Health Bill [HL]

Amendment 125 seeks important changes to organ donation that aim to enable a person or the family of a person to express a wish that a specific family member or friend who is on the transplant list should receive that person’s organs after death. I am pleased to be able to inform the noble Baroness, Lady Finlay, and the Committee that such a change has already been agreed in principle by the Department of Health and that the process of implementation has started to be worked through. I pay tribute to the noble Baroness, Lady Finlay, for her work on this. We have been in dialogue on it since our last debate on the issue in this Room. Members of the Committee will be aware that current policy is that organ donation is a gift and the donated organ is allocated on the basis of clinical need. This policy, as has been mentioned, reflects a case a few years ago where a patient's family agreed to a donation on the basis that the organs could only be given to specific ethnic group. However, as the noble Baroness has clearly set out, this policy has led to some rare but difficult situations where the clinical team would have preferred flexibility to take account of a patient’s, or their family’s, wishes. Department of Health officials have been working with the Human Tissue Authority and NHS Blood and Transplant over the past year to consider the various legal, ethical and public health implications of a review of the existing policy that would give a deceased donor similar opportunities as a living donor, as the noble Baroness mentioned, to donate an organ to a close relative or friend. It might be helpful to outline some of the issues to be considered. Perhaps the key consideration, as the noble Baroness recognises within her amendment, is the need to ensure that others in urgent clinical need of the organ would not be harmed—for example, patients registered on the urgent heart scheme, liver patients registered as "super-urgent" or renal patients identified as "highly sensitised". There are also legal implications to consider—for example, whether or not directed deceased donation could be seen as discriminatory or open to legal challenge. The numbers involved are likely to be so small as to make it difficult to show discrimination. However, any change of the policy would require careful monitoring. If, following monitoring, there was evidence of disproportionate impact, we would need the flexibility to reconsider the policy and the justifications for it. NHS Blood and Transplant has written to the Department of Health, giving its views and those of the Human Tissue Authority. There was agreement by both organisations, and broadly across the transplant community, that unconditional directed donation was acceptable in exceptional circumstances where the following principles apply: that there were no others in urgent clinical need of an organ who may be harmed by directed donation; that there was appropriate consent to donation; that the deceased had indicated a wish to donate to a specific named relative or friend, or relatives had expressed that wish on their behalf; that the intention to donate was not conditional on the directed donation going ahead; and that the need for a transplant was clinically indicated for the intended recipient. I assure Members of the Committee that Department of Health Ministers have agreed in principle to a change of existing policy to enable the directed donation of an organ from a deceased donor in certain exceptional circumstances. However, there are a number of important areas that still need to be worked through. First, it is vital that we agree a UK-wide approach. It would be unacceptable for there to be different policies in different parts of the UK. As Members of the Committee know, organs donated in one part of the UK can be transplanted in another. Therefore, the implications of any change of policy would need to be considered and agreed by all the UK Administrations. NHS Blood and Transplant has already written similarly to Ministers in Wales, Scotland and Northern Ireland. I am aware that the framework proposed by NHS Blood and Transplant is being actively considered by Ministers in Scotland, and that Ministers in Wales and Northern Ireland have already agreed in principle. A review of policy in this area is justified, and they want it to be subject to certain safeguards. We are making progress and are very busy indeed on this. The Department of Health will work with the other health administrations to take this forward as quickly as we can. We are considering the safeguards necessary to support the implementation of any change of policy—for example, the need for guidance for professionals in the transplant community. In recognition of the fact that there will always be difficult cases that require further discussion, arrangements for the decision-making process and lines of accountability will also need to be clear. Implementation of the framework will also need to be monitored routinely to understand how consistently, accurately and legally it was being applied. In conclusion, I hope that I have given Members of the Committee some assurance that we have agreed in principle to a change of policy and that work is in hand. However, as I say, any change would have UK-wide agreement. The best approach would be to have more detailed guidance, possibly supported by directions. I understand that that guidance is also in draft. I hope that Members of the Committee agree that good progress is already being made. I am confident that, by Easter, we will be able to identify the necessary work to take this forward and the timescale involved. I will write to Members of the Committee immediately after the Easter Recess with a more detailed update. In light of those reassurances, I hope that the noble Baroness feels able to withdraw the amendment.