Meeting of the Parliament 09 February 2016
I add my thanks to all the witnesses who gave evidence to the Health and Sport Committee, to the committee clerks for their hard work and support in bringing that evidence together and to the member in charge of the bill for raising the profile of the hugely important issue of organ donation. I know that Anne McTaggart is passionate about the need to increase organ donation in Scotland. There were some highly charged emotional moments during the stage 1 scrutiny of the bill.
When the committee began to take evidence on the bill, I fully expected to be recommending to parliamentary colleagues that we should support it. However, as our scrutiny progressed, I became less convinced that the provisions in Anne McTaggart’s bill would lead to the desired outcome and the ultimate increase in organ transplantation for which we all wish. I will spend a little time dealing with one or two of my concerns.
Having said that, I doubt whether there is anyone in the chamber who does not wish to see the availability of many more organs, to save and improve the lives of the many people with end-stage organ disease whose only hope of recovery at present is transplantation.
As many members know, I have a personal interest in this, because my son has just passed the 24th anniversary of his liver transplant. He would not have had those years without it, and nor would I have my two grandchildren. However, even with my motivation, it still took me more than a decade to sign up to the organ donor register. That inertia led me to think that the soft opt-out would be the solution until, as I said, we scrutinised the bill.
Spain is held up as the exemplar on organ donation, with a donor rate in 2006 of 35 donors per million of population—the highest in Europe. At that time, the UK rate was one of the lowest, at 13 donors per million of population. However, the improved donor rate in Spain was not achieved until 10 years after it adopted opt-out legislation, and we were told that the increase came about only after significant structural change to the nationally organised organ donor system. It does not seem at all clear from international evidence that legislation per se is responsible for an increase in donor rates.
It is generally accepted that, with or without a change in legislation, more can be done to increase the donor rate in Scotland. The classic approach that is in place, which involves publicity campaigns, donor registers, recording information on driving licences and education programmes in schools, has resulted in a significant improvement. Even in Spain, however, with opt-out legislation in place, it is only when discussion takes place with the family at the point of death that rates begin to show real improvement, and the Spanish see that conversation as pivotal.
In its “Organ Donation and Transplantation Activity Report 2013/14”, NHS Blood and Transplant showed that, when a specialist nurse in organ donation is involved in approaching families to ask for consent to organ donation, family approval rates go up by almost 50 per cent. A whole-hospital approach should make a difference—that means that staff across the whole hospital, and not just transplant teams, give thought to organ donation, and a specialist nurse in donation rather than an intensive care consultant is present to have the conversation with the family. I hope that that approach can be taken in Scotland, certainly in our bigger hospitals, because it has the potential to make a difference. Legislation is not necessary for that.
It is fairly widely believed that a number of provisions in the bill could be counterproductive to increasing the rate and use of organ donations. The use of proxies to make decisions about authorisation on the deceased’s behalf could result in the family being marginalised or excluded from the organ donation process. The family might be the only people with detailed knowledge about the deceased that could have a bearing on the usability of their donated organs. There was also concern that having to contact one or more proxies could result in delays, which could harm the organ donation process. We know that organs are already lost because families pull out when they regard the process as too protracted and stressful, and the bill could make matters worse.