Dr. James O'Rourke:

I promise to be brief. I thank the joint committee for its invitation to speak today.

Mr. Hickey has devoted his whole life to transplantation and if anyone deserves to be a professor, it is him for sure and I mean that sincerely. He has alluded to the entire spectrum of organ donation, from the time an organ comes from the donor patient to when it is transplanted into the recipient patient, where it goes and the circumstances involved, as well as the resources and funding available at each stage. My colleague, Dr. Dwyer, and I work together in the intensive care unit of Beaumont Hospital. Both of us care for patients with neurocritical injuries - traumatic brain injuries or intracranial haemorrhages. In his presentation Dr. Dwyer alludes to the fact that when we started 20 years ago, we used to carry out brainstem tests perhaps once a week. Certainly, the demographic of patients we see is testimony to the success of the Road Safety Authority. As members are aware, in 1998 approximately 400 people were killed on the roads, whereas in 2012, approximately 160 people died. Organ donation rates mirror exactly road fatality rates. Clearly, the number of people killed will also reflect the number who experience catastrophic injuries, which is testimony to the success of the Road Safety Authority and its laudable work in recent years.

Essentially, the pool of potential organ donors has decreased. As to what should be done about this, my colleagues have suggested and I strongly concur that we must never miss an opportunity where there is the potential for organ donation. However, we lack infrastructure that could facilitate this process. I will speak a little about that issue. The other aspect is that we must look a little more widely in the field. My own area of specialist interest is donation after determination of death by cardiovascular criteria, also known as donation after cardiac death, DCD, or non-heart beating donation. This is an area in which I am very interested and which in a way mirrors donation after brainstem death, DBD. They are similar in a way, in pertaining to deceased donation.

I will read briefly from my statement. On the proposed changes to the current opt-in system of legislation, I support fully the position taken by the Intensive Care Society of Ireland in stating the majority of its members oppose changes to current legislation. This opinion has not changed since the previous submission made in 2009. Members will be aware that in that public consultation document the opinion of 23 of 30 learned organisations canvassed on the topic was against a presumed consent model. This is my personal opinion and we are all on the same page, in that no one will argue that to receive an organ transplant is a life-saving procedure. For my part, as an intensive care clinician, I am very committed and believe it to be the gift of life. However, nothing can ever be presumed in a gift and nothing should be taken for granted. We rely on public trust and confidence in the medical profession and it would only require a single case to go wrong or blown up in the newspapers for such trust to be damaged. Were the public to be led to believe doctors are now entitled to take organs, unless they have signed up to an opt-out register of some kind, this could be counter-productive overall. In my submission I state further that in 2010 Ireland ranked ninth out of 27 countries in our rates of organ donations, at 17 per million of population. That is not bad if one thinks that among the European Union of 27 member states Ireland ranks ninth. While that is okay, we run a long way behind Spain where there is a rate of 30 organ donors per million of population.

The rest of my submission relates to the subject about which Mr. Hickey and Professor Conlon have spoken, with a little bit drawn from my own area of intensive care, essentially on resourcing the donor transplant co-ordinators and providing more level 3 clinical intensive care beds. I am very proud to work in Beaumont Hospital which is a great institution. When I qualified there in 1995, we had 20 intensive care beds, whereas today we have 17. The population has not become smaller and one must now be pretty sick to get into the intensive care unit in Beaumont Hospital. As a result, while we would like to give everyone the opportunity and facilitate organ donation, where possible, one's bed is not cold in Beaumont Hospital before someone else is in it. That is a fact. The resourcing of intensive care beds is an important component of organ donation. Families should be given the opportunity, where possible, to enable their loved ones to become organ donors. However, as often happens in the triage of patients, in a case in which one patient has been critically injured and will not survive and someone else is arriving in casualty who is gasping for breath, one will always take the patient gasping for breath because he or she has a chance of living. However, resourcing intensive care units and providing high level intensive care beds should be a key priority. Beyond this, from my perspective, I can only echo what Mr. Hickey and Professor Conlon said.

While I accept that the medical literature shows a positive slant where presumed consent has been introduced, this is somewhat clouded by turning the camera on organ donation for a short period of time and increasing public awareness. The increased organ donor numbers seen where presumed consent was introduced may be a reflection of this, that is, a reflection of increased infrastructural investment in the area.

The new driving licences are great, as they are little cards that allow for a code 15 regarding organ donation to be included. Personally, it should be more like the American model and more explicit. It should be a mandated request on documentation for passports or driving licences. I am also in favour of requiring a request in order that each patient or each family can be given the opportunity to donate organs, if there is potential for organ donation.