Kidney Transplant Bill [HL]

My Lords, in thanking the noble Baroness for introducing the Bill, I apologise to her for missing her first few remarks because business moved a little faster than I expected. As all noble Lords who have spoken have pointed out, the Bill tackles an important health problem involving the unnecessary deaths of approximately 1,000 potentially treatable people every year, 400 of whom are on the waiting list for transplants. There have been several debates in your Lordships’ House on this issue, most recently that initiated by my noble friend Lord Hughes of Woodside in July 2005 and the debate on the amendment moved by my noble friend Lord Chandos during the passage of the Human Tissue Act. There have also been many Parliamentary Questions in both Houses. Until very recently, the Government have been unwilling to move from opting in to opting out—presumed consent—for organ donation. However, there has now been a change following the Chief Medical Officer’s plea in his most recent annual report for the introduction of presumed consent as soon as possible, and following a change of Prime Minister. The Bill is thus very timely. It coincides with the publication of the first report of the Department of Health’s Organ Transplant Taskforce. However, that report does not at this stage advocate a change to presumed consent, which the Bill does. The task force is now engaged in a widespread consultation on the question of presumed consent. The results will be published later this year and are expected to back a change to presumed consent. This will require legislation that has some of the same effects as the Bill, but will be brought in only after groundwork is done to ensure its successful operation. This groundwork is described in detail in the task force’s report, and I will say a little more about it later. It would be interesting to know whether the Government felt that they could use the noble Baroness’s Bill, amended as necessary, as a basis for the legislation that they will require perhaps a little later this year to make the change to presumed consent. One obvious amendment is the one that has already been suggested—including all organ transplants, not only kidney transplants, in its remit. The task force report mentions that eight different organs are currently transplanted, although kidneys will remain the most numerous organ involved. The need for all forms of transplantable organs is likely to increase as the average age of the population increases, but end-stage renal failure—the reason why kidney transplantation is mostly required—is increasing particularly rapid, largely as a consequence of diabetes, which is on the increase, as the noble Baroness explained. This is in association with the rapid increase in obesity, and in this connection it will be extremely interesting to know when the Government will come up with their full response to the Foresight report on obesity, which has recently been published. As the noble Baroness, Lady Verma, has said, our immigrant population is particularly susceptible to diabetes and renal failure, particularly when they move to a more affluent western-style diet. This particularly affects those of south Asian origin than of west African and Afro-Caribbean origin, whose kidney failure is more often due to their higher prevalence of hypertension than diabetes. At present, there is a lower than average kidney donation rate from those communities, as she has pointed out. The number of people on the transplant waiting list is going up steadily, from 5,248 in 1997 to 7,234 in the last year for which there are figures, while the number of transplants has remained level or has fallen slightly from 2,527 to 2,385 over the same period. Other countries, particularly Spain and the United States, have a much better donor rate than the UK. Spain has a rate of 35 per million of the population, while the UK has just 13—about a third as high. It is figures such as these that have belatedly led the Government to act. In its recommendations, the task force has benefited from the Spanish experience and has followed the trend of some of its policies. In a nutshell, the recommendations build on the work of UK Transplant—a division of NHS Blood and Transplant, which is responsible for managing transplant waiting lists—and that of the UK Transplant Support Service Authority, and suggest strengthening them by creating a UK-wide organ donation organisation that is centrally funded to eliminate competition for funds with other services provided by PCTs and acute care trusts, which has been a problem and has led to the uneven provision of transplantation services throughout the country. Crucially, among many other detailed recommendations is the suggestion that each acute trust should formally appoint a consultant-level clinical champion who, "““will be responsible for developing and implementing local policies to maximise donation, ensuring that all appropriate staff receive necessary training, and reporting donation activity to the Trust donation committee””," which: "““Every acute Trust should establish””." It is interesting that in Spain it has never been necessary to remove an organ from a donor without the consent of relatives or friends, despite there being presumed-consent legislation. In this instance, it would be interesting to know how many organs are removed from deceased persons in Spain when the relatives cannot be contacted. In this country, organs are wasted because the permission of relatives is required. In Spain, despite the presumed-consent rule very seldom having to be applied, the attitude of the Spanish public has changed as a result of the change of policy to being that organ transplantation should be regarded as the norm, and even welcomed as a gift of life to another that compensates to some extent for the loss of a loved one. The noble Baroness’s Bill has stimulated public discussion of this vital issue—a discussion that needs to become more widespread as the campaign to boost organ donation gets under way.