Dr. Colman O'Loughlin:

I would like to address the question raised by Deputy Billy Kelleher about whether it is the treating doctor who raises the issue of organ donation with the family. It is the treating intensivist who does it. By necessity and largely because the process begins when a patient is admitted to an intensive care unit with a brain injury which progresses to brain death, we recognise this process quickly and in all of our interactions with our very sick patients - the sickest patients are in intensive care units - we focus on the family dynamics because they are extraordinarily overwhelming and very difficult for us, as well as for the families involved. From the outset, we pay particular attention to developing a bond with the families. We must explain the concept of brain death. As many learned individuals still struggle with the concept, trying to explain it to a family coming in cold is difficult. Their relative is warm and has a pulse, the screen monitor looks normal and yet he or she is dead. One then throws organ donation on top of this. We develop a bond and try to build trust, which is extraordinarily important and can make a significant difference. The corollary - lack of trust - can blow everything out of the water. We must, therefore, be very careful in that regard. It is necessary that the person involved with the patient is present when one brings up the issue of organ donation.

Should we have support? Yes, we should, but we do not have it. We have an organ procurement office in Beaumont Hospital run by a fantastic group of people who are also transplant co-ordinators. Having a procurement person who is also a transplant co-ordinator and on both sides of the fence would be horrendous in any other civilised country. That cannot continue and must stop. We must have a dedicated organ procurement office staffed separately from transplant co-ordinators. They are different jobs and should be staffed differently. Should they be in a position to come to the hospital when we have a potential organ donor? Yes, they should. I did most of my speciality training in Melbourne where there was a fantastic organisation called Life Gift Victoria which was run by the government rather than medics. It had people on call to arrive at a hospital within whatever timeframe was possible when they heard about a potential organ donor. They were present when one approached the families and would have received specialist training. I have received as much training as I can have in this area. I have 30 other patients in my intensive care unit at the same time, but these are the people who are dedicated to this cause and have fantastic skills. Therefore, we should have them.

To respond to some of Deputy Catherine Byrne's comments, this is a very difficult time. We are very encouraged when a family comes forward to us with its support for the organ donation process. We must bear in mind, however, that it is within the right of the family not to go down that route. We must be very careful not to guide it one way or another. We can bring up the issue. That is the best we can do with trust. I am very glad the Deputy had a positive experience with the medical specialists with whom she dealt. We focus on that relationship with the family, which is incredibly important. I do not have strong feelings on this issue because the family has the ultimate say as to whether to opt in or out. As Professor Hickey said, we would never overrule its decision. Generating trust with the family and developing that bond is very important for us.

Any external influence such as the presumption of consent or the idea that altruism is being removed from the process is potentially dangerous. I do not have any figures for the committee, as the research is very weak. Mr. Joe Brolly, whom we all should congratulate for raising the topic, continually describes the euphoria he felt in gifting his kidney. That is important - he gifted it and felt euphoric. There is a small chance that the concept of the presumption of consent might take away slightly from this; therefore, it is very difficult to bring that argument into the process.