Mr. Joe Brolly:

It is evident from the Spanish rates in terms of organ donation. I have worked with Mr. Nizam Mamode, head of transplant services at Guy's Hospital. He has a very close working relationship with Dr. Rafael. The document I have circulated was vetted by Mr. Mamode. This is not my document. While I put it together and my name is at the end of it, many other people contributed to it.

In spite of the advances in England, while last year organ donation increased to approximately 20 per million of population there were 125 refusals by families, which equates to approximately 800 potentially life saving transplants of people on the organ donor register. Within the constraints of the opt-in system the debate now beginning in England, with which we disagree because we believe that donation is a sacred and family gift because donation also affects the family of the deceased person, is on why a family should be allowed to override the consent of a person who signed up to the organ donor register. We believe that is a dangerous route to go down because death is a communal thing in the end. In an effort to move this on, the head of the organ donation task force in the UK has stated that she believes that family consent should be over-borne by a person's name being on the register. The answer to the problem of family refusal is soft opt-out. The reason for this is set out not only in the international research but in the British Medical Association's recent report, which is set out in the document circulated and which I will not bore members by reading.

I agree with Deputy Regina Doherty's comments. People with whom I usually discussed football are now raising this issue with me. When the question becomes, "Is there a reason we should not be organ donors?" the cultural shift is affected. As stated in the British Medical Association's report, organ donation then becomes the default position, which with public support changes cultural expectations in society and represents a more positive view of organ donation. I do not believe there is any particular magic to that: it is just logic. Appendix I, which was drafted by Dr. Paul Glover, who is the counterpart of Professor Jim Egan in the North, states that organ donation rates in the North have increased by 54% since the implementation of all of the changes. However, attainment of the maximum donor potential has not been fully realised despite the creation of this infrastructure, which contains aspects of the Spanish model. In a nutshell, this does not pose any threat: it is a good message. People will be content once family consent is at the heart of what is proposed.

On the issue raised earlier - I cannot recall which Member asked the question - about doctors asking questions, this does not arise where specialised nurses exist. We have 14 specialised nurses in the North, who are embedded in the intensive care units. Their first job is to ask the questions. It is not the job of doctors to do so. As Ms Cunningham will agree it would not be the job of someone like Dave Hickey, who at 2 a.m. is driving to Sligo hospital to help procure organs, to do so. There are embedded people in the system whose job it is to spend time with the families and ask the questions in a sensitive way. In those circumstances, the three-pronged approach of soft opt-out, proper infrastructure and good public awareness is the way to go, as is the case in the leading donor rate countries. There is no reason we ought not to follow that.