Organ Transplants: 17th July 2013

The Parliamentary Under-Secretary of State for Health (Anna Soubry)
Let me begin by congratulating the hon. Member for Stretford and Urmston (Kate Green) on securing this debate, raising this important issue, and enabling us to discuss it for this very short period. It is not really a debate but a number of questions quite properly asked, no doubt many of which I will not answer, through no unwillingness on my part but because, as I always say, the usual rules apply. However, all questions will be answered, if not by me tonight then certainly by way of a letter. I thank the hon. Member for Strangford (Jim Shannon) for his helpful and interesting contribution. He has been good enough to provide me with a clipping. I believe that it is about kidney transplants and kidney donations, and I will make further inquiries.

As you will know and understand, Mr Deputy Speaker, this matter has come up by way of the fact that hon. Lady, as she explained, has a constituent, Natalie McCusker, who has had a lung transplant. We are all delighted that she was able to have that lung transplant.

As we know, the donation of organs is sometimes from a living source, to put it in crude terms. There are many examples of people who have made the most amazing sacrifices, often within families, to supply a kidney to a loved one so that they can live. There is, of course, the whole additional subject of what happens on death and the wishes of somebody in relation to their organs, and the absolutely amazing difference that that generosity after life can make to people. No doubt Natalie is a very fine example of that, and no doubt she and her family are profoundly grateful to the person who had the good sense to indicate that they were willing that on their death their organs would be donated. Then there is the great and often very emotional matter of the family deciding that they are all content for this to happen. There is nothing worse than when someone is taken from us when they die. It is very difficult for anyone in the medical profession—we have nurses who are specially trained in this—to approach the family in those profoundly difficult times and discuss the possibility of organ donation. The work of those nurses and other medical professionals is one of the reasons we have seen an increase in organ donation.

We all know the benefits of transplants and know that we need to do more to increase the number of organs donated. That would give many more people the opportunity to benefit from a transplant that could save their life or significantly improve the quality of their life. About 8,000 people are listed on the national transplant list waiting for a transplant. Many more could be listed if more donated organs were available for transplant. Many people wait months and years for a phone call telling them that a suitable organ has been donated and calling them in for a transplant. I am aware through my work as a Minister of some of those families and their anguish as they literally sit around waiting for that phone call, especially when it is a child who so desperately needs the transplant to, in effect, save or improve the quality of their life. For some, that phone call never comes and about three people—adults and children—die every day waiting for a transplant that could have saved their lives.

Given that the number of people needing organ transplants in the United Kingdom is greater than the number of donor organs available, there has to be a ​system to ensure that patients are treated equitably and that donated organs are allocated in a fair and unbiased way. Allocation is based on the patient’s need and the importance of achieving the closest possible match between donor and recipient, which is often very difficult.

All patients waiting for transplants are registered on the national transplant database. Rules for allocating organs are determined by the medical profession in consultation with other health professionals in health departments and specialist solid organ advisory groups. The blood group, age and size of both the donor and the recipient are all taken into account to ensure the best possible match for each patient, and the cardiothoracic advisory group is currently looking at improving the allocation of donated lungs to help to ensure equity and better outcomes for patients.

At present, lungs are allocated to the transplant centre based on the location of the donor, as the hon. Member for Stretford and Urmston said. The transplant centre will decide whether or not to accept the lungs and will select the most appropriate recipient. NHS Blood and Transplant is working with transplant centres to consider whether the current allocation system can be improved. It is considering whether it would be worth while implementing a national allocation scheme offering lungs and other organs nationally, rather than by centre. Other models are also being considered. NHS Blood and Transplant monitors the current allocation system closely to ensure that there is equity of access across the UK, and a recent analysis showed no statistical differences in outcomes across the UK in relation to lung transplant centres.

Kate Green
I appreciate that the Minister may not immediately know the answer to this, but does the equity of outcome apply not just to survival rates, but to waiting times?

Anna Soubry
As the hon. Lady has anticipated, I do not have the answer to that question in my brief, but I will make sure that she receives a proper answer.

Over the past five years, we have been strengthening the donation infrastructure by implementing the 14 recommendations of the organ donation taskforce, which were published in 2008. Is it not nice that in this sort of debate we can pay tribute to another Government of a different political persuasion? We are all united on this issue; it is not a party political issue and it is always a pleasure to take part in these sorts of debates.

The number of donor co-ordinators across the United Kingdom has nearly doubled. They are working closely with intensive care clinicians and families to identify potential donors and obtain consent. As I have said, it is difficult work but, goodness me, what a difference it can make when it is successful.

We have appointed clinical leads and established donation committees and chairmen in all trusts. This has driven improvement in hospitals, optimising the potential for organ donation. I am delighted that we have achieved an increase of 50% in organ donor rates and of 30% in transplant rates over the past five years, helping many more people to have the transplant that they so desperately need. We need to do more, however, to enable many ​more people like Natalie to receive the organ transplant that in many circumstances will save or enhance their life.

On 11 July, NHS Blood and Transplant published the new UK strategy for organ donation and transplantation. “Taking Organ Transplantation to 2020” sets the agenda for increasing organ donation and transplant rates to world-class standards over the next seven years by aiming to improve consent rates to organ donation to more than 80%—they are currently 57%—and transplant more organs and increase the number of people receiving an organ. The strategy calls for a revolution in public attitudes and behaviours, and emphasises the importance of individuals and families agreeing to donation. That important work needs to take place irrespective of someone’s background, ethnicity, religion, faith or whatever else. We need to ensure that more people in all parts of society sign up to donate their organs and that we are able to persuade people’s families to allow their organs to be donated upon death.

Jim Shannon
The Welsh Assembly has recently taken a decision on organ donation, which is a positive step. Is it the intention to consider having that system in England, because that might help the hon. Member for Stretford and Urmston (Kate Green) in her quest?
 
Anna Soubry
The Welsh Government have introduced legislation under which people will have to opt out. We need to work with the Welsh Government to ensure that that system works, because there are concerns about the effect it will have across the United Kingdom when one country has people opting out as opposed to opting in, as in the rest of the United Kingdom.

The independent organ donation taskforce examined the case for moving to an opt-out system in 2008 and its recommendation was against such a system. Spain had an opt-out system, but I think that it has now rejected it. In any event, it no longer has an opt-out system. I know that because I had a conversation with Spain’s Health Minister at a recent EU conference, as one does at such events, where people learn from each other, which is extremely useful. Spain has one of the highest uptake levels for organ donation and there is an awful lot that we can learn from it.

When people apply for a driving licence, they can now tick a box to sign up for organ donation. That has its value. I think we should take every opportunity to encourage people to donate. However, if people are applying for a driving licence, there will be a tendency to skip that box because they want to get on with filling in the form.

I will be quite frank. When I got this job, ITV ran an excellent campaign for about a week in which it encouraged its viewers to sign up to be donors. I suddenly realised that I did not have a donor card. I was informed by my brilliant officials that I did not need a donor card and that all I needed to do was go online. I went online and signed up extremely easily and quickly. I was highly impressed by that system. I would not have known about it if ITV had not run that campaign. There are many opportunities to encourage and positively enable people to sign up and donate.

I will keep an open mind on the opt-out system. We will look at what happens in Wales. We may well have a great deal to learn from it. It may be that that system, ​which the Welsh Government have great hopes for, will be successful and that, in looking at it, we will form a different view. It is important to keep all one’s options open.

As I was saying, NHS Blood and Transplant announced its new strategy on 11 July. It has a new chair who is full of vigour and who I am sure will do an extremely good job.

In conclusion, transplantation offers many people the opportunity of life and enhances the lives of many others. I am delighted that Natalie has had that opportunity and we all wish her a long, happy and healthy life. We have made significant progress over the past five years and we must thank all the families of donors for agreeing to or supporting donation and giving the gift of life at such a terrible time in their own lives. We want to build on that progress and increase our donation and transplantation rates up to 2020 to match the world-class ​performance in many other countries. There is no reason why we cannot do as well as the Spanish or even better. We will continue to monitor the procedures in the United Kingdom for the selection and allocation of organs, and to consider whether changes to the allocation of organs need to be made to ensure equity of access for all people on the national waiting list.

I hope that the hon. Member for Stretford and Urmston, whom I congratulate again on securing this debate, has been heartened by the points that I have made. If there are any questions that I have not answered, I will of course write to her, unless she wants to make a quick intervention before I finish. She seems content and I am grateful for that.