Secondly, among the 20 per cent of people who have registered their consent to donate, some could have their wishes overturned by relatives, particularly if they had failed to make their wishes known to relatives before their deaths. Again, valuable organs are not available. The situation must be addressed because patients are, quite literally, waiting and dying for a transplant.
My noble friend will recall that last autumn the issue was raised during the passage of the Human Tissue Act 2004. At that time my noble friends Lord Chandos and Lord Davies of Coity and the noble Lord, Lord Brooke of Sutton Mandeville, and I tabled an amendment to enable the Secretary of State to tackle the root cause of the problems; namely, the current system of consent for organ donation.
The amendment would have allowed the Secretary of State to move from the present system of informal consent to a system in which presumed consent would operate. That system was favoured by, among others, the National Kidney Research Fund, the British Medical Association and other health organisations. It would be based on the presumption that an individual's organs would be made available for donation unless he or she registered their desire to opt-out. As part of a package of measures to tackle the shortage of organs, that would significantly increase the level of organ donation in this country. The package would include better training for hospital staff when approaching patients and relatives about donation and education initiatives so that people better understand what organ donation involves.
Moreover, that system will help to address relatives' refusal, which is a key factor preventing organs being made available for donation. Relatives are often unsure of an individual's wishes and therefore revert to the default position, which presently presumes that organs will not be donated. Even when individuals' wishes are known, difficulties can arise. In Glasgow a few weeks ago, I met the partner of an accident victim who described her feelings on being approached regarding the use of her late partner's organs. He was
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on the register, but notwithstanding that, she found it very difficult. The deciding factor as to whether to give consent was the fact that he had made his wishes very clear to her before he died. It is not enough simply to be on the register; it is important that those on the register discuss the matter clearly with their relatives before death.
If the system were changed, that would alleviate the huge pressure on relatives to have to second-guess the deceased's wishes. The system would still ensure that relatives were approached and informed before any organs were made available, so that any objection to donation on their part could be made. Other European countries which have adopted, and continue to practice, a system of presumed consent have organ donation rates almost twice as high as that of the UK. For example, figures for 2003 show that the UK had 12.1 cadaveric donors per million of the population compared with 23.3 in Austria and 24.4 in Belgium, where presumed consent is practised.
I shall briefly mention the tragedies that occurred at Alder Hey and Bristol. They were very sad—indeed outrageous—events and it is right that the Government should have taken action to ensure that they never happen again. In the case of organ donation, it is imperative that the wishes of the deceased are paramount.
The Human Tissue Act 2004 makes clear that where an adult has given consent to organ donation following his death, that consent is sufficient for the activity to be lawful. My noble friend Lady Hayman may say more about that later. However, in its draft codes of practice published this week, the newly established Human Tissue Authority clearly states that it is also necessary to ensure that relatives are advised ahead of any removal. In fact, it states:
"If the family or those close to the deceased object to the donation, for whatever purpose, when the deceased has explicitly consented, health professionals should seek to discuss the matter sensitively with the family, encouraging them to accept the wishes of the deceased and making clear that they do not have the legal right to veto or overrule the deceased's wishes".
"Health professionals need to consider each case individually and whether, in extreme cases, it would be appropriate not to proceed with organ donation in the face of continued objection by the bereaved family".
That suggests that even if a person registered his wish to become an organ donor, that wish could still be overturned by relatives. That undermines the principle that the deceased's wishes are paramount, and could prevent organs being used for a life-saving transplant. If the system were changed, whereas at present there is little to encourage health professionals to make the approach to relatives in the first place, that, too, would change.
A system of presumed consent would place a positive emphasis on the importance that organ donation can make to the lives of those waiting for a transplant. It would reassure healthcare professionals that it was acceptable to request donation and encourage them to approach relatives more routinely.
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There is a need for research into the reasons behind the decision of relatives to ignore or who feel unable to accede to a dead relatives' wishes. I know that research is being undertaken on that at some universities on that point at present. Can the Minister say something about that, as the findings could be extremely valuable to us in making informed decisions in future?
I sometimes believe that we are all guilty of shortcomings in our communication with the public on the vital issue of organ donation. As a nation, we are not very good at discussing death. It is something to shy away from. If we could only convey the lifesaving role of transplants and the joy of recipients and their relatives, we would be more than halfway towards winning the battle against the shortage.
In Glasgow, a few weeks ago, the "Love Seat" was unveiled. It is made from 14 different Scottish woods, with a central silver motif to represent Scottish organ donors before the year 2000 and an individual silver motif for each donor in this century, which will be added to as each new donor appears. That innovative way of celebrating and thanking organ donors has been funded by public donations and the NKRF. It is currently on display in the Wolfson institute at the University of Glasgow and will have a permanent home in the refurbished Kelvingrove Gallery.
At the unveiling, I met a 10 year-old boy who had a heart transplant and whose life had been transformed so that he could be a normal lad, able to play football with his mates. I met a 14 year-old girl who had a kidney transplant and whose life was similarly transformed. I met a middle-aged woman on dialysis who was waiting for a transplant. Often we do not pay enough tribute to dialysis departments, which do sterling work to keep people alive until a donor organ becomes available. I especially commend them for their dedication and service.
I met a middle-aged man who had a long wait for a kidney transplant, and who was ecstatic about his freedom and liberation from dialysis. He was active in raising awareness in the community of the benefits of organ donation and transplants. For all those reasons, I hope that the Government will seriously consider putting in place a system of presumed consent and making progress in improving the rate of organ donation in this country. I beg to move for Papers.
11.42 am
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