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Stephen O'Brien opposes presumed consent for organ donation

Stephen_obrien_mpShadow Health Minister Stephen O'Brien spoke on Friday on a Bill from Lib Dem MP Jeremy Browne to bring in presumed consent for organ donation.

(The Prime Minister once opposed presumed consent, but now supports it.)

Highlights from Mr O'Brien's speech follow:

"To discuss organ donation is literally to discuss life and death. We must recognise that, and I am sure the whole House will join me in paying tribute to all those who are donors, whether of blood, plasma or bone marrow, and all those on the organ donation register— 15.8 million people, according to NHS Blood and Transplant. I am glad to note that it was my right hon. Friend the Member for North-West Hampshire (Sir George Young) who, in his first debate in the House after he was elected in 1979, sought to move forward the donor campaign. We must pay tribute not only to all those who have given up their organs in death so that others might live, but to their friends and families who, in their moment of grief, were prepared to take or support that step.

When contemplating those who have not, for whatever reason, registered for organ donation—and the hon. Member for Taunton mentioned this—I would say that it is probably not a matter of laziness, although there is certainly a lack of knowledge and education on the part of some. Often, people are worried not so much about themselves, but about the turmoil for those they leave behind, and whether it would be an extra stress for them to face the idea of their loved one’s body having an organ taken from it. When talking to those who have been through this process, we find that some families, oddly enough, found the process helpful because the fact that their loved one was useful to the future life of someone else gave them a focus. Although that would not apply to all, it is useful to bear it in mind when seeking to persuade people that they ought to consider being on the organ donation register.


As of today, 7,981 people are waiting for transplants, but only about 3,000 transplants are carried out each year. Tragically, that leads to more than 1,000 people a year dying for want of a transplant. The chief medical officer has stated that others are dying silently because doctors who know that there is no hope of their getting treatment are not putting them on transplant waiting lists. In Britain we have about 13 donors per 1 million people in our population. Spain is the best in the world in that regard, with 35 per million.

As hon. Members will know, this issue was last raised in legislative terms during the passage of the Human Tissue Act 2004, with the hon. Member for Oxford, West and Abingdon (Dr. Harris) pushing for a system of presumed consent. Then, as now, the issue was one of conscience. It is therefore free vote territory for the Opposition and, I believe, for all parties. As the Conservative spokesman on health, and on this matter in particular, I emphasise that my words today do not constitute a party line. I believe that that is also true of the words of the hon. Member for Taunton, although I know that he has been able to attract the support of some of his colleagues. Hon. Members will know how they voted in 2004. For my part, I voted against introducing a system of presumed consent, as did the current Prime Minister.


We cannot escape the fact that this subject touches on people’s notions of what is appropriate in death and on the sanctity and ownership of our bodies, through either any form of living will before death or next of kin after death. The primary hurdle to overcome before legislating is the existence of evidence that any change in the law would lead to an increase in organ transplants and universal access to them across the country. There is no evidence to suggest that.


Equally, it is worth noting that the report of the Organ Donation Taskforce says that clinicians from intensive care, where the majority of deaths leading to donation occur, are in the forefront of opposing presumed consent, while according to the Intensive Care Society, they are pretty evenly split on the question. Those who oppose it do so vehemently. In the words of the report,

    “the strength of feeling among those who are opposed is considerable”.

This is in contrast to the cry of doctors’ leaders such as those at the British Medical Association, who continue to push the presumed consent model in the face of evidence from their members. Any movement on the presumed consent question will have to be predicated on the satisfaction of these front-line intensive care professionals with the protection of their patients and the work that they do—in particular, preserving patient trust as regards fears of the temptation to “harvest” organs.


I should quickly deal with the experience in Spain. It is worth noting that although Spain is often prayed in aid for presumed consent, in truth transplant surgery is so widespread in so many categories that prior consent of the individual or next of kin is established without the presumption of consent needing to be relied upon. The question therefore becomes whether presumed consent is the best way of educating a populace about organ donation and convincing them that it is the right thing to do. The architect of the Spanish system, Professor Rafael Matesanz, has explicitly rejected the argument that legislation provides a solution, saying:

    “There is no country in the world where there has been sustained improvement after changing the law.”

Instead, he argues that the comprehensive transplant programme accounts for their success. In Spain, it is also extremely well done in lots of local areas, so it is not all to do with long distances and a lack of ownership, as it were. Spain changed the law to introduce its opt-out scheme in 1979; however, it had no impact until 10 years later, when the Spanish Government invested in specific training for health care professionals, appointing donor transplant co-ordinators in every intensive care unit.

Another opt-out country, Sweden, has fewer organs available for donation than Britain. Equally, the USA has achieved an impressive increase in donor numbers at the same time as rejecting any legislative move towards presumed consent. If the experts cannot produce evidence that this will increase transplants, there is no case to change the law, and we should focus on increasing education and capacity. There is an opportunity for the Government, as they take forward the results of the report, to focus on those as the dynamic way forward that is most likely to increase the amount of take-up in the donor population in our country.


It is clear from the Organ Donation Taskforce’s autumn report that it does not believe at this stage that presumed consent is the best way to achieve the desired outcome of more successful transplants. It is also clear that there is much that the Government need to do, and that questions have been asked about their performance so far in increasing transplantation rates. The taskforce was saying that to us when we were in office, so we must push forward together on education and opportunity.

The report’s outcome is slightly embarrassing for the Prime Minister because of his change of mind, but I do not blame him for changing his mind on a conscience issue.


On current evidence, it is impossible for me to support the Bill."

The debate will be resumed on Friday 19 June.


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