Dr. Liam Plant:

Deputy Billy Kelleher's question resonates with my own experience of moving from Scotland to Ireland. I asked my colleagues why we were not participating with others in other parts of these islands. If one is operating in a wider geographic catchment, typically there is movement of donor organs within an area. This means the time between organ removal and placement becomes extended in what is called a longer cold aschemia time. The cold aschemia time in the Republic of Ireland is considerably shorter than it is in the United Kingdom. There is an inexorable logic, whereby four or five areas joined together, with a common rule of sharing, will produce an imbalance of trade after a period of time because smaller areas will disproportionately provide more organs for larger areas. The other issue is the nature of the background donor population. Our ethnic background and age structure are different from those in the United Kingdom. Kidney donors on this island tend to be younger, the cold aschemia time tends to be shorter and such an imbalance of trade is relatively minor. When I first returned here, I was strongly of the view that we should share, but my experience and observations over time have led me to believe we are just about big enough.