Kidney Transplant Bill [HL]

My Lords, I beg to move that this Bill be now read a second time. I am delighted to introduce this Bill, particularly after the clear support of the Prime Minister and this week’s report from the Organ Donation Taskforce which details all the needed infrastructure improvements. This Bill, if passed into law, will authorise doctors to remove from dead patients over the age of 18 one kidney for transplant purposes. There are strictly defined conditions under which such action may be taken. In particular, the kidney to be removed must be suitable for transplantation and there must be no evidence either from a central registry or from the dead patient’s relatives that he or she has opted out of being a potential kidney donor. I emphasise that the relatives must be consulted about the person’s views. Why do we need such legislation? More people are waiting for kidney transplants than for any other organ. More than 7,500 people are this morning waiting for an organ transplant and of those over 88 per cent need a kidney, an organ without which they will soon die. But that does not tell the whole story. There are more than 20,000 patients on dialysis who have end-stage renal failure, many of whom should have a transplant but are not registered because the list is already dauntingly long. Since I introduced the Bill on 28 November last year, a further 45 people have been added to the kidney transplant list—nearly one a day. Make no mistake: we have an organ donation crisis in this country, but that should not be the case. Kidney transplantation is now routine surgery, with a very high success rate. The closer the tissue match genetically, the better is the chance that the kidney will not be rejected. Yet in some parts of the country, the number of donated organs is lamentably low. These are often areas whose population has a fourfold higher incidence of end-stage renal failure and need for transplant. Sadly, despite an annual 8 per cent increase in the number registered for transplant, the overall number of donors is not rising. Every year in England and Wales there are nearly 3,000 deaths from brain tumours, nearly 7,500 deaths from intracranial haemorrhage and 20,000 deaths in accidents of various kinds. If only one in five of those people had a kidney suitable for transplantation and it could be established that they had no objection to its removal after death, we would virtually eliminate the waiting list for kidneys at a stroke. But the sad reality is that it is only in intensive care units that the necessary conversations with relatives tend to occur and a transplant co-ordinator is introduced to the family. When that happens, many families want to donate, despite their grief, but the conversations are just not happening often enough. No one should underestimate the terrible trauma for these families, faced with an unexpected tragedy and then, on top of that, having to decide about organ donation. They have to try to guess what the deceased person would have really wanted in the circumstances and often end up feeling that they just cannot face anything else. It is not surprising that 40 per cent decline consent in the acute pangs of their grief. Sadly, very many of them subsequently regret the decision. Interestingly, the task force report estimates that the infrastructure improvements which it recommends should over five years increase the consent rate for all organs from 60 per cent to at least 70 per cent, but that would still leave a growing gap between supply and need. We know that 24 per cent of the population have registered a wish to donate organs, but data suggest that about 90 per cent of the population support donation after death. However, when the time comes to donate, in 40 per cent of cases that wish will not be respected. I emphasise that although these people are carrying donor cards, their wishes are not automatically respected. The Bill reflects the reality that people want to give the gift of life after their death. The law currently assumes the reverse—that they do not want to donate and that permission must be sought. How would my Bill change the situation? It presumes the deceased’s willingness to donate, a presumption which would have to be validated before a kidney could be removed. This would be done by a check to establish whether the deceased had registered not to donate and by discussions with his or her family members about their understanding of the wishes of the deceased. So the Bill contains a clear safeguard. If the family states that the person would not have wanted to donate, the kidney cannot be taken. There is no provision here forcibly to remove a kidney; such action would be unlawful and unethical. It would devastatingly compound the overwhelming grief of the family—who anyway would not supply the important background information about the person’s medical history which is part of the process to determine an organ’s suitability for donation. However, the Bill would ensure that these all-important but difficult conversations do happen. Today, the opposite is too common an experience—clinical staff do not even ask. As Mrs Stoner said about her daughter’s death after she was hit by a car: "““Nobody approached us in the hospital to ask whether we would think about donating Jade’s organs””." I emphasise, in case it is not completely clear, that we are talking about taking organs after death. Even though it is possible, as noble Lords will be aware, to remove one kidney from a living person without harm, my Bill contains no provision for harvesting organs during a patient’s lifetime. Let there be no mistake: we are talking about when someone is dead and their organs are of no further use to them. I hope I have demonstrated that there are strong humanitarian grounds for the Bill, to save the lives of literally thousands of people in need of kidney transplants, but there are other reasons on which we should reflect. A kidney transplant costs around £46,000 in total, plus about £3,000 a year in follow-up medication. So if a transplanted kidney lasts 10 years, the total cost to the NHS is nearly £80,000. Without a kidney transplant, the same patient on haemodialysis would cost more than £300,000—nearly four times as much in the same period. Moreover, the life expectancy of someone on haemodialysis at the age of 40 is 10 years, but with a kidney transplant the same person’s life expectancy doubles to 20 years. These people are contributing economically to our society; they are often young patients who are the breadwinners. The proportion of patients who can return fully to work is much higher post-transplant than with dialysis, and their reported quality of life is much higher. The Bill therefore makes sense in economic terms alone. However, when we add in the cost to society of young parents dying much earlier than they otherwise would for lack of a kidney—the social cost of bereaved children, and the loss to the nation of potential income from people who are economically active—then the cost savings in medical care fade into insignificance. It more than offsets the cost of the public communication programme needed to ensure that the public are aware of their right to opt out and of providing information to help people discuss their wishes. I shall briefly address some specific concerns that have been raised with me. Why is the Bill restricted to kidney donation? First, the major need for organs is for kidneys. Secondly, there is a despicable trade in selling kidneys in some parts of the world by people who are desperate for money for their families to live on. They need international aid, not a market for kidneys that puts their lives in jeopardy and flagrantly exploits their terrible poverty. My Bill will discourage this trade because UK patients will no longer go abroad in desperation to buy a trafficked kidney. Thirdly, there is no emotional or ethical complexity regarding the removal of one kidney; almost everyone has two, one is almost a spare part. It is not like the concerns that some have about taking a heart, lung or liver, or even about the new horizons of face transplants. The Bill concerns only England and Wales. It concerns those above the age of 18, not children. While in law a minor aged 16 or 17 can consent to a procedure, their withholding consent—