Kidney Transplant Bill [HL]

My Lords, I, too, thank the noble Baroness, Lady Finlay, for introducing the Bill. Whatever happens to it, it will, as the noble Baroness, Lady Tonge, just said, continue to stimulate the debate. I hope that it will have the desired effect. I declare an interest. Inevitably I am biased; I used to do kidney transplant operations and I well know how such an operation can completely transform the life of someone in renal failure. The quality of life is so much better than life on renal dialysis. Of all the operations that I have done and am still doing, kidney transplantation is by far the most thrilling. One is presented with a cold, lifeless-looking donor kidney from some part of this country or flown in from any part of Europe. One connects the artery and vein to a large artery and vein in the lower abdomen and, when one takes the clamps off, this lifeless thing springs to life. It is a most amazing sight. One of the curious features used to be that French kidneys would start passing urine immediately on the table before the ureter was even plumbed into the bladder. I was curious to know what it was about the French kidneys that made that possible. An immediate explanation was that it was French wine; after all, wine is a diuretic. In fact, the explanation was quite different; the French surgeons were taking the kidney while the heart was still beating and therefore it was in much better condition. That was during a time when there was a lot of discussion about the determination of brain stem death. That whole problem has now been resolved, leaving no doubt about when brain stem death has occurred. Removing organs for transplantation, as the noble Baroness, Lady Finlay, and others said, can be a wearing and upsetting affair. Imagine a surgeon operating on a patient who becomes brain stem dead and whose kidneys are probably suitable for transplantation. The relatives have to be told of the death of their loved one and then they are asked whether the patient’s organs can be removed for transplantation. It is an extremely fraught situation that requires great understanding, sensitivity and skill, and it puts great pressure on the staff, as I know from personal experience. Those pressures are much better managed nowadays, but there is still the persistent problem of a great shortage of donors, as all speakers have mentioned. The noble Baroness’s Bill would allow one kidney to be taken on the basis of presumed consent. I fully understand the rationale for that. There are, however, some problems. Ninety per cent of people are in favour of organ donation in principle but the actual donation rate remains poor, partly due to the 40 per cent of relatives who refuse. The reason behind the Bill is presumably that asking for only one kidney might persuade some of the 40 per cent of the unwilling relatives. However, a survey in March last showed that, of the more than 14 million people on the donor register, 89 per cent were ready to donate all their organs and only 0.7 per cent stipulated that only the kidneys could be taken. That might indicate that asking for only one kidney might not yield more donors, as the noble Lord, Lord Hughes, said. However, as the noble Baroness, Lady Tonge, said, some people are averse to having particular organs, such as the cornea, taken. I very much like the suggestion of the noble Lord, Lord Elder, that when somebody signs a donor card they should have a go at their relatives and make sure that they understand that the request is genuine and do all that they can to make sure, if the occasion arises, that donation takes place. I believe that the situation has been radically changed this week by the report Organs for Transplant. It is an absolutely brilliant report, outstanding in every way. On Tuesday morning, when it was presented to the stakeholders, everyone was very excited and supportive. Universal approval is not always the case in medical circles. Everyone associated with the report is to be congratulated. I am sure that the task force is right when it estimates that its 14 recommendations will produce a 50 per cent increase in donations. That will mean an additional 1,200 transplants a year. I am well aware that medicine and prophecy and two quite separate subjects, but such is the sound reasoning and practicality of these recommendations that I am sure they will work. They are based on what has worked so well in Spain. The first three recommendations are simply part of good management. Recommendation 4 is one of the most important. It stresses: "““All parts of the NHS must embrace organ donation as a usual, not an unusual event. Local policies, constructed around national guidelines, should be put in place. Discussions about donation should be part of all end-of-life care when appropriate. Each Trust should have an identified clinical donation champion and a Trust donation committee to help achieve this””." That is a very important recommendation indeed. Recommendation 5 says: "““Minimum notification criteria for potential organ donors should be introduced on a UK-wide basis””." The sixth recommendation will, I hope, be national and be monitored nationally. It says: "““Donation activity in all Trusts should be monitored. Rates of potential donor identification, referral, approach to the family and consent to donation should be reported””." The seventh recommendation says that brain stem death testing, "““should be carried out in all patients where BSD is a likely diagnosis, even if organ donation is an unlikely outcome””." Again, I think that that is very important. The eighth recommendation is also important from a financial point of view. It says: "““Financial disincentives to Trusts facilitating donation should be removed through the development and introduction of appropriate reimbursement””." Many noble Lords have said that the extremely important network of donor transplant co-ordinators should be expanded and strengthened, as stated in Recommendation 9. Recommendation 10 is about establishing a United Kingdom-wide network of dedicated organ retrieval teams. The report then talks about training. The last recommendation, which is for guidelines to be given to coroners, is very far-sighted. The practice of coroners varies enormously throughout the country, so guidelines could be a great help. I am happy that soft presumed consent has been omitted from this splendid report and I was glad to hear that the task force will examine it. I am aware that this is the law in Spain, but no one makes use of it. It has been argued that having the law in place would make it easier to ask relatives for organs. My party wishes to leave the law in the United Kingdom as it is for the time being and to wait for the great improvements that we can expect from the implementation of the task force’s recommendations.