Kidney Transplant Bill [HL]

My Lords, I, too, welcome the Bill and congratulate the noble Baroness, Lady Finlay of Llandaff, although, like others, I have some reservations which I will come to later. However, I agree with others that it provides a good opportunity to discuss the general issue, and presumed consent in particular. I have hurried back down from Scotland specifically to participate in this debate. Fortunately, I came by train; for a variety of reasons, that was well chosen. I was in the Scottish Parliament yesterday asking a Question of the First Minister, Alex Salmond, on this very subject. I am pleased to say that he agreed with me. When Alex Salmond agrees not just with me but with Gordon Brown, you begin to get the feeling that we are moving in the right direction—I certainly did. I am also pleased to follow my noble friend Lord Elder; I say ““friend”” not because that is the convention here, but because he is my friend and has been for a long time. He represents living proof of the value and importance of organ donation. However, at this stage of the debate, the old saying is true: everything that needs to be said has been said, but not everyone has yet said it. I have two and a half hours of the debate left in which to indulge myself, but I can assure noble Lords, in particular the Whip, that I will not take advantage of that opportunity. The noble Baroness, Lady Finlay, should be added to the roll of honour of people who, over the years, have raised this issue in Bills again and again. They are my old friend Tam Dalyell in 1971, and the late Lord Finsberg, the former MP John Marshall, the right honourable Kenneth Clarke MP, and my noble friends Tom Watson MP and Siobhain McDonagh MP. The inspiration for many of those Bills came from the BMA, and it is important that the initiative continues to be taken up by Members of both Houses. I am impressed by the parade of statistics underlining the arguments that have been repeated in our debate. That is because I am a convert to this issue. I effectively voted against presumed consent when I was a Member of the other place, but I have been convinced by the arguments. The Chief Medical Officer has said that at least 1,000 people die needlessly every year for the lack of a transplant. That is a powerful argument. Moreover, the waiting lists do not reflect the real need for organs. Chris Rudge, medical director of UK Transplant, said in evidence to Sub-committee G of the European Union Committee: "““The organ donor rate and therefore the transplant rate in the UK is poor and it is static: it has not really changed for ten years or more … The number of people who … are on the waiting list is a very poor reflection of the number of people who … need a transplant. Most transplant units limit the number of people who are put on the waiting list to an approximation of the likely number of organs that are going to be available … There are probably thousands more patients a year—it is unquantified, but it is in the thousands and probably the tens of thousands—who would benefit from a transplant but are never placed on the waiting list””." Finally in relation to statistics, I pay tribute to the work of Mrs Elisabeth Buggins, chair of the Organ Donation Taskforce—I am sure she is fed up with the jokes about why she was chosen. As she rightly said in a press release on 16 January: "““90% of the UK population supports organ donation and transplantation in principle—but only a quarter of the population holds donor cards””." That ““aching gap””, as the Prime Minister described it, is a strong argument for consent. So I have become a convert not just because I have known my noble friend Lord Elder for some time, but because of my old colleague, Sam Galbraith, who is another recipient of a transplant. He went on to contribute so much to the Commons and the Scottish Parliament, and of course through his work as a leading neurosurgeon. It was at the launch of the Transplant Games, mentioned by my noble friend Lord Elder, that I became a cardholder and joined the register. Before that I had been part of the ““aching gap””. I spoke to a transplant surgeon at the games and said, ““I am not sure that many of my organs will be of much use at this stage””. He looked me straight in the eye and said, ““Well, your eyes look quite good””. I must say that the tone of his voice worried me slightly, but did not put me off signing the register. Since then I have had a number of meetings with the British Medical Association both in Scotland and London, and I pay tribute to its work and the pressure it has exerted on this issue. I have also had the privilege of being briefed by Department of Health civil servants who are working in this area, and again I pay tribute to them. As a result of all this, I have tabled a Motion in the Scottish Parliament calling for a fresh debate on organ donation, which now has wide cross-party support, and next Wednesday evening I will be holding a debate in Holyrood. A peculiar advantage of being one of the two people who are Members of both the Scottish and the United Kingdom Parliaments is that I can raise issues at both levels. With that I come back to the question I put to the noble Baroness when I intervened during her introduction of the Bill. We need legislation that makes the same arrangements throughout the whole of the United Kingdom. That has been underlined to me again and again. Even the most fervent nationalists accept that the position should be the same everywhere because it is a universal arrangement. People from Scotland go down to Newcastle and there is a whole range of organ transfers throughout the United Kingdom, so it is very important that it is done on that basis. I should also like to pay tribute to Scotland on Sunday. Week after week the paper has been arguing the case for transplantation in its campaign in support of presumed consent. A point I recall from the debate in the House of Commons is the importance of ensuring that public opinion is behind a change in the law, and I am glad to see from the British Medical Association poll that that seems to be the case. Indeed, only the noble Lord, Lord Sheikh, has spoken against presumed consent in this debate. It seems that more and more people are coming round to this view. A number of Members of the Scottish Parliament who did not support presumed consent before have now signed my motion, and the more they look at the detail, the more they come round to supporting it. The Spanish model has been very successful and is being followed in other countries. That scheme is not just about presumed consent, as others have said. It has a number of pillars: more transplant co-ordinators available 24 hours a day, seven days a week; they receive extensive training centrally; and there is better co-ordination both within and between hospitals. All that has accompanied the change to the legislation towards presumed consent. All that has been instrumental in bringing about a large increase in the number of donors in Spain. I hope that Sub-Committee G, which is looking at the question, might consider visiting Spain to see what the arrangements are like there and reporting back to the House. I am not a member of the committee, so I have no personal interest. Like others, I have some reservations about the Bill. Why one kidney and not two, as my noble friend Lord Hughes asked? What about other organs? The noble Baroness, Lady Finlay, will have to check whether this Bill is amendable, because my noble friend believes that it is not. Also, the opt-out is really quite hard rather than the soft choice I would like to see. The category for those, "““with lasting power of attorney for personal welfare””," covers a very limited number of people who can refuse. The opt-out is a bit tougher than the noble Baroness indicated in her introduction. I do not support the Bill in this form, but I welcome the opportunity to discuss the issue. As others have said, I am really delighted that the Prime Minister has given this change his personal blessing, and I understand and welcome the reasons why he has done it. There is an urgent need to advance towards presumed consent and I am glad that the Government have accepted all the recommendations made by the task force in its first report, and that they have now asked the task force to look at presumed consent. I hope that we will get an indication from the noble Baroness, Lady Royall, that the Government will move swiftly. I say that because every day that it is delayed, people will die needlessly. While I look forward to the change, I think that we all agree that in the mean time, everyone should do as I did when I attended the Transplant Games: they should sign the register and take the card—and do it willingly until such time as the law is changed.